Mechanic D, McAlpine D D
Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, NJ 08901-1293, USA.
Psychiatr Serv. 2000 Mar;51(3):354-8. doi: 10.1176/appi.ps.51.3.354.
The study examined patterns of care for persons with mental illness in nursing homes in the United States from 1985 to 1995. During that period resident populations in public mental hospitals declined, and legislation aimed at diverting psychiatric patients from nursing homes was enacted.
Estimates of the number of current residents with a mental illness diagnosis and those with a severe mental illness were derived from the 1985 and 1995 National Nursing Home Surveys and the 1987 and 1996 Medical Expenditure Surveys. Trends by age group and changes in the mentally ill population over this period were assessed.
The number of nursing home residents diagnosed with dementia-related illnesses and depressive illnesses increased, but the number with schizophrenia-related diagnoses declined. The most substantial declines occurred among residents under age 65; more than 60 percent fewer had any primary psychiatric diagnosis or severe mental illness.
These findings suggest a reduced role for nursing homes in caring for persons with severe mental illness, especially those who are young and do not have comorbid physical conditions. Overall, it appears that nursing homes play a relatively minor role in the present system of mental health services for all but elderly persons with dementia.
本研究调查了1985年至1995年美国养老院中精神疾病患者的护理模式。在此期间，公立精神病院的住院人数有所下降，并且颁布了旨在将精神病患者从养老院转移出去的立法。
1985年和1995年的全国养老院调查以及1987年和1996年的医疗支出调查得出了当前被诊断患有精神疾病的居民以及患有严重精神疾病的居民人数估计值。评估了这一时期按年龄组划分的趋势以及精神病患者人数的变化。
被诊断患有与痴呆相关疾病和抑郁疾病的养老院居民人数增加，但被诊断患有与精神分裂症相关疾病的人数下降。65岁以下居民的下降幅度最大；患有任何原发性精神疾病诊断或严重精神疾病的人数减少了60%以上。
这些发现表明养老院在照顾严重精神疾病患者，尤其是那些年轻且没有合并身体疾病的患者方面的作用有所降低。总体而言，除了患有痴呆症的老年人外，养老院在目前的心理健康服务体系中似乎发挥着相对较小的作用。
