Unmet Need for Help With Activities of Daily Living Disabilities and Emergency Department Admissions Among Older Medicare Recipients
Unmet Need for Help With Activities of Daily Living Disabilities and Emergency Department Admissions Among Older Medicare Recipients
复制标题
DOI：
10.1093/geront/gnv142
复制
发表时间：
2017-04-01
期刊：
影响因子：
5.7
通讯作者：
Sands, Laura P.
中科院分区：
文献类型：
--
作者：
Hass, Zach;DePalma, Glen;Sands, Laura P.
研究目的：本研究确定是否自我报告的未满足的日常生活活动（ADL）的残疾需要帮助的预后急诊科（艾德）utilization.Design和Methods：这项前瞻性队列研究的2,194社区生活，ADL残疾的主题相结合的2004年国家长期护理调查的反应，通过2005年的相关医疗保险数据。计算负二项计数模型，以评估未满足的ADL需求和随后的艾德入院数量之间的关联，同时对与老年人艾德入院相关的易感性、使能性和需求特征进行统计学调整。结果：未满足需求的艾德入院调整后的年发病率（IR）比满足需求的高19（IR = 1.19; 95%置信区间[CI] = 1.00-1.40; p = 0.047）。与ADL需求得到满足的患者相比，ADL需求未得到满足的患者因福尔斯和损伤而入院艾德的IR更高（IR = 1.43; 95% CI = 1.10-1.86），并且在因皮肤破裂而入院的艾德中有显著性趋势（IR = 2.02; 95% CI = 0.97-2.88），但对于因脱水入院的艾德无显著性差异结论：ADL需求未得到满足是艾德住院的预后因素，尤其是福尔斯和外伤。未来的研究需要确定未满足的ADL需求的解决是否会降低艾德的利用率。
Purpose of the Study: This study determined whether self-reports of unmet need for help with activities of daily living (ADL) disabilities are prognostic of emergency department (ED) utilization.Design and Methods: This prospective cohort study of 2,194 community-living, ADL-disabled subjects combined 2004 National Long-Term Care Survey responses with linked Medicare data through 2005. A negative binomial count model was computed to assess the association between unmet ADL need and number of subsequent ED admissions while statistically adjusting for predisposing, enabling, and need characteristics associated with ED admissions among older adults.Results: The adjusted annual incidence rate (IR) for ED admissions was 19% higher for unmet versus met need (IR = 1.19; 95% confidence interval [CI] = 1.00-1.40; p =.047). The IR for ED admissions for falls and injuries was higher for those with unmet ADL versus met ADL need (IR = 1.43; 95% CI = 1.10-1.86), and trended toward significance for ED admissions for skin breakdown (IR = 2.02; 95% CI = 0.97-2.88), but was not significant for ED admissions for dehydration (IR = 1.13; 95% CI=0.79-1.63).Implications: Unmet ADL need is prognostic of ED admissions, especially for falls and injuries. Future research is needed to determine whether resolution of unmet ADL need reduces ED utilization.