Transitions in Care in a Nationally Representative Sample of Older Americans with Dementia
Transitions in Care in a Nationally Representative Sample of Older Americans with Dementia
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DOI：
10.1111/jgs.13540
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发表时间：
2015-08-01
影响因子：
6.3
通讯作者：
Clark, Daniel O.
中科院分区：
文献类型：
--
作者：
Callahan, Christopher M.;Tu, Wanzhu;Clark, Daniel O.
目的描述从国家代表性队列中确定的老年痴呆症患者护理的转变，并描述认知和功能损害程度更严重的老年人的转换率。设计纵向队列研究。设置健康和退休研究(HRS)参与者65岁及以上的HRS受访者的调查数据与1999年至2008年的医疗保险索赔相关(N=16,186)。测量：家庭、有正规服务的家庭、医院和护理机构之间的护理转变；认知功能；日常生活活动能力；以及死亡率。结果3447名(21.3%)曾被诊断为痴呆症的HRS受试者经历了频繁的转变。在从住院过渡的受试者中，52.2%的人在没有家庭护理服务的情况下回家，33.8%的人过渡到护理机构。在从护理机构过渡的受试者中，59.2%的人过渡到医院，25.3%的人在没有服务的情况下回家。有2139人过渡到死亡，58.7%的痴呆症患者死于家中。即使在中度到重度痴呆症患者中，也记录了多次护理过渡，包括从医院到家庭再回到医院的过渡。结论在这个具有全国代表性的老年人样本中，被诊断为痴呆症的受试者经历了频繁的过渡。在家中接受照顾并过渡回家的痴呆症患者往往在功能和认知方面有中度到重度的损害。
ObjectivesTo describe transitions in care for older adults with dementia identified from a nationally representative cohort and to describe transition rates in those with more-severe levels of cognitive and functional impairment.DesignLongitudinal cohort study.SettingHealth and Retirement Study (HRS).ParticipantsHRS respondents aged 65 and older whose survey data were linked with Medicare claims from 1999 to 2008 (N=16,186).MeasurementsTransitions in care between home, home with formal services, hospital, and nursing facility care; cognitive function; activities of daily living; and mortality.ResultsThe 3,447 (21.3%) HRS subjects who were ever diagnosed with dementia experienced frequent transitions. Of subjects transitioning from a hospital stay, 52.2% returned home without home care services, and 33.8% transitioned to a nursing facility. Of subjects transitioning from a nursing facility, 59.2% transitioned to the hospital, and 25.3% returned home without services. There were 2,139 transitions to death, and 58.7% of HRS subjects with dementia died at home. Even in persons with moderate to severe dementia, multiple transitions in care were documented, including transitions from the hospital to home and back to the hospital.ConclusionIn this nationally representative sample of older adults, subjects diagnosed with dementia experience frequent transitions. Persons with dementia who are cared for at home and who transition back to home often have moderate to severe impairments in function and cognition.