Does diagnosis determine delivery? The Islington study of older people's needs and health care costs
Does diagnosis determine delivery? The Islington study of older people's needs and health care costs
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DOI：
10.1017/s0033291703008808
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发表时间：
2004-01-01
影响因子：
6.9
通讯作者：
Katona, C
中科院分区：
文献类型：
--
作者：
Nelson, T;Fernandez, JL;Katona, C
背景资料。人们对老年人接受护理的相关因素知之甚少。本研究调查了居住在伦敦市中心的65岁或以上老年人的使用情况、费用以及与服务使用相关的因素。一项以社区为基础的调查，使用问卷，检查了精神和身体发病率、正式和非正式护理。采用多元回归分析人口统计学、病理特征与医疗费用和社会护理费用之间的关系。共有1085人在家中接受了采访，其中18%的人根本没有得到任何服务。痴呆症患者每周的总服务成本为109英镑，活动限制为14英镑，抑郁症患者为12英镑。身体限制对接受社会照顾的影响最大。痴呆症对接受社会护理服务的影响最大。抑郁症增加的医疗费用比社会医疗费用要大得多。尽管黑人老年人提供服务，但与其他有同样需求的人相比，他们得到的医疗保健明显较少。独居的老年人更有可能获得社会护理支持，而似乎不太可能使用医疗服务。身体依赖对健康和社会护理费用都有很大影响。认知障碍的增加主要是导致社会护理成本的增加。身体依赖、痴呆症、抑郁症、主观健康问题、独居会增加总成本，而身为黑人会对总成本产生负面影响。
Background. Little is known about the factors associated with the receipt of care by older people. This study investigates the use, costs and factors associated with service usage among people aged 65 or older living in inner London.Method. A community-based survey, using questionnaires, examined psychiatric and physical morbidity, formal and informal care. The relationships between demographic, pathological features and the costs of health and social care were explored using multivariate regression.Results. A total of 1085 people were interviewed at home of these 18% did not receive any service at all. The total cost of services per week for people with dementia was 109 pounds, with activity limitation 14 pounds and with depression 12 pounds. The greatest effect of physical limitation was on the receipt of social care. Dementia had the strongest effect on receipt of social care services. Depression increased health care costs to a much greater degree than social care costs. Despite presenting to services, black elders received significantly less health care than other people with the same needs. Older people living alone were more likely to receive social care support and appeared less likely to use health services.Conclusions. Physical dependency significantly affects both health and social care costs. Increasing cognitive impairment mainly leads to increasing social care costs. Overall costs are increased by physical dependency, dementia, depression, subjective health problems, living alone and are negatively affected by being black.