Trends in Receipt of Help at Home After Hospital Discharge Among Older Adults in the US.
Trends in Receipt of Help at Home After Hospital Discharge Among Older Adults in the US.
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DOI：
10.1001/jamanetworkopen.2021.35346
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发表时间：
2021-11-01
影响因子：
13.8
通讯作者：
Werner RM
中科院分区：
文献类型：
--
作者：
Bressman E;Coe NB;Chen X;Konetzka RT;Werner RM
这项横断面研究估计了出院回家的老年人在日常生活活动方面接受帮助的频率和持续时间的趋势。在机构急性期后护理使用减少的背景下，老年人出院后对家庭帮助的需求如何变化？在这项针对3591名参与者的横断面研究中，老年人在产后期间在家接受帮助的比例从2011年到2017年有所增加。这包括增加非医疗保险报销的帮助来源。随着机构急性期后护理的使用随着时间的推移而减少，需要更多关注的是，转移回家是否会增加家人和朋友的护理负担，以及是否需要额外的支持来支持家庭护理。随着机构急性期后护理的使用减少，更多的患者在出院后直接回家。出院后在家里需要多少帮助的后果尚不清楚。估计出院老年人接受日常生活活动（ADL）帮助的频率和持续时间的趋势。对2011年至2017年出院后回家的社区居住老年人的全国样本进行了重复横断面研究。参与者包括国家健康与老龄化趋势研究（NHATS）的受访者，这是一项针对医疗保险受益人的年度基于人口的、具有全国代表性的调查，这些受益人年龄在69岁或以上，在研究期间从急症护理医院出院回家。一个全国代表性的样本估计使用NHATS的分析权重。报告了未加权频率以及加权和未加权百分比。分析于二零二零年九月至二零二一年十月期间进行。急性护理住院出院。出院后3个月内接受ADL帮助。在研究期间从急性护理医院出院回家的3591名调查参与者中，53.3%为女性，54.8%已婚或与伴侣生活，平均（SD）年龄为78.5（7.0）岁。其中，1710人（44.1%）报告在出院后3个月内接受了帮助。与未接受帮助的人相比，接受帮助的人年龄更大（平均[SD]岁，79.7 [7.5]岁vs 77.6 [6.3]岁），基线时的自评健康状况更差（47.1%健康状况一般或较差vs 26.5%），更容易患痴呆症（21.8% vs 5.5%）。在研究期间，报告接受帮助的受访者比例从2011年的38.1%增加到2017年的51.5%。对于住院前ADL独立的患者，出院后接受帮助的比例在研究期间增加了一倍多，从2011年的9.3%增加到2017年的31.8%。在没有接受医疗保险报销的家庭健康的患者中，接受帮助的比例也从22.1%增加到28.1%。在那些出院后接受帮助的人中，在随后的9个月里，对帮助的需求慢慢下降到住院前的水平。在这项横断面研究中，老年人出院后在家中接受帮助的人数从2011年到2017年有所增加，包括依赖非医疗保险资助的护理来源的患者。随着付款人引导患者远离住院急性期后护理设施，政策制定者将需要注意这种不断变化的护理负担。
This cross-sectional study estimates trends in the frequency and duration of receipt of help with activities of daily living among older adults discharged home. How has the need for help at home after hospital discharge among older adults changed in the context of declining use of institutional postacute care? In this cross-sectional study of 3591 participants, the prevalence of older adults receiving help at home during the posthospital period increased from 2011 to 2017. This included increases in non-Medicare reimbursed sources of help. As the use of institutional postacute care declines over time, additional attention will need to focus on whether the shift home increases the burden of care on family and friends and whether additional support is needed to support home-based care. With declining use of institutional postacute care, more patients are going directly home after hospital discharge. The consequences on the amount of help needed at home after discharge are unknown. To estimate trends in the frequency and duration of receipt of help with activities of daily living (ADLs) among older adults discharged home. Repeated cross-sectional study of a national sample of community-dwelling older adults who returned home after hospital discharge from 2011 to 2017. Participants included respondents to National Health and Aging Trends Study (NHATS), an annual population-based, nationally representative survey of Medicare beneficiaries, who were 69 years or older and were discharged from an acute care hospital to home during the years of the study. A nationally representative sample was estimated using NHATS’ analytic weights. Unweighted frequencies and weighted and unweighted percentages are reported. The analysis was conducted from September 2020 to October 2021. Discharge from an acute care hospitalization. Receipt of help with ADLs during the 3 months after hospital discharge. Of the 3591 survey participants who were discharged home from an acute care hospital during the study period, 53.3% were female, 54.8% were married or living with a partner, and the mean (SD) age was 78.5 (7.0) years. Of these, 1710 (44.1%) reported receiving help within 3 months of discharge. Compared with people not receiving help, those receiving help were older (mean [SD] years, 79.7 [7.5] years vs 77.6 [6.3] years), had worse self-rated health at baseline (47.1% with fair or poor health vs 26.5%) and were more likely to have dementia (21.8% vs 5.5%). The percentage of respondents who reported receiving help increased during the study period from 38.1% of hospital discharges in 2011 to 51.5% in 2017. For those who were independent in their ADLs before hospitalization, the percentage receiving help after discharge more than doubled over the study period increasing from 9.3% receiving help in 2011 to 31.8% in 2017. Among patients who did not receive Medicare-reimbursed home health, the percentage receiving help also increased from 22.1% to 28.1%. Among those who received help after discharge, the need for help slowly declined to prehospitalization levels over the ensuing 9 months. In this cross-sectional study, older adults’ receipt of help at home after hospital discharge increased from 2011 to 2017, including patients relying on non-Medicare funded sources of care. As payers steer patients away from inpatient postacute care facilities, policymakers will need to pay attention to this shifting burden of care.
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DOI：
10.1377/hlthaff.2019.01800
发表时间：
2020-08
期刊：
Health affairs (Project Hope)
影响因子：
--
作者：
Van Houtven CH;Konetzka RT;Taggert E;Coe NB
通讯作者：
Coe NB
DOI：
10.1093/gerona/glr087
发表时间：
2011-09-01
影响因子：
5.1
作者：
Freedman, Vicki A.;Kasper, Judith D.;Wolf, Douglas A.
通讯作者：
Wolf, Douglas A.
影响因子：
39
作者：
Werner, Rachel M.;Coe, Norma B.;Konetzka, Tamara
通讯作者：
Konetzka, Tamara
影响因子：
39
作者：
McWilliams JM;Gilstrap LG;Stevenson DG;Chernew ME;Huskamp HA;Grabowski DC
通讯作者：
Grabowski DC
影响因子：
3.4
作者：
Chari, Amalavoyal V.;Engberg, John;Mehrotra, Ateev
通讯作者：
Mehrotra, Ateev