Smith G E, Kokmen E, O'Brien P C
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota 55901, USA.
J Am Geriatr Soc. 2000 May;48(5):519-25. doi: 10.1111/j.1532-5415.2000.tb04998.x.
To examine risk factors for nursing home placement in a population-based dementia cohort.
The Mayo Clinic Medical Records linkage system was used to identify all patients with onset of dementia between 1980 and 1984. The patient group included 314 cases who met DSM-III-R criteria for dementia, including 220 cases who were community dwelling at onset. All dementia patients were followed until death. A control group included 323 patients who did not, at any point, meet DSM-III-R criterion for dementia. The groups were initially matched on age, gender, and year of initial registration. Demographic, medical, social, and functional predictors were examined as static and time-dependent risk factors for nursing home placement in the initial community-dwelling subgroups, using stepwise Cox regression modeling.
Of the 314 dementia patients, 282 took residence in licensed skilled nursing homes for at least 6 weeks, suggestive of custodial care, at some point during the course of their illness. In the control group, 162 of the 323 people required nursing home placement. Within controls, the predictor variables of time to nursing home placement included initial age, being divorced, living in a townhome, apartment or assisted living apartment, change in Charlson comorbidity score, and change in amount of daily assistance required. Within the dementia sample, seven predictors were eventually determined to be associated with time to nursing home placement. These included total number of years of education, age at onset of dementia, being single, living in a retirement or supervised apartment at onset, change in Charlson comorbidity score, and a change in the amount of daily assistance required.
Cumulative incidence of placement was 90% in the dementia cohort and 50% in the controls. Certain variables seem to impact time to nursing home placement in all older persons, whether they have dementia or not. Among these are age, living in assisted living settings, increasing comorbidity scores, and increasing need for functional assistance. Certain additional factors may have a specific impact in dementia. Among these is education, which seems to provide a protective effect. These predictors may be important covariates in clinical dementia studies that include time to nursing home placement as an outcome variable.
研究基于人群的痴呆队列中入住养老院的风险因素。
利用梅奥诊所医疗记录链接系统识别1980年至1984年间所有痴呆起病的患者。患者组包括314例符合DSM-III-R痴呆标准的病例，其中220例起病时居住在社区。所有痴呆患者均随访至死亡。对照组包括323例在任何时间点均不符合DSM-III-R痴呆标准的患者。两组最初在年龄、性别和初次登记年份上进行匹配。使用逐步Cox回归模型，将人口统计学、医学、社会和功能预测因素作为初始社区居住亚组中入住养老院的静态和时间依赖性风险因素进行检验。
在314例痴呆患者中，282例在病程中的某个时间点在持牌专业护理院居住至少6周，提示为监护护理。在对照组中，323人中有162人需要入住养老院。在对照组中，入住养老院时间的预测变量包括初始年龄、离婚、居住在联排别墅、公寓或辅助生活公寓、查尔森合并症评分变化以及所需日常协助量的变化。在痴呆样本中，最终确定有七个预测因素与入住养老院的时间相关。这些因素包括受教育总年限、痴呆起病年龄、单身、起病时居住在退休或受监管公寓、查尔森合并症评分变化以及所需日常协助量的变化。
痴呆队列中的入住累积发生率为90%，对照组为50%。某些变量似乎会影响所有老年人入住养老院的时间，无论他们是否患有痴呆。其中包括年龄、居住在辅助生活环境中、合并症评分增加以及对功能协助的需求增加。某些其他因素可能对痴呆有特定影响。其中包括教育，似乎具有保护作用。这些预测因素可能是临床痴呆研究中的重要协变量，这些研究将入住养老院的时间作为结果变量。
