Predictors of nursing facility admission: A 12-year epidemiological study in the United States
Predictors of nursing facility admission: A 12-year epidemiological study in the United States
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DOI：
10.1111/j.1532-5415.2004.52118.x
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发表时间：
2004-03-01
影响因子：
6.3
通讯作者：
Ganguli, M
中科院分区：
文献类型：
--
作者：
Bharucha, AJ;Pandav, R;Ganguli, M
目的：在一个以社区为基础的老年人队列中确定机构化的预测因素。设计：前瞻性，纵向。在进入研究时进行初步评估后，对存活的参与者进行了一系列大约两年一次的重新评估，直到2001年10月;目前分析的基线是第2波（1989-91）。一项基于人群的队列研究，包括1，147名年龄在66岁及以上的成年人（平均74.1），这些人还没有被收容，并且他们有关于所有感兴趣的变量的完整数据。考克斯比例风险模型被用来从基线测量的选定变量中识别机构化的预测因子，这些变量包括年龄、性别、教育、婚姻状况，生活安排、进行工具性日常生活活动（IADL）的能力、抑郁症状、处方药数量（作为总体发病率的指标）、自我报告的社会支持、前一年的住院情况和认知功能。根据精神障碍诊断和统计手册第三版修订版的操作标准，并根据标准化临床评估，通过临床痴呆评分为0.5或更高来定义痴呆。结果变量是机构化，定义为进入养老院。结果：机构化的显着预测因子是痴呆（风险比（HR）=5.09，95%置信区间（CI）=2.92-8.84），作为时间依赖变量测量;年龄较大（HR=1.06，95% CI=1.03-1.10）; IADL残疾（HR=1.31，95% CI=1.15-1.50）;社会支持更差/更少（HR=1.27，95% CI=1.10-1.46）;和处方药数量（HR=1.21，95% CI=1.11-1.32），在基线时测量。处方药和痴呆症的数量之间的相互作用也是显着的，这表明处方药的数量对机构化的影响较小，在那些与痴呆症比那些没有.CONCLUSION：痴呆症成为最有力的危险因素，在这个12年的社区为基础的流行病学研究机构化。医疗负担赋予更大的脆弱性，在非痴呆症的人比痴呆症患者的机构。
OBJECTIVES: To identify predictors of institutionalization in a community-based cohort of older adults.DESIGN: Prospective, longitudinal. After initial assessment at study entry, surviving participants were reassessed in a series of approximately biennial waves until October 2001; baseline for the current analysis was Wave 2 (1989-91).SETTING: Largely rural, blue-collar community in the mid-Monongahela Valley of southwestern Pennsylvania.PARTICIPANTS: A population-based cohort of 1,147 adults, aged 66 and older (mean 74.1) at baseline, who were not already institutionalized and who had complete data on all variables of interest.MEASUREMENTS: Cox proportional hazards models were used to identify predictors of institutionalization from among selected variables measured at baseline, including age, sex, education, marital status, living arrangements, ability to perform instrumental activities of daily living (IADLs), depressive symptoms, number of prescription medications (as an index of overall morbidity), self-reported social support, hospitalization during the preceding year, and cognitive functioning. Dementia was defined according to the operational criteria of the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised, and by a Clinical Dementia Rating of 0.5 or greater, based on a standardized clinical assessment. The outcome variable was institutionalization, defined as entry into in a nursing home.RESULTS: Significant predictors of institutionalization were dementia (hazard ratio (HR)=5.09, 95% confidence interval (CI)=2.92-8.84), measured as a time-dependent variable; older age (HR=1.06, 95% CI=1.03-1.10); IADL disability (HR=1.31, 95% CI=1.15-1.50); worse/less social support (HR=1.27, 95% CI=1.10-1.46); and number of prescription medications (HR=1.21, 95% CI=1.11-1.32), measured at baseline. The interaction between number of prescription drugs and dementia was also significant, suggesting that prescription medication count had less effect on institutionalization in those with dementia than in those without.CONCLUSION: Dementia emerged as the most potent risk factor for institutionalization in this 12-year community-based epidemiological study. Medical burden conferred greater vulnerability to institutionalization in nondemented persons than in those with dementia.