From Hospital to Home for Persons Living with Dementia and their Family Caregivers
Bibliographic record
Abstract
Older adults living with dementia are at risk for more complex health care transitions than individuals without this condition. The central research question guiding this thesis was: “How do older adults living with dementia and/or their caregivers experience and perceive the hospital-to-home care transition?” One study with three separate areas of inquiry was pursued. For Paper 1, a body of qualitative literature was systematically searched and synthesized using a meta-ethnography approach. The analysis revealed three categories: (1) feelings associated with the health care transition; (2) processes associated with the care transition; and (3) evaluation of the quality of care associated with the care transition. The objective of paper 2 sought to develop a theoretical understanding of the social processes engaged in by people with dementia and their family caregivers leading to and following a care transition to hospital and then home. A constructivist grounded theory was used, and a total of 25 people participated in 21 interviews. Study findings contribute to the dementia care transition literature by providing a conceptual framework that explains what family caregivers do (taking over), how they manage (connecting dots), and what they experience (rising up) following a care transition. Situated centrally is the core process, Seeing the day-to-day situation, which is characterized by caregivers as constant intermediaries between patients and the health system. In paper 3, a qualitative descriptive design was used to capture perceptions of quality home and community care for those living with dementia and their caregivers. Study findings found that supporting people with dementia to live in the community requires available, acceptable, adaptable and affordable home and community-based care services. Overall, this thesis demonstrates the complex nature of care transitions for those living with dementia and their caregivers. Compounding the already strained experience are perceived challenges in communication and care coordination processes, and an inadequately resourced and inflexible home and community care system.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.012 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.006 | 0.002 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.001 | 0.003 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".