Show-Me State Times

Researchers at the University of Missouri are focusing on reducing avoidable hospitalizations for nursing home residents with dementia. These hospital transfers often cause confusion and stress for residents and cost the U.S. healthcare system $2.6 billion annually.

Kimberly Powell, an assistant professor in the Sinclair School of Nursing, led a study that revealed nursing home residents with Alzheimer's disease or related dementias are more likely to experience unnecessary hospital transfers compared to those without dementia. This issue often arises from a mismatch between provided care and residents' personal preferences.

Powell highlighted the Age-Friendly Health System Initiative, which aims to align care with patients' priorities while minimizing trauma and risk. "Not all residents with dementia can tell the nursing home staff they don’t want to be transferred to the hospital, so our research highlights the importance of documenting advanced care planning for residents ahead of time," she stated.

The study utilized data from the Missouri Quality Initiative, funded by the Centers for Medicare and Medicaid, which embedded advanced practice registered nurses into 16 Missouri nursing homes with high hospitalization rates. Powell noted that individuals with progressive diseases like Alzheimer's value dignity and comfort later in life, surrounded by familiar people.

Ashley Woods, a doctoral student in the Sinclair School of Nursing and nurse practitioner in New Mexico, experiences these issues firsthand. She mentioned that there is sometimes a disconnect regarding patients' wishes not to be transferred. "Those with dementia may experience a temporary episode of agitation in the nursing home, but by the time I see them in the hospital, everything looks good," Woods explained.

Woods' research focuses on how frequently pain is addressed in residents with dementia. Powell emphasized its importance: "Two-thirds of nursing home residents have cognitive impairment... this will become an increasingly relevant topic."

The study titled “Untangling the complex web of avoidable nursing home-to-hospital transfers of residents with dementia” was published recently. The National Institutes of Health funded it, involving collaboration across various university departments.

Mizzou has a history of researching avoidable hospitalizations. Notably, Powell received a $1 million grant from NIH in 2022 to explore texting as a tool for improving decision-making among nursing home staff. Other studies include findings on racial disparities in transfer rates and significant savings achieved by reducing unnecessary hospitalizations.