Scocco Paolo, Rapattoni Monica, Fantoni Giovanna
Department of Mental Health, Padua, Italy.
Int J Geriatr Psychiatry. 2006 Mar;21(3):281-7. doi: 10.1002/gps.1453.
To investigate why elderly persons moved to a nursing home and detect any change in their psychopathological and cognitive profile, dependency and perceived QOL.
We considered 100 elderly consecutively admitted to a nursing home, within 1 week of admission and 6 months later. Data were collected from medical and nursing records (medical and psychiatric history, ADL), interviews (MMSE, reasons for admission) and self-report instruments (GDS, BSI, WHOQOL-brief).
At admission, 68 subjects were able to participate in the survey and agreed to take part. Only 5.9% (n = 4) had moved to the nursing home by their own choice, 26.5% (n = 18) because they were lonely and 36.7% (n = 25) because they had no caregiver available. The reasons for admission reported by the interviewed residents only partly corresponded with the ones noted in their records. Twenty-six subjects had an MMSE score >or= 18 and agreed to undertake complete assessment. The scores of 20 of the 26 subjects exceeded the cut-off on the GDS and five of the nine BSI subscales. During the follow-up period, 19 of the 68 originally assessed residents died (33 of the entire sample of 100) and one refused to continue to take part in the survey. The mean MMSE and ADL scores of the 48 survivors decreased from 16.87 (SD +/- 7.32) to 14.27 (SD +/- 7.24; t = 4.89, p < 0.000) and from 8.22 (SD +/- 3.55) to 6.39 (SD +/- 3.56; t = 5.34, p < 0.000), respectively. The scores achieved on GDI and BSI subscales worsened in 20 survivors with MMSE >or= 18. The score achieved on the QOL physical health domain also worsened. Comparison of the subjects who died and survived during the follow-up period showed a significant difference in terms of ADL (6.60 SD +/- 4.221 vs 3.64 SD +/- 3.773 F = 11.639; p < 0.001).
The 68 original participants expressed feelings of loneliness and marginalization, but these experiences were not noted in their personal records. Most subjects presented psychiatric symptoms and cognitive decline. After 6 months, the clinical condition of the sample, particularly the females, had worsened, with a 33% mortality rate. This suggests that moving to a nursing home did not bring about improvement or stabilization; rather, psychiatric symptoms worsened and quality of life was perceived more poorly.
调查老年人入住养老院的原因，并检测其心理病理和认知状况、依赖程度及感知生活质量的变化。
我们纳入了100名连续入住养老院的老年人，在入院1周内及6个月后进行观察。数据收集自医疗和护理记录（病史和精神病史、日常生活活动能力）、访谈（简易精神状态检查表、入院原因）及自我报告工具（老年抑郁量表、症状自评量表、世界卫生组织生活质量简表）。
入院时，68名受试者能够参与调查并同意参加。只有5.9%（n = 4）是自行选择入住养老院，26.5%（n = 18）是因为感到孤独，36.7%（n = 25）是因为无人照顾。受访居民报告的入院原因与记录中所记部分相符。26名简易精神状态检查表得分≥18分的受试者同意接受全面评估。26名受试者中有20名的得分超过了老年抑郁量表的临界值，9个症状自评量表子量表中有5个也是如此。在随访期间，最初评估的68名居民中有19人死亡（100人整个样本中的33人），1人拒绝继续参与调查。48名幸存者的简易精神状态检查表和日常生活活动能力平均得分分别从16.87（标准差±7.32）降至14.27（标准差±7.24；t = 4.89，p < 0.000），从8.22（标准差±3.55）降至6.39（标准差±3.56；t = 5.34，p < 0.000）。简易精神状态检查表得分≥18分的20名幸存者在老年抑郁量表和症状自评量表子量表上的得分变差。生活质量身体健康领域的得分也变差。随访期间死亡和存活受试者的比较显示，在日常生活活动能力方面存在显著差异（6.60标准差±4.221 vs 3.64标准差±3.773，F = 11.639；p < 0.001）。
最初的68名参与者表达了孤独和被边缘化的感受，但这些经历在他们的个人记录中并未体现。大多数受试者存在精神症状和认知衰退。6个月后，样本尤其是女性的临床状况恶化，死亡率为33%。这表明入住养老院并未带来改善或稳定；相反，精神症状恶化，生活质量的感知更差。
