Association of incident dementia with hospitalizations.
Association of incident dementia with hospitalizations.
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DOI：
10.1001/jama.2011.1964
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发表时间：
2012-01-11
影响因子：
120.7
通讯作者：
Larson, Eric B.
中科院分区：
文献类型：
--
作者：
Phelan, Elizabeth A.;Borson, Soo;Grothaus, Louis;Balch, Steven;Larson, Eric B.
痴呆症与住院率增加和住院结果往往较差有关，包括认知状态恶化。需要新的证据来确定痴呆症的过度入院是否可能是可以预防的。确定痴呆发作是否与较高的住院率或不同的住院原因相关，特别是对于门诊护理敏感性疾病（ACSC），积极的门诊护理可能会阻止住院的需要。我们对3019名参与者的住院情况进行了回顾性分析，这是一项纵向队列研究，研究对象是参加综合医疗保健系统的65岁及以上的初始非痴呆成年人。自动化数据用于识别从ACT入组至死亡、从健康计划中退出或随访结束（以先发生者为准）的所有住院情况。研究期间为1994年2月1日至2007年12月31日。痴呆症和无痴呆症群体的住院率，按入院类型和ACSC分列的所有原因。494名认知正常的人最终发展为痴呆症，其中427人（86%）至少入院一次; 2525人无痴呆症，1478人（59%）至少入院一次。痴呆组的未校正全因入院率为419例/1000人年，而无痴呆组为200例/1000人年。校正年龄、性别和其他潜在混杂因素后，全因入院的入院率比值为1.41（95%可信区间[CI]，1.23 ~ 1.61; P<.0001），而ACSC的调整后入院率比值为1.78（95% CI，1.38 ~ 2.31; P<.0001）。在大多数类别中，痴呆症组按身体系统分类的调整后入院率显著较高。所有类型的ACSC，包括细菌性肺炎，充血性心力衰竭，脱水，十二指肠溃疡和尿路感染的调整后的入院率，在痴呆患者中显着较高。在65岁及以上的患者中，痴呆事件与住院风险增加显著相关，包括因ACSC住院。
Dementia is associated with increased rates and often poorer outcomes of hospitalization, including worsening cognitive status. New evidence is needed to determine whether excess admissions in dementia might be potentially preventable. To determine whether dementia onset is associated with higher rates or different reasons for hospitalization, particularly for ambulatory care sensitive conditions (ACSCs) for which proactive outpatient care might prevent the need for a hospital stay. We conducted a retrospective analysis of hospitalizations among 3019 participants in Adult Changes in Thought (ACT), a longitudinal cohort study of initially non-demented adults aged 65 and older enrolled in an integrated healthcare system. Automated data were used to identify all hospitalizations from time of enrollment in ACT until death, disenrollment from the health plan, or end of follow-up, whichever came first. The study period spanned from February 1, 1994 to December 31, 2007. Hospital admission rates for dementia and dementia-free groups, for all causes, by type of admission, and for ACSCs. Four hundred ninety-four cognitively normal individuals eventually developed dementia and 427 (86%) of these persons were admitted at least once; 2525 remained dementia free and 1478 (59%) were admitted at least once. The unadjusted all-cause admission rate in the dementia group was 419 admits per 1000 person-years vs. 200 admits/1000 in the dementia-free group. After adjustment for age, gender, and other potential confounders, the ratio of admission rates for all-cause admissions was 1.41 (95% confidence interval [CI], 1.23 to 1.61; P<.0001), while for ACSCs, the adjusted ratio of admission rates was 1.78 (95% CI, 1.38 to 2.31; P<.0001). Adjusted admission rates classified by body system were significantly higher in the demented group for most categories. Adjusted admission rates for all types of ACSCs, including bacterial pneumonia, congestive heart failure, dehydration, duodenal ulcer, and urinary tract infection, were significantly higher among those with dementia. Among patients aged 65 years and older, incident dementia was significantly associated with increased risk of hospitalization, including hospitalization for ACSCs.
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影响因子：
158.5
作者：
Inouye, SK;Bogardus, ST;Cooney, LW
通讯作者：
Cooney, LW
DOI：
10.1093/gerona/54.5.m267
发表时间：
1999-05-01
影响因子：
5.1
作者：
Albert, SM;Costa, R;Stern, Y
通讯作者：
Stern, Y
影响因子：
2.1
作者：
Bradford A;Kunik ME;Schulz P;Williams SP;Singh H
通讯作者：
Singh H
影响因子：
3
作者：
Culler, SD;Parchman, ML;Przybylski, M
通讯作者：
Przybylski, M
影响因子：
3
作者：
Fishman, PA;Goodman, MJ;Rosetti, MCO
通讯作者：
Rosetti, MCO