Caregiving and institutionalization of cognitively impaired older people: Utilizing dynamic predictors of change
Caregiving and institutionalization of cognitively impaired older people: Utilizing dynamic predictors of change
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DOI：
10.1093/geront/43.2.219
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发表时间：
2003-04-01
期刊：
影响因子：
5.7
通讯作者：
Newcomer, R
中科院分区：
文献类型：
--
作者：
Gaugler, JE;Kane, RL;Newcomer, R
目的：本研究的目的是在 3,944 名基线时居住在家庭环境中的痴呆症患者样本中确定 3 年期间进入疗养院的可靠预测因素。该分析的优势包括多区域招募策略、纳入显着的护理人员特征以及 3 年前瞻性设计，该设计允许在预测住院时间时对重要变量（例如，护理接受者功能状态或护理指标）的变化进行建模。设计和方法：数据源自医疗保险阿尔茨海默病示范评估 (MADDE) 的对照样本。使用 Cox 比例风险模型来预测痴呆症患者入院的时间（基线为 MADDE 的注册）。预测因素包括护理接受者人口统计、护理者人口统计以及护理接受者功能状态、护理指标和服务利用率的随时间变化的测量。还纳入了变化指标，以利用可用的预期数据。结果：尽管一些结果与之前的发现一致，但护理指标（即负担和自评健康）和基于社区的服务使用是早期安置的重要预测因素。照顾者日常生活工具性活动和照顾者日常生活活动的变化也与加速收容有关。启示：研究结果强调，在制定旨在预防或延迟痴呆症患者入院的计划时，将护理接受者和护理者的功能和服务使用模式结合起来的重要性。
Purpose: The purpose of this study was to identify reliable predictors of nursing home entry over a 3-year period in a sample of 3,944 persons with dementia who resided in a home setting at baseline. Strengths of the analysis include a multiregional recruitment strategy, incorporation of salient caregiver characteristics, and a 3-year prospective design that allows for the modeling of change in important variables (e.g., care recipient functional status or caregiving indicators) when time to institutionalization is predicted. Design and Methods: Data were derived from the control sample of the Medicare Alzheimer's Disease Demonstration Evaluation (MADDE). A Cox proportional hazards model was used to predict time to institutionalization among individuals with dementia (baseline was enrollment into MADDE). Predictors included care recipient demographics, caregiver demographics, and time-varying measurements of care recipient functional status, caregiving indicators, and service utilization. Indicators of change were also incorporated to capitalize on the prospective data available. Results: Although several results were consistent with prior findings, caregiving indicators (i.e., burden and self-rated health) and community-based service use were significant predictors of earlier placement. Change in caregiver instrumental activities of daily living and care recipient activities of daily living were also related to expedited institutionalization. Implications: The findings emphasize the importance of incorporating both care recipient and caregiver function and service use patterns when targeting programs designed to prevent or delay institutionalization for people with dementia.