Functional and residential status transitions among nursing home residents
Functional and residential status transitions among nursing home residents
复制标题
DOI：
10.1093/gerona/51a.1.m29
复制
发表时间：
1996-01-01
影响因子：
5.1
通讯作者：
Freiberger, W
中科院分区：
文献类型：
--
作者：
Gillen, P;Spore, D;Freiberger, W
背景资料。这项研究考察了入住至少100天的新养老院的功能状态和出院目的地的转变，并确定了与转变模式相关的基线协变量。利用完全观测的连续时间马尔可夫链模型进行概率强度的最大似然估计，刻画了转移过程。长期住院队列(n=9,541)来自于1983至1987年间在48家国家卫生公司(NHC)疗养院新住的老年人的样本。使用改良的Katz ADL量表在入院后的第一、二、三个月以及第二、三、四个季度对功能状态进行评估。调查了后三个季度的四种类型的居住变化(如死亡率)。在养老院的头90天里，稳定性是主要的模式，51.5%的居民经历了功能的变化。适度(一个级别)而不是重大变化的变化概率更高，这种变化代表改善而不是下降。超过25%的长期居留样本在第二季度离开，其中37%的人回国。返家率和死亡率与功能水平密切相关。几个社会人口学变量(如年龄、支付来源)、诊断指标(如癌症)和定向状态与功能相同组中的转化率一致相关。总体而言，研究结果突显了一个亚群的过渡模式的异质性和复杂性，这些亚群在历史上被认为可能会下降或保持稳定，并被视为“永久”居民。该模型可用于描述较年长的长期居留者的挥发性转变过程。
Background. The present study examines transitions in the functional status and discharge destination of new nursing home admissions who remain at least 100 days, and ascertains baseline covariates associated with transition patterns.Methods. Using a fully observed, continuous-time Markov chain model for maximum likelihood estimation of probability intensities, transition processes are characterized. The long-stay cohort (n = 9,541) was derived from a sample of elders newly admitted to 48 National Health Corporation (NHC) nursing homes between 1983 and 1987. Assessment of functional status, using a modified Katz ADL scale, occurred during the first, second, and third months, and the second, third, and fourth quarters after admission. Four types of residential changes (e.g., mortality) were examined for the latter three quarters.Results. While stability was the predominant pattern during the first 90 days in the nursing home, 51.5% of residents experienced a change in function. The probability of change was higher for modest (one level) rather than substantial change, and for such change to represent improvement rather than decline. Over 25% of this long-stay sample exited in the second quarter, 37% of them returning home. The rates for returns to home and for mortality were strongly related to functional level. Several sociodemographic variables (e.g., age, source of payment), diagnostic indicators (e.g., cancer), and orientation status were consistently associated with transition rates within functionally homogeneous groups.Conclusions. Overall, findings underscore the heterogeneity and complexity of transition patterns for a subgroup historically treated as likely to decline or remain stable, and viewed as ''permanent'' residents. The model was useful in describing the volatile transition process among older long-stayers.