Nihtilä Elina K, Martikainen Pekka T, Koskinen Seppo V P, Reunanen Antti R, Noro Anja M, Häkkinen Unto T
Population Research Unit, Department of Sociology, University of Helsinki, Finland.
Eur J Public Health. 2008 Feb;18(1):77-84. doi: 10.1093/eurpub/ckm025. Epub 2007 Jun 11.
As the public expenditure on long-term care is likely to increase with the ageing of the population, identifying chronic medical conditions associated with the risk of long-term institutionalization is of particular interest. However, there is little systematic evidence showing how chronic medical conditions, other than dementia, affect the risk of entering into institutional care in the general older population.
We used population-based follow-up data on Finnish older people aged 65 and over (n = 280 722), to estimate the impact of different chronic conditions on the risk of long-term institutionalization. Furthermore, we analysed which chronic conditions were more strongly associated with the risk of institutionalization than with the risk of death without institutionalization. Cox proportional hazard regression models were used.
Our results showed that dementia, Parkinson's disease, stroke, depressive symptoms, other mental health problems, hip fracture and diabetes were strongly associated with increased risk of long-term institutionalization, independent of socio-demographic confounders and the presence of other chronic conditions. All these conditions raised the risk of institutionalization by 50% or more. Dementia, Parkinson's disease, stroke and mental health problems were more strongly associated with the risk of institutionalization than with the risk of death without institutionalization.
Overall, these results show that the future demand for institutional care depends not only on the ageing of the population but also on the development of the prevalence and severity of chronic conditions associated with institutionalization.
随着人口老龄化，长期护理的公共支出可能会增加，因此确定与长期机构化风险相关的慢性疾病尤为重要。然而，几乎没有系统的证据表明，除痴呆症外，慢性疾病如何影响一般老年人群进入机构护理的风险。
我们使用了芬兰65岁及以上老年人（n = 280722）的基于人群的随访数据，以估计不同慢性疾病对长期机构化风险的影响。此外，我们分析了哪些慢性疾病与机构化风险的关联比与非机构化死亡风险的关联更强。使用了Cox比例风险回归模型。
我们的结果表明，痴呆症、帕金森病、中风、抑郁症状、其他心理健康问题、髋部骨折和糖尿病与长期机构化风险增加密切相关，独立于社会人口学混杂因素和其他慢性疾病的存在。所有这些疾病使机构化风险提高了50%或更多。痴呆症、帕金森病、中风和心理健康问题与机构化风险的关联比与非机构化死亡风险的关联更强。
总体而言，这些结果表明，未来对机构护理的需求不仅取决于人口老龄化，还取决于与机构化相关的慢性疾病的患病率和严重程度的发展。
