Hospital diagnoses, medicare charges, and nursing home admissions in the year when older persons become severely disabled
Hospital diagnoses, medicare charges, and nursing home admissions in the year when older persons become severely disabled
复制标题
DOI：
10.1001/jama.277.9.728
复制
发表时间：
1997-01-01
期刊：
影响因子：
--
通讯作者：
Havlik, Richard J.
中科院分区：
文献类型：
--
作者：
Ferrucci, Luigi;Guralnik, Jack M.;Havlik, Richard J.
目的：了解老年人严重残疾当年的医院诊断、程序和收费以及疗养院入院情况，比较严重残疾迅速发展的老年人与残疾逐渐发展的老年人。设计：一项基于人群的前瞻性队列研究，从 1982 年开始每年至少进行 6 次访谈。 背景：总共 3 个社区：东波士顿、马萨诸塞州、纽黑文、康涅狄格州以及爱荷华州和华盛顿县。受试者：总共 6070 名年龄至少 70 岁的人，在第四次年度随访后至少接受过 1 次访谈，并且没有先前严重残疾的证据，定义为 3 项或以上日常生活活动 (ADL) 的残疾。主要结果指标：第四次年度随访后与严重残疾发展相关的特征，其中，如果个人在严重残疾发生之前的 2 次访谈中没有报告任何 ADL 残疾，则该残疾被归类为灾难性残疾；如果个人之前有 1 或 2 个 ADL 残疾，则该残疾被归类为进行性残疾。结果：在发生严重残疾的一年中，72.1% 的灾难性残疾患者和 48.6% 的进行性残疾患者住院治疗。相应年份，病情稳定、无残疾的患者中只有14.7%住院治疗，而有一定残疾的患者中只有22.3%住院治疗。 6 种最常见的主要出院诊断包括中风、髋部骨折、充血性心力衰竭和肺炎（均属于严重残疾亚组）；冠心病和癌症造成的灾难性残疾；以及糖尿病和脱水导致的渐进性残疾。这些诊断发生在 49% 的灾难性残疾患者和 25% 的进行性残疾患者中。在这两个严重残疾亚群中，从手术、诊断和康复费用以及接受主要诊断程序的百分比来看，最年长的患者接受的重症监护程度较低；他们也更常被送进疗养院。结论：在严重失能当年，很大一部分老年人因少数疾病住院。旨在减轻这些疾病的严重程度和功能后果的医院干预措施可能会对减少严重残疾产生重大影响。
Objective: To characterize hospital diagnoses, procedures and charges, and nursing home admissions in the year when older persons become severely disabled, comparing those in whom severe disability develops rapidly with those in whom disability develops gradually. Design: A prospective, population-based cohort study with at least 6 annual interviews beginning in 1982. Setting: A total of 3 communities: East Boston, Mass, New Haven, Conn, and Iowa and Washington counties in Iowa. Subjects: A total of 6070 persons at least 70 years old with at least 1 interview after the fourth annual follow-up and without evidence of previous severe disability, defined as disability in 3 or more activities of daily living (ADLs). Main Outcome Measures: Characteristics associated with development of severe disability after the fourth annual follow-up, in which the disability is classified as catastrophic disability if the individual did not report any ADL disability in the 2 interviews prior to severe disability onset or as progressive disability if the individual had previous disability in 1 or 2 ADLs. Results: In the year during which severe disability developed, hospitalizations were documented for 72.1% of those developing catastrophic disability and for 48.6% of those developing progressive disability. In the corresponding year, only 14.7% of those who were stable with no disability and 22.3% of those with some disability were hospitalized. The 6 most frequent principal discharge diagnoses included stroke, hip fracture, congestive heart failure, and pneumonia in both severe disability subsets; coronary heart disease and cancer in catastrophic disability; and diabetes and dehydration in progressive disability. These diagnoses occurred in 49% of those with catastrophic disability and 25% of those with progressive disability. In both severe disability subsets, the oldest patients received less intensive hospital care as indicated by charges for surgery, diagnostics, and rehabilitation and by the percentage who received major diagnostic procedures; they were also more often admitted to nursing homes. Conclusions: In the year when they become severely disabled, a large proportion of older persons are hospitalized for a small group of diseases. Hospital-based interventions aimed at reducing the severity and functional consequences of these diseases could have a large impact on reduction of severe disability.