PREDICTORS OF INSTITUTIONALIZATION IN DEMENTIA PATIENTS

1985年，有130万人住在养老院， 机构护理超过家庭护理的直接医疗费用， 每名患者每年11,000美元。然而，导致 老年痴呆症患者的住院治疗尚不清楚。' The 本研究将实现四个相关目标。一是 确定人口中机构化的累积发生率- 基于痴呆患者及其匹配对照的队列。第二 是为了确定痴呆症患者住院的风险 与a）人口统计学因素，B）共病，c）非 护理之家的卫生保健利用和d）特定的因素 精神错乱的疾病第三个目标是确定频率， 哪个机构是由家庭成员发起的， 护理专业人员。第四个目标是区分 存在功能状态恶化和照顾者的能力， 容忍这些缺陷。这些目标中的每一个都与公众有关。 为痴呆症患者提供的政策和护理创新。本研究将 利用马约诊所阿尔茨海默病患者登记处（ADPR） 并仿效ADPR的现有计划， 预期的组成部分。回顾性样本是基于人群的， 包括662名痴呆患者，痴呆发作发生在 1975-1984年和662名年龄和性别匹配的对照。的医疗记录 1975-1979年和1980-1984年回顾性队列中的病例和对照将 抽象，以确定日期和地点的养老院安置。 由于马约诊所的医疗记录链接系统， 记录是完整的所有奥姆斯特德县，明尼苏达州的病人。护理率 将计算痴呆样本中的家庭安置。危害 与各种人口因素相关的安置模型以及 计算共病指数。前瞻性样本为 目前包括536对匹配的痴呆症患者 患者和对照组。关于居住的数据将在 ADPR纵向随访程序。与会者将在他们的 随访时的居住地，以便通过以下方式确定居住地 直接观察。疾病特异性变量，包括认知状态， 功能状态和行为障碍将与共同 发病率和人口统计数据， 制度化的前瞻性样本。了解哪些 痴呆疾病过程的特征最直接相关于 制度化是干预战略的必要前提 寻求延迟或阻止对机构化护理的需求。

In 1985 1.3 million people were residing in nursing homes with costs of institutional care exceeding the direct medical costs of home care by as much as $11,000 per patient-year. Yet the factors contributing to institutionalization of dementia patients are not clearly understood.' The present study will undertake four related objectives. The first is to determine the cumulative incidence of institutionalization in population- based cohorts of dementia patients and their matched controls. The second is to determine risk for institutionalization of dementia patients associated with a) demographic factors, b) co-morbid illness c) non- nursing home health' care utilization and d) factors specific to the dementing illness. The third Objective is to determine the frequency with which institutionalization is initiated by family members versus health care professionals. The fourth objective is to distinguish between the presence of deteriorated functional status and caregivers' abilities to tolerate these impairments. Each of these aims has relevance for public policy and care innovations for dementia patients. The present study will capitalize on the Mayo Clinic Alzheimer's Disease Patient Registry (ADPR) and emulate the existing scheme of the ADPR in having retrospective and prospective components. The retrospective sample is population-based and includes 662 dementia patients with onset of dementia occurring between 1975-1984 and 662 age- and sex-matched controls. The medical records of cases and controls in 1975-1979 and 1980-1984 retrospective cohorts will be abstracted to determine the date and place of nursing home placement. Because of the medical records-linkage system at the Mayo Clinic these records are complete for all Olmsted County, MN patients. Rates of nursing home placement within the dementia sample will be calculated. Hazards models for placement associated with various demographic factors and an index of co-morbid illness will be calculated. The prospective sample is community-based and currently includes 536 matched pairs of dementia patients and controls. Data regarding residence will be collected during ADPR longitudinal follow-up procedures. Participants will be seen in their residence at follow-up so that place of residence will be determined by direct observation. Disease specific variables including cognitive status, functional status and behavioral disturbance will be integrated with co- morbidity and demographic data to develop hazards models for institutionalization in the prospective sample. Understanding which features of dementing disease processes are most directly related to institutionalization is a necessary precursor to intervention strategies seeking to delay or prevent the need for institutionalized care.