Mortality in older care home residents in England and Wales
Mortality in older care home residents in England and Wales
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DOI：
10.1093/ageing/afs174
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发表时间：
2013-03-01
期刊：
影响因子：
6.7
通讯作者：
Cook, Derek G.
中科院分区：
文献类型：
--
作者：
Shah, Sunil M.;Carey, Iain M.;Cook, Derek G.
背景资料：英国护理之家的死亡率没有得到很好的描述。目的：描述老年护理之家居民与社区居民相比的1年死亡率和预测因素。方法：使用THIN初级保健数据库进行队列研究，2009年在293个英格兰和威尔士全科诊所中有9，772个护理之家和354，306个65-104岁的社区居民。结果：共有2，558名（26.2%）护理院和11，602名（3.3%）社区居民在1年内死亡。养老院的年龄和性别标准化死亡率为419（95%CI：396-442），而养老院为284（266-302）。与社区相比，护理院与糖尿病相关的死亡率增加不太明显。在这两种情况下，合并症和识别为不适合慢性病管理目标的预测死亡率，但在护理之家的关联较弱。处方的药物类别和初级保健接触的数量是最强的临床预测死亡率在护理homes.Conclusions：老年护理院居民的死亡率高。与社区相比，年龄和诊断特征是护理院内死亡风险的较弱预测因素。初级保健利用率的措施可能是有用的代理脆弱和改善困难的临终关怀决定在护理院。
Background: mortality in UK care homes is not well described.Objective: to describe 1-year mortality and predictors in older care home residents compared with community residents.Method: cohort study using the THIN primary care database with 9,772 care home and 354,306 community residents aged 65-104 years in 293 English and Welsh general practices in 2009.Results: a total of 2,558 (26.2%) care home and 11,602 (3.3%) community residents died within 1 year. The age and sex standardised mortality ratio for nursing homes was 419 (95% CI: 396-442) and for residential homes was 284 (266-302). Age-related increases in mortality were less marked in care homes than community. Comorbidities and identification as inappropriate for chronic disease management targets predicted mortality in both settings, but associations were weaker in care homes. The number of drug classes prescribed and primary care contact were the strongest clinical predictors of mortality in care homes.Conclusions: older care home residents experience high mortality. Age and diagnostic characteristics are weaker predictors of risk of death within care homes than the community. Measures of primary care utilisation may be useful proxies for frailty and improve difficult end of life care decisions in care homes.