PREDICTORS OF INSTITUTIONALIZATION IN DEMENTIA PATIENTS

1985年，有130万人住在养老院，费用为 机构护理超过AS家庭护理的直接医疗费用 每名患者每年高达11,000美元。然而，导致这些问题的因素 对痴呆症患者的住院治疗还没有明确的了解。这个 本研究将承担四个相关目标。第一个是 确定人口中制度化的累积发生率- 以痴呆患者及其匹配的对照组为基础的队列。第二 是为了确定痴呆症患者住院的风险 与a)人口统计因素、b)共病疾病c)非 疗养院卫生保健利用和d)特定于 精神错乱的疾病。第三个目标是确定频率 哪些制度化是由家庭成员发起的，而不是健康 护理专业人士。第四个目标是区分 存在功能状态恶化和照顾者的 容忍这些损害。这些目标中的每一个都与公众相关 痴呆症患者的政策和护理创新。本研究将 利用梅奥诊所阿尔茨海默病患者登记处(ADPR) 并仿效ADPR的现有方案，进行追溯和 预期的组件。回溯样本是以人口为基础的， 包括662名痴呆症患者，他们的痴呆症发生在 1975-1984年和662名年龄和性别匹配的对照组。他的病历记录 1975-1979年和1980-1984年的病例和对照将追溯队列 抽象确定养老院安置的日期和地点。 由于梅奥诊所的病历链接系统， 所有奥姆斯特德县，明尼苏达州患者的记录都是完整的。护理率 痴呆症样本中的家庭安置将被计算出来。危害 与各种人口统计因素相关的安置模型 将计算合并症指数。预期样本为 以社区为基础，目前包括536对匹配的痴呆症 病人和对照组。有关居住的数据将在#年期间收集 ADPR纵向随访程序。参赛者将身着他们的 在后续行动中的居住地，因此居住地将由 直接观察。疾病特定变量包括认知状态， 功能状态和行为障碍将与协同 发病率和人口学数据，以开发风险模型 预期样本中的制度化。了解哪些内容 痴呆症过程的特征最直接地与 制度化是干预战略的必要先导 试图推迟或阻止对制度化护理的需要。

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.