Neuropsychiatric Disorders and Potentially Preventable Hospitalizations in a Prospective Cohort Study of Older Americans
Neuropsychiatric Disorders and Potentially Preventable Hospitalizations in a Prospective Cohort Study of Older Americans
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DOI：
10.1007/s11606-014-2916-8
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发表时间：
2014-10-01
影响因子：
5.7
通讯作者：
Iwashyna, Theodore J.
中科院分区：
文献类型：
--
作者：
Davydow, Dimitry S.;Zivin, Kara;Iwashyna, Theodore J.
抑郁症、无痴呆认知障碍（CIND）和痴呆对老年人潜在可预防的住院风险的相对贡献尚不清楚，为了确定抑郁症、CIND和/或痴呆是否各自与因门诊护理敏感性疾病（ACSC）住院和因肺炎、充血性心力衰竭（CHF）住院后30天内再住院独立相关，前瞻性队列研究：7，031名参与健康与退休研究（1998-2008）的50岁以上美国人的基于人群的样本。使用8项流行病学研究中心抑郁量表和/或国际疾病分类，第九次修订，临床修改（ICD-9-CM）抑郁诊断来确定基线抑郁。认知状态和/或ICD-9-CM痴呆诊断的改良电话访谈用于确定基线CIND或痴呆。主要结局为至ACSC住院的时间和住院后30天内因肺炎、CHF或MI住院的情况。所有五种基线神经精神障碍状态均与ACSC住院风险增加独立相关（单独抑郁：风险比[HR]：1.33，95%置信区间[95%CI]：1.18，1.52;单独CIND：HR：1.25，95%CI：1.10，1.41;单独痴呆：HR：1.32，95%CI：1.12，1.55;共病抑郁症和CIND：HR：1.43，95%CI：1.20，1.69;共病抑郁症和痴呆：HR：1.66，95%CI：1.38，2.00）。抑郁（比值比[OR]：1.37，95%CI：1.01，1.84），共病抑郁症和CIND（OR：1.98，95%CI：1.40，2.81），或抑郁和痴呆共病（OR：1.58，95%CI：1.06，2.35）与肺炎、CHF或MI住院后30天内再住院的几率增加独立相关。抑郁、CIND，和痴呆症都与美国老年人潜在的可预防的住院治疗独立相关。患有抑郁症和认知障碍共病的老年人是一个特别危险的群体，可以从有针对性的干预措施中受益。
The relative contributions of depression, cognitive impairment without dementia (CIND), and dementia to the risk of potentially preventable hospitalizations in older adults are not well understood.To determine if depression, CIND, and/or dementia are each independently associated with hospitalizations for ambulatory care-sensitive conditions (ACSCs) and rehospitalizations within 30 days after hospitalization for pneumonia, congestive heart failure (CHF), or myocardial infarction (MI).Prospective cohort study.Population-based sample of 7,031 Americans > 50 years old participating in the Health and Retirement Study (1998-2008).The eight-item Center for Epidemiologic Studies Depression Scale and/or International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) depression diagnoses were used to identify baseline depression. The Modified Telephone Interview for Cognitive Status and/or ICD-9-CM dementia diagnoses were used to identify baseline CIND or dementia. Primary outcomes were time to hospitalization for an ACSC and presence of a hospitalization within 30 days after hospitalization for pneumonia, CHF, or MI.All five categories of baseline neuropsychiatric disorder status were independently associated with increased risk of hospitalization for an ACSC (depression alone: Hazard Ratio [HR]: 1.33, 95 % Confidence Interval [95%CI]: 1.18, 1.52; CIND alone: HR: 1.25, 95%CI: 1.10, 1.41; dementia alone: HR: 1.32, 95%CI: 1.12, 1.55; comorbid depression and CIND: HR: 1.43, 95%CI: 1.20, 1.69; comorbid depression and dementia: HR: 1.66, 95%CI: 1.38, 2.00). Depression (Odds Ratio [OR]: 1.37, 95%CI: 1.01, 1.84), comorbid depression and CIND (OR: 1.98, 95%CI: 1.40, 2.81), or comorbid depression and dementia (OR: 1.58, 95%CI: 1.06, 2.35) were independently associated with increased odds of rehospitalization within 30 days after hospitalization for pneumonia, CHF, or MI.Depression, CIND, and dementia are each independently associated with potentially preventable hospitalizations in older Americans. Older adults with comorbid depression and cognitive impairment represent a particularly at-risk group that could benefit from targeted interventions.