{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:12:13Z","timestamp":1787015533510,"version":"build-2736575974"},"reference-count":36,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T00:00:00Z","timestamp":1775692800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T00:00:00Z","timestamp":1775692800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["PJT\u2010173346"],"award-info":[{"award-number":["PJT\u2010173346"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["agsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J American Geriatrics Society"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Transfers from long\u2010term care (LTC) to hospital near the end of life can be burdensome for LTC residents. Dementia and frailty are common in this population, yet their relationship to burdensome transitions remains unclear. This study examined the joint associations between dementia, frailty, and end\u2010of\u2010life burdensome transitions among LTC residents.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a population\u2010based retrospective cohort study using health administrative data, capturing LTC residents aged \u2265\u200965 who died in Ontario, Canada, January 1, 2015\u2013March 31, 2020. Dementia was identified using a validated algorithm, supplemented with Resident Assessment Instrument\u2014Minimum Dataset 2.0 (RAI\u2010MDS) data. Frailty (non\u2010frail, pre\u2010frail, frail) was assessed using a 72\u2010item frailty index developed for use with the RAI\u2010MDS. Burdensome transitions were defined as 3+ transfers to hospital (\u2265\u20092 if due to pneumonia, urinary tract infection, sepsis, dehydration) in the last 90\u2009days of life (last 180\u2009days as secondary outcome). Poisson regression was used to estimate adjusted relative risks (RRs) and 95% confidence intervals (CIs) for burdensome transitions by dementia and frailty status.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 88,507 LTC decedents, most were frail (67.6%) and had dementia (87.5%). Approximately 4.7% of residents experienced a burdensome transition in the last 90\u2009days of life (8.8% in the last 180\u2009days). Dementia was associated with a reduced risk of burdensome transitions in the last 90\u2009days of life across frailty strata (non\u2010frail: RR\u2009=\u20090.77, 95% CI, 0.64\u20130.92; pre\u2010frail: RR\u2009=\u20090.86, 95% CI, 0.77\u20130.97; frail: RR\u2009=\u20090.79, 95% CI, 0.71\u20130.89). Similar findings were observed when examining burdensome transitions in the last 180\u2009days of life.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Dementia and frailty are independently associated with a lower likelihood of burdensome transitions near the end of life in LTC residents. Further research is needed to explore the appropriateness of hospital transfers at the end of life, considering the perspectives of LTC residents, family, and healthcare providers.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgs.70418","type":"journal-article","created":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T06:39:00Z","timestamp":1775803140000},"page":"1386-1394","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Evaluating the Joint Effects of Dementia and Frailty on Burdensome Transitions Among Long\u2010Term Care Residents in Ontario, Canada"],"prefix":"10.1111","volume":"74","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9193-5386","authenticated-orcid":false,"given":"Colleen","family":"Webber","sequence":"first","affiliation":[{"name":"Bruy\u00e8re Health Research Institute  Ottawa Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Konikoff","sequence":"additional","affiliation":[{"name":"Bruy\u00e8re Health Research Institute  Ottawa Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenshan","family":"Li","sequence":"additional","affiliation":[{"name":"Ottawa Hospital Research Institute  Ottawa Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas","family":"Grubic","sequence":"additional","affiliation":[{"name":"ICES  Ottawa Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7988-2899","authenticated-orcid":false,"given":"Colleen J.","family":"Maxwell","sequence":"additional","affiliation":[{"name":"ICES  Ottawa Ontario Canada"},{"name":"School of Pharmacy, University of Waterloo  Waterloo Ontario Canada"},{"name":"School of Public Health Sciences, University of Waterloo  Waterloo Ontario 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Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Tanuseputro","sequence":"additional","affiliation":[{"name":"Department of Family Medicine University of Hong Kong  Pok Fu Lam Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danial","family":"Qureshi","sequence":"additional","affiliation":[{"name":"Bruy\u00e8re Health Research Institute  Ottawa Ontario Canada"},{"name":"Ottawa Hospital Research Institute  Ottawa Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,9]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/nejmsa1100347"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12904\u2010022\u201001023\u20101"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/1472\u2010684X\u201012\u20107"},{"key":"e_1_2_10_5_1","doi-asserted-by":"crossref","unstructured":"K.Tate G.Cummings 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