Another Look Awardees
In its fifth year of awards for research on elder health in care facilities, Donaghue awarded $250,000 in the fall of 2017 for two studies. Letters of intent for the next cycle are due on February 5, 2018 (details are available at donaghue.org.)
Laura Hatfield, PhD
Harvard School of Medicine
Using Telemedicine to Reduce Hospital Transfers
For older adults, unnecessary emergency department visits are a major source of excess morbidity and health care spending. In independent living communities, a transfer to the ED is often the default response to a call for help. We propose to study whether providing access to physicians via telemedicine reduces unnecessary ED visits for residents of independent living communities. Continuing Life, our partnering stakeholder organization, operates three independent living communities in California, each with several hundred residents. Residents wear a pendant button that they can use to call for help. Staff members who respond to these calls are trained as emergency medical technicians and therefore can respond to some medical needs and triage to the ED. Nearly one‐half of these calls result in a transfer to the ED. In May of 2017, Continuing Life introduced a telemedicine intervention into one of its three communities. Staff members there now respond to calls while carrying a mobile tablet that allows residents and staff to interact with an emergency medicine physician via video. Bringing this expertise directly into the older adult’s home may result in fewer residents being transferred to the ED. We will compare the rate of ED transfers and hospital admissions in the intervention community before and after the introduction of telemedicine to the change over the same period in two other Continuing Life communities. The results will inform investment in and support for services like telemedicine that are traditionally excluded from fee‐for‐service payment models.
Carolyn Thorpe, PhD, MPH
University of Pittsburgh School of Pharmacy
De-prescribing of Anti-dementia Medications
The overarching goal of this project is to generate evidence regarding risks and benefits associated with de-prescribing AchEIS in nursing home residents with advanced dementia and to support improved shared decision-making about if and when to stop therapy as dementia progresses. We will examine whether de-prescribing of AchEIs is associated with increased risks, including increases in behavioral symptoms or other negative events, as well as effects on polypharmacy and potentially inappropriate medications. Aim 1 will investigate differences in behavioral outcomes (aggression, depression) and prescribing outcomes (total number of medications, use of potentially inappropriate anti-cholinergic and anti-psychotic medications) between those who stop therapy and those who continue. Aim 2 will identify differences in time to all-cause negative events (hospitalization, emergency department visits, or death). To address confounding by indication, our analyses will incorporate propensity score methods. Study results are intended to be used by health professionals, NH residents with dementia, and their family members to inform evidence-based, shared treatment decisions about continuing versus discontinuing AchEIs for treatment of advanced dementia.