Hospitalization and Alzheimer's disease: Results from a community-based study
Hospitalization and Alzheimer's disease: Results from a community-based study
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DOI：
10.1093/gerona/54.5.m267
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发表时间：
1999-05-01
影响因子：
5.1
通讯作者：
Stern, Y
中科院分区：
文献类型：
--
作者：
Albert, SM;Costa, R;Stern, Y
背景关于阿尔茨海默病（AD）是否与住院风险增加相关，先前的研究提供了相互矛盾的发现。我们在华盛顿高地-因伍德哥伦比亚老龄化项目（WHICAP）中调查了AD和住院情况，该项目是一项对纽约市2,334名老年人进行的基于社区的研究。在1996年，建立了一个电子病历系统，允许电子邮件警报发送到研究小组时，WHICAP受试者被接纳到哥伦比亚长老会医疗中心（CPMC），网站的医院护理的大多数subject.Results.Results.在WHICAP队列中，13.1%的患者在21个月的随访中入住CPMC; 17.5%的AD患者和11.9%的未受影响的受试者入住（p <0.01）。多变量logistic回归模型显示，更晚期AD（临床痴呆评定量表3+）是住院的显著风险因素，与年龄、性别、教育、共病医疗状况和随访期间死亡无关（OR 2.3; 95% CI：1.1，4.6）;轻度或中度AD受试者未显示出显著升高的风险。在报告期内住院的AD受试者和未住院的AD受试者之间，精神症状的患病率没有差异。感染性疾病是AD患者更常见的出院诊断（p <0.05）。在该基于社区的队列中，重度AD受试者比未受影响的受试者更有可能住院。这些AD患者增加使用医院护理似乎是AD特有的，但不是精神病发病率或临终关怀的结果。相反，需要住院治疗的医学并发症的风险更大，特别是感染，似乎是重度AD的特征。
Background. Prior studies offer conflicting findings on whether Alzheimer's disease (AD) is associated with an increased risk of hospitalization.Methods. We investigated AD and hospitalization in the Washington Heights-Inwood Columbia Aging Project (WHICAP), a community-based study of 2,334 elders in New York City. In 1996, an electronic medical records system was established that allows an e-mail alert to be sent to the research team whenever WHICAP subjects are admitted to Columbia-Presbyterian Medical Center (CPMC), the site of hospital care for the majority of subjects.Results. Of the WHICAP cohort, 13.1% was admitted to CPMC in 21 months of follow-up; 17.5% of AD patients and 11.9% of unaffected subjects were admitted (p < .01). Multivariate logistic regression models showed that more advanced AD (Clinical Dementia Rating scale 3+) was a significant risk factor for hospitalization independently of age, gender, education, comorbid medical conditions, and death in the follow-up period (OR 2.3; 95% CI: 1.1, 4.6); subjects with mild or moderate AD did not show a significantly elevated risk. The prevalence of psychiatric symptoms did not differ between AD subjects who were hospitalized in the reporting period and AD subjects who were not hospitalized. Infectious disease was a more common discharge diagnosis for subjects with AD (p < .05).Conclusions. In this community-based cohort, subjects with severe AD were more likely to be hospitalized than unaffected subjects. The increased use of hospital care by these AD patients appears to be specific to AD but is not a result of psychiatric morbidity or end-of-life care. Rather, a greater risk of medical complications that require hospital care, especially infections, appears to be characteristic of severe AD.