Many Older Adults with Dementia Experience Recurrent ED Visits, Study Finds

McKnight’s Home Care
 
A “significant portion” of community-dwelling older adults with dementia display a pattern of repeated emergency department (ED) visits, according to a study published Wednesday by the American Geriatrics Society (AGS).
 
The “population-based retrospective cohort study,” which analyzed ED visits among community-dwelling adults 66 years and older in Ontario, Canada, over a nearly 10-year period, also found that frequent users of anticonvulsants, antipsychotics and benzodiazepines had the highest risk of recurrent ED visits. 
 
Of the over 175,000 older adults studied, two groups — Group J (10,365 individuals) and Group L (7,353 individuals) — were deemed to be at a “higher-risk” of recurrent ED visits. Both groups included more individuals residing in rural and low-income areas and also having higher usage rates of anticonvulsants, antipsychotics, and benzodiazepines.
 
Dementia prevalence is expected to increase globally, from 57 million in 2020 to 153 million by 2050, but higher healthcare costs and barriers to diagnosis and care access are creating health disparities, the study said. 
 
The study also found that a history of an ED visit or visits during the prior year was the strongest predictor of recurrent visits and perhaps the most useful for identifying older adults in need of interventions.

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Trouble Falling Asleep, Staying Asleep Linked to Increased Risk of Stroke

By American Academy of Neurology

People who have insomnia symptoms such as trouble falling asleep, staying asleep and waking up too early, may be more likely to have a stroke, according to a study published in Neurology. In addition, researchers found the risk was much higher in people under 50 years old. The study does not prove that insomnia symptoms cause stroke; it only shows an association.

"There are many therapies that can help people improve the quality of their sleep, so determining which sleep problems lead to an increased risk of stroke may allow for earlier treatments or behavioral therapies for people who are having trouble sleeping and possibly reducing their risk of stroke later in life," said study author Wendemi Sawadogo, MD, MPH, Ph.D., of Virginia Commonwealth University in Richmond and member of the American Academy of Neurology.

The study involved 31,126 people with an average age of 61. Participants had no history of stroke at the beginning of the study.

Participants were asked four questions about how often they had trouble falling asleep, trouble with waking up during the night, trouble with waking up too early and not being able to return to sleep, and how often they felt rested in the morning. Response options included "most of the time", "sometimes" or "rarely or never." Scores ranged from zero to eight, with a higher number meaning more severe symptoms.

The people were then followed for an average of nine years. During that time, there were 2,101 cases of stroke.

After adjusting for other factors that could affect the risk of stroke including alcohol use, smoking and level of physical activity, researchers found that people with one to four symptoms had a 16% increased risk of stroke compared to people with no symptoms. Of the 19,149 people with one to four symptoms, 1,300 had a stroke. Of the 6,282 people with no symptoms, 365 had a stroke. People with five to eight symptoms of insomnia had a 51% increased risk. Of the 5,695 people with five to eight symptoms, 436 had a stroke.

The link between insomnia symptoms and stroke was stronger in participants under age 50 with those who experienced five to eight symptoms having nearly four times the risk of stroke compared to people with no symptoms. Of the 458 people under age 50 with five to eight symptoms, 27 had a stroke. People age 50 or older with the same number of symptoms had a 38% increased risk of stroke compared to people with 33 had a stroke.

"This difference in risk between these two age groups may be explained by the higher occurrence of stroke at an older age, " Sawadogo added. "The list of stroke risk factors such as high blood pressure and diabetes can grow as people age, making insomnia symptoms one of many possible factors. This striking difference suggests that managing insomnia symptoms at a younger age may be an effective strategy for stroke prevention. Future research should explore the reduction of stroke risk through management of sleeping problems."

This association increased further for people with diabetes, hypertension, heart disease and depression.

A limitation of the study was that people reported their own symptoms of insomnia, so the information may not have been accurate.

More information: Neurology (2023).

Journal information: Neurology 

Home Health Industry Still Not Seeing Referral Rejection Rate Improvements

Home Health Care News | By Joyce Famakinwa
 
Home health providers’ referral rejection rates skyrocketed in 2021. Two years later, the issue does not seem to be improving.
 
Referral rejection rates capture providers’ need to turn down new patients being discharged from the hospital or other care settings, often due to staffing constraints.  Home Health Care News and workflow management company Forcura examined the key metric as part of an online survey, with results released earlier this week.
 
Overall, 64% of industry professionals who participated in that survey said that their referral rejection rates have stayed the same or worsened since last year.
 
The survey examined the challenges that providers are facing in the current referral landscape, along with how they’re responding to these issues. It gathered insights from 154 participants who identify as professionals working at home-based care organizations.
 
More than half of the respondents surveyed said they held leadership positions, such as directors, vice presidents, C-suite executives and owners. 
 
For those surveyed, the majority of their referral sources were institutional. Specifically, 32% of respondents said they had more institutional referrals than community-based ones.
Only 17% of respondents said their organizations had an even share of community and institutional referral sources. 
 
More than 70% of respondents reported that staff at their organization use three to five methods for receiving referrals. Phone calls, referral portals and fax were the most common referral channels for participants. 
 
When respondents were asked to rank the importance of referral criteria — such as payer, primary diagnosis, services requested and requested start of care date — the payer type came out on top. 
 
While communication hasn’t presented a significant challenge for organizations with referrals, 31% of respondents reported having issues around accepting referrals without enough staff in place to deliver care…

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https://homehealthcarenews.com/2023/06/majority-of-home-health-professionals-arent-seeing-referral-rejection-rate-improvements/

Brain Stimulation May Prove Helpful to Acute Stroke Patients, Pilot Study Suggests

University of California, Los Angeles

Highly targeted electrical stimulation to the brain showed promise as a new treatment for the most common type of stroke, according to a pilot study led by UCLA Health researchers.

The study is the first in humans to test the feasibility of using a targeted type of electrical current, called high-definition cathodal transcranial direct current stimulation (HD C-tDCS), to treat acute ischemic stroke, which occurs when a clot blocks blood supply to part of the brain and accounts for approximately 85% of all strokes. Stroke is a leading cause of death and disability in the United States.

Many patients are not candidates for the two main treatments currently available for acute ischemic stroke: clot-dissolving drugs and a device that reaches into the bloodstream and yanks out clots. Even among those who are eligible for those treatments, just an estimated 20%–30% are disability-free three months after their stroke.

In their new study, published June 21 in JAMA Network Open, UCLA Health researchers tested HD C-tDCS as a novel therapy for acute ischemic stroke, in which a series of electrodes are strategically placed across the scalp to deliver a weak inhibitory form of electrical current to the part of the brain suffering from low blood flow.

This form of noninvasive stimulation has been used to treat certain neurological and psychiatric conditions, and the researchers had noted the electrical currents appeared to have an effect on the brain's blood flow. The researchers theorized it may be possible to use HD C tDCS to enhance blood flow to parts of the brain impacted by stroke and protect the threatened brain tissue, known as the penumbra, from irreversible injury.

The pilot study involved 10 acute stroke patients who presented to the emergency department or were admitted at neuro-intensive care and stroke units, were ineligible for currently available treatments, and were within 24 hours of stroke onset. Seven patients were randomized to receive active HD C-tDCS treatment, and three received "sham" stimulation. Using hemodynamic brain scans that acute stroke patients receive upon arrival, the researchers located the stroke area with low blood flow to where the HD C-tDCS treatment was delivered.

"This treatment was aimed at being as targeted and as individualized as possible, only to the area of the brain that has low blood flow or is suffering from stroke," said the lead researcher on this innovative project, Mersedeh Bahr-Hosseini, MD, a vascular neurologist at UCLA Health. "With this high-definition form of C-tDCS, we were able to refine this electrical field to focus it just on this area."

The first set of patients, which included 3 patients in the treatment arm and one in the sham group, received 20 minutes of 1 milliamp of stimulation. In the remaining patients, the dose was escalated to 2 milliamps for 20 minutes.

Researchers were able to efficiently provide the treatment in emergency settings, and patients tolerated the treatment.

Bahr-Hosseini said the most exciting finding was that in patients receiving HD C-tDCS, a median of 66% of the penumbra—the threatened brain tissue surrounding the core of the stroke—was rescued in the first 24 hours after stroke, compared to 0% in the sham group.

According to the hemodynamic brain scans performed soon after treatment, patients who received HD C-tDCS showed signs of improved blood flow that was greater in patients receiving 2 milliamps compared to 1 milliamp. In contrast, the blood flow decreased in sham group. "That was also very exciting, because it showed a possibly true biological effect of the treatment," she said.

Researchers are planning a new multi-site study with Johns Hopkins, Duke University, and the University of Pennsylvania, to gather more data on the treatment's safety and efficacy. The next study will also include patients who are eligible for the clot-dissolving drugs, known as intravenous thrombolytics.