Smith G E, O'Brien P C, Ivnik R J, Kokmen E, Tangalos E G
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55901, USA.
Neurology. 2001 Oct 23;57(8):1467-73. doi: 10.1212/wnl.57.8.1467.
To examine risk factors for nursing home placement in a community-based dementia cohort.
Cognitively normal participants and cognitively impaired patients from a large AD Patient Registry were followed from diagnosis to placement, death, or last follow-up. This included over 3,600 person-years of surveillance. The normal group included 473 participants who did not, at any point, meet Diagnostic and Statistical Manual of Mental Disorders, 3rd ed., revised (DSM-III-R) criteria for dementia. The patient group included 512 patients who met DSM-III-R criteria for dementia or criteria for mild cognitive impairment at diagnosis. Demographic, medical, social, cognitive, behavioral, and functional predictors of time to placement were examined using Cox modeling.
In the normal group, only 21 people (4%) required nursing home placement. With subjects, enrollment year, age at initial evaluation, being widowed, and living in a retirement community were associated with time to placement in separate univariate analyses. Of 512 cognitively impaired patients, 203 (39.6%) were placed in nursing homes. Median time from diagnosis to placement was 5.3 years. Within the patient sample, four predictors were determined to be associated with time to nursing home placement. These included gender, enrollment year, functional status, and cognitive score. Interactions were present for functional status with cognitive score and enrollment year.
In patients with dementia who are within 5 years of diagnosis, placement rates of approximately 10% per year can be expected. Disease severity indices including degree of cognitive and functional impairment are primary risk factors for placement.
研究社区痴呆队列中入住养老院的风险因素。
对来自大型阿尔茨海默病患者登记处的认知正常参与者和认知受损患者从诊断到入住养老院、死亡或最后一次随访进行跟踪。这包括超过3600人年的监测。正常组包括473名在任何时候都不符合《精神疾病诊断与统计手册》第三版修订版（DSM-III-R）痴呆标准的参与者。患者组包括512名在诊断时符合DSM-III-R痴呆标准或轻度认知障碍标准的患者。使用Cox模型检查入住养老院时间的人口统计学、医学、社会、认知、行为和功能预测因素。
在正常组中，只有21人（4%）需要入住养老院。在单变量分析中，受试者、入组年份、初次评估时的年龄、丧偶以及居住在退休社区与入住养老院的时间相关。在512名认知受损患者中，203人（39.6%）被安置在养老院。从诊断到入住养老院的中位时间为5.3年。在患者样本中，确定有四个预测因素与入住养老院的时间相关。这些因素包括性别、入组年份、功能状态和认知评分。功能状态与认知评分和入组年份之间存在相互作用。
在诊断后5年内的痴呆患者中，预计每年的入住率约为10%。包括认知和功能损害程度在内的疾病严重程度指标是入住养老院的主要风险因素。
