Characteristics predicting nursing home admission in the program of all-inclusive care for elderly people
Characteristics predicting nursing home admission in the program of all-inclusive care for elderly people
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DOI：
10.1093/geront/45.2.157
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发表时间：
2005-04-01
期刊：
影响因子：
5.7
通讯作者：
Mukamel, DB
中科院分区：
文献类型：
--
作者：
Friedman, SM;Steinwachs, DM;Mukamel, DB
目的：这项研究确定了在全面老年护理计划(PACE)中长期入住养老院的总体风险和预测因素。设计和方法：从1990年6月1日至1998年6月30日期间，获得4646名年龄在55岁或以上的参与者的DataPACE记录，他们参加了12项由联邦医疗保险和医疗补助资助的PACE计划。参与者被登记至少30天，并在登记后30天内进行基线评估。估计了预测养老院入院30天或更长时间的COX比例风险模型。结果：3年内入住养老院30天以上的累积危险度为14.9%。从养老院登记的人未来入院的风险非常高，与独居的人相比，相对风险为5.20。在从社区登记的个体中，年龄、日常生活依赖的器质性活动和大便失禁是随后进入养老院的预测因素。亚裔和黑人被制度化的风险比白人低。然而，其他特征并不是制度化的独立预测因素，即认知状态差、慢性病的数量、日常生活缺陷的活动能力、尿失禁、几种行为障碍和程序运行的持续时间。在调整其他变量之前，疗养院入院的风险有很大的地点变异性；在调整其他特征后，这种差异显著降低。影响：尽管100%的PACE参与者是可认证的疗养院，但从社区注册后长期进入疗养院的风险很低。一些可逆风险因素的存在可能会对早期干预产生影响，以进一步降低风险，尽管这些干预措施的效果可能不大。在PACE注册之前在疗养院接受长期护理的个人仍然面临重新入院的高风险，尽管提供了全面的服务。
Purpose: This study determined overall risk and predictors of long-term nursing home admission within the Program of All-Inclusive Care for the Elderly (PACE). Design and Methods: DataPACE records for 4,646 participants aged 55 years or older who were enrolled in 12 Medicare- and Medicaid-capitated PACE programs during the period from June 1, 1990, to June 30, 1998, were obtained. Participants were enrolled for at least 30 days and had baseline evaluations within 30 days of enrollment. Cox proportional hazard models predicting an outcome of nursing home admission of 30 days or longer were estimated. Results: The cumulative risk of admission to nursing homes for 30 days or longer was 14.9% within 3 years. Individuals enrolled from a nursing home were at very high risk for future admission, with a relative risk of 5.20 when compared with those living alone. Among individuals enrolled in PACE from the community, age, instrumental activity of daily living dependence, and bowel incontinence were predictive of subsequent nursing home admission. Asians and Blacks had a lower risk of institutionalization than Whites. However, other characteristics were not independently predictive of institutionalization, namely poor cognitive status, number of chronic conditions, activity of daily living deficits, urinary incontinence, several behavioral disturbances, and duration of program operation. Before adjusting for other variables, there was substantial site variability in risk of nursing home admission; this decreased considerably after other characteristics were adjusted for. Implications: Despite the fact that 100% of the PACE participants were nursing home certifiable, the risk of being admitted to a nursing home long term following enrollment from the community is low. The presence of some reversible risk factors may have implications for early intervention to reduce risk further, although the effect of these interventions is likely to be modest. Individuals who received long-term care in a nursing home prior to enrollment in PACE remain at high risk of readmission, despite the availability of comprehensive services.