Trajectories of physical frailty and cognitive impairment in older adults in United States nursing homes.
Trajectories of physical frailty and cognitive impairment in older adults in United States nursing homes.
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美国疗养院老年人身体虚弱和认知障碍的轨迹。
DOI：
10.1186/s12877-022-03012-8
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发表时间：
2022-04-19
期刊：
影响因子：
4.1
通讯作者：
Ulbricht, Christine M.
中科院分区：
文献类型：
--
作者：
Yuan, Yiyang;Lapane, Kate L.;Tjia, Jennifer;Baek, Jonggyu;Liu, Shao-Hsien;Ulbricht, Christine M.
美国养老院为超过120万老年人提供长期护理，其中60%身体虚弱，68%有中度或重度认知障碍。有限的研究已经检查了这两个条件的纵向经验，在老年疗养院居民。这项国家纵向研究包括新入院的非熟练护理老年居民，他们在入院时、3个月和6个月时进行了最小数据集（MDS）3.0（2014-16）评估（n = 266，001）。通过FRAIL-NH测量身体虚弱，通过精神状态简短访谈测量认知障碍。单独的组为基础的轨迹模型进行了拟合，以确定身体虚弱的轨迹和认知障碍的轨迹，并估计老年居民的特点在入院时与每组轨迹之间的关联。双轨迹模型被用来量化身体虚弱轨迹和认知障碍轨迹之间的关联。在入院后的前六个月，五个身体虚弱的轨迹[“一致性虚弱”]（流行率：53.0%），“虚弱前一致”（29.0%），“虚弱加重”（7.6%），“改善虚弱”（5.5%）和“一致稳健”（4.8%）]和三种认知障碍轨迹[“一致性重度认知障碍”（35.5%）、“一致性中度认知障碍”（31.8%）、“一致性完整/轻度认知障碍”（32.7%）]。五分之一的老年居民同时遵循“一致性脆弱”和“一致性严重认知障碍”的轨迹。与“虚弱改善”、“虚弱恶化”、“虚弱前一致性”和“虚弱一致性”轨迹发生率较高相关的特征包括入院时认知障碍较大、年龄≥ 85岁、从急症医院入院、心血管/代谢诊断、神经系统诊断、髋关节或其他骨折以及存在疼痛。与“一致性中度认知障碍”和“一致性重度认知障碍”发生率较高相关的特征包括入院时身体虚弱、神经系统诊断、髋部骨折和接受抗精神病药物治疗。研究结果提供了有关身体虚弱的轨迹，认知障碍的轨迹，两组轨迹之间的关联，以及它们与老年人入住美国养老院后前六个月居民特征的关联的信息。了解居民最有可能遵循的轨迹可以提供信息，以制定针对其特定医疗保健目标的综合护理方法。在线版本包含补充材料，可通过10.1186/s12877-022-03012-8获得。
U.S. nursing homes provide long-term care to over 1.2 million older adults, 60% of whom were physically frail and 68% had moderate or severe cognitive impairment. Limited research has examined the longitudinal experience of these two conditions in older nursing home residents. This national longitudinal study included newly-admitted non-skilled nursing care older residents who had Minimum Data Set (MDS) 3.0 (2014–16) assessments at admission, 3 months, and 6 months (n = 266,001). Physical frailty was measured by FRAIL-NH and cognitive impairment by the Brief Interview for Mental Status. Separate sets of group-based trajectory models were fitted to identify the trajectories of physical frailty and trajectories of cognitive impairment, and to estimate the association between older residents’ characteristics at admission with each set of trajectories. A dual trajectory model was used to quantify the association between the physical frailty trajectories and cognitive impairment trajectories. Over the course of the first six months post-admission, five physical frailty trajectories [“Consistently Frail” (prevalence: 53.0%), “Consistently Pre-frail” (29.0%), “Worsening Frailty” (7.6%), “Improving Frailty” (5.5%), and “Consistently Robust” (4.8%)] and three cognitive impairment trajectories [“Consistently Severe Cognitive Impairment” (35.5%), “Consistently Moderate Cognitive Impairment” (31.8%), “Consistently Intact/Mild Cognitive Impairment” (32.7%)] were identified. One in five older residents simultaneously followed the trajectories of “Consistently Frail” and “Consistently Severe Cognitive Impairment”. Characteristics associated with higher odds of the “Improving Frailty”, “Worsening Frailty”, “Consistently Pre-frail” and “Consistently Frail” trajectories included greater at-admission cognitive impairment, age ≥ 85 years, admitted from acute hospitals, cardiovascular/metabolic diagnoses, neurological diagnoses, hip or other fractures, and presence of pain. Characteristics associated with higher odds of the “Consistently Moderate Cognitive Impairment” and “Consistently Severe Cognitive Impairment” included worse at-admission physical frailty, neurological diagnoses, hip fracture, and receipt of antipsychotics. Findings provided information regarding the trajectories of physical frailty, the trajectories of cognitive impairment, the association between the two sets of trajectories, and their association with residents’ characteristics in older adults’ first six months post-admission to U.S. nursing homes. Understanding the trajectory that the residents would most likely follow may provide information to develop a comprehensive care approach tailored to their specific healthcare goals. The online version contains supplementary material available at 10.1186/s12877-022-03012-8.
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影响因子：
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