Association of Social Isolation of Long-term Care Facilities in the United States With 30-Day Mortality.
Association of Social Isolation of Long-term Care Facilities in the United States With 30-Day Mortality.
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DOI：
10.1001/jamanetworkopen.2021.13361
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发表时间：
2021-06-01
影响因子：
13.8
通讯作者：
Briesacher BA
中科院分区：
文献类型：
--
作者：
Park C;Kim D;Briesacher BA
美国长期护理机构在多大程度上位于社会隔离的社区，与30天死亡率的风险有什么关系？这项横断面研究发现，美国的长期护理设施位于65岁或以上独居者比例最高的社区的可能性是比例最低的社区的8倍。在社会隔离的社区长期护理设施与居民30天全因死亡率的风险增加有关。研究结果表明，需要特别关注和策略，以保持长期护理居民与家人和朋友的联系。这项横断面研究探讨了美国社会隔离社区长期护理（LTC）设施的患病率，并评估了与居住在社会隔离程度较高的地区的LTC设施相关的30天死亡风险。长期护理（LTC）的居民可能容易受到社会孤立，如果生活在设施位于缺乏社会联系的社区。描述居住在美国长期护理中心设施的居民的社会隔离状况。这项横断面研究包括2011年美国8652个邮政编码制表区（ZCTA）14224个LTC设施的730524名LTC居民。一个包含ZCTA数据的全国性LTC数据库与美国人口普查局的人口地理数据相关联。于二零一九年一月至二零二零年十二月进行统计分析。感兴趣的主要变量是LTC社区的社会隔离，定义为ZCTA中65岁或65岁以上的独居家庭的百分比，并归类为社会隔离的四分位数。生成的地图，以说明地理变化的LTC设施在ZCTA水平的四分之一的社会孤立的社区。广义估计方程被用来估计调整后的可能性，LTC设施位于社会隔离程度最高的地区。我们还使用了多水平逻辑回归模型来评估LTC设施社区的社会隔离与LTC入院后30天全因死亡率之间的关联。按人种和种族进行亚组分析。在美国的33120个ZCTA中，8652个（26.1%）至少有一个LTC设施。在研究的14 224个LTC设施中包括的730 524名LTC居民中，458 136名（62.71%）是女性，610 802名（83.61%）是非西班牙裔白色人，419 654名（57.45%）年龄在80岁或以上。LTC设施的位置与社会隔离水平的增加相关（四分位数1 = 9.72% [n = 840];四分位数2 = 18.60% [n = 1607];四分位数3 = 32.23% [n = 2784];四分位数4 = 39.45% [n = 3408]; P <0.001）。在多变量模型中，LTC设施位于ZCTAs的可能性是8倍，其中居住在单人家庭中的老年人比例最高（比值比[OR]，8.46; 95%CI，7.44-9.65; P <0.001），与ZCTAs的比例最低相比。这种关联在大多数人口为非洲裔美国人和西班牙裔个体的ZCTA中保持，尽管在大多数人口为白色个体的ZCTA中最强。与老年人社会隔离水平最低的社区相比，进入老年人社会隔离水平最高的社区的LTC居民的30天死亡率风险高出17%（OR，1.17; 95%CI，1.10-1.25; P < .001）。这项研究发现，LTC设施通常位于社会隔离的社区，这表明需要特别关注和策略，以保持LTC居民与家人和朋友的联系，以获得最佳健康。
To what extent are US long-term care facilities located in socially isolated neighborhoods and what is the association with the risk of 30-day mortality? This cross-sectional study found that long-term care facilities in the US were approximately 8 times more likely to be located in neighborhoods with the highest percentage of individuals aged 65 years or older living alone compared with neighborhoods with the lowest percentage. Long-term care facilities in socially isolated neighborhoods were associated with increased risk of 30-day all-cause mortality among residents. The findings suggest the need for special attention and strategies to keep long-term care residents connected to their family and friends. This cross-sectional study examines the prevalence of long-term care (LTC) facilities in socially isolated neighborhoods in the US and assesses the 30-day mortality risk associated with residence in an LTC facility located in an area with a high level of social isolation. Long-term care (LTC) residents may be susceptible to social isolation if living in facilities located in neighborhoods lacking social connection. To characterize the social isolation of residents living in LTC facilities in the US. This cross-sectional study included 730 524 LTC residents from 14 224 LTC facilities in 8652 zip code tabulation areas (ZCTAs) in the US in 2011. A nationwide LTC database with ZCTA data was linked to population-level geographic data from the US Census Bureau. Statistical analysis was performed from January 2019 to December 2020. The primary variable of interest was the social isolation of LTC neighborhoods defined as the percentage of households in the ZCTA with individuals aged 65 years or older who lived alone and categorized into quartiles of social isolation. Maps were generated to illustrate geographic variation of LTC facilities at the ZCTA level by the quartile of socially isolated neighborhoods. Generalized estimating equations were used to estimate the adjusted likelihood that LTC facilities were located in areas of highest social isolation. We also used multilevel logistic regression models to assess the association between the social isolation of neighborhoods of LTC facilities and 30-day all-cause mortality after LTC admission. Subgroup analyses were conducted by race and ethnicity. Among 33 120 ZCTAs in the US, 8652 (26.1%) had at least 1 LTC facility. Among the 730 524 LTC residents included in the study’s 14 224 LTC facilities, 458 136 (62.71%) were female, 610 802 (83.61%) were non-Hispanic White, and 419 654 (57.45%) were aged 80 years or older. Location of LTC facilities was associated with increasing levels of social isolation (quartile 1 = 9.72% [n = 840]; quartile 2 = 18.60% [n = 1607]; quartile 3 = 32.23% [n = 2784]; quartile 4 = 39.45% [n = 3408]; P < .001). In multivariate models, LTC facilities were 8 times more likely to be located in ZCTAs with the highest percentages of older adults residing in single-occupancy households (odds ratio [OR], 8.46; 95% CI, 7.44-9.65; P < .001), compared with ZCTAs with the lowest percentages. This association held across ZCTAs with a majority population of African American and Hispanic individuals, although it was strongest in ZCTAs with a majority population of White individuals. LTC residents entering facilities in neighborhoods with the highest levels of social isolation among older adults had a 17% higher risk of 30-day mortality (OR, 1.17; 95% CI, 1.10-1.25; P < .001) compared with those in neighborhoods with the lowest levels of social isolation among older adults. This study found that LTC facilities were often located in socially isolated neighborhoods, suggesting the need for special attention and strategies to keep LTC residents connected to their family and friends for optimal health.
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影响因子：
3
作者：
Gambassi, G;Landi, F;Bernabei, R
通讯作者：
Bernabei, R
没有其他安全护理选项：疗养院作为最后的手段策略。
DOI：
10.1093/geront/gnaa077
发表时间：
2020-11-23
期刊：
The Gerontologist
影响因子：
--
作者：
Campbell-Enns HJ;Campbell M;Rieger KL;Thompson GN;Doupe MB
通讯作者：
Doupe MB
影响因子：
3
作者：
Grabowski DC;Mitchell SL
通讯作者：
Mitchell SL
影响因子：
3.3
作者：
Chan E;Procter-Gray E;Churchill L;Cheng J;Siden R;Aguirre A;Li W
通讯作者：
Li W
影响因子：
12.7
作者：
Pesis-Katz, Irena;Phelps, Charles E.;Mukamel, Dana B.
通讯作者：
Mukamel, Dana B.