Kemper P, Murtaugh C M
Division of Long Term Care Studies, Center for Intramural Research, Agency for Health Care Policy Research, Rockville, MD 20857.
N Engl J Med. 1991 Feb 28;324(9):595-600. doi: 10.1056/NEJM199102283240905.
Despite the growth in the number of Americans in nursing homes, there are only limited data on the total amount of time that people spend in such facilities. We estimate the amount of time the average person spends in nursing homes over his or her lifetime (lifetime nursing home use), using data from the National Mortality Followback Survey of the next of kin of a sample of persons 25 years of age or older who died in 1986. On the basis of these data, we estimated the likelihood that Americans will use nursing home care during the course of their lifetimes and the total duration of such care. Current data on life expectancy were then used to reweight the sample to project lifetime nursing home use for those who became 65 years old in 1990.
Of those who died in 1986 at 25 years of age or older, 29 percent had at some time been residents in a nursing home, and almost half of those who entered a nursing home spent a cumulative total of at least one year there. The probability of nursing home use increased sharply with age at death: 17 percent for age 65 to 74, 36 percent for age 75 to 84, and 60 percent for age 85 to 94. For persons who turned 65 in 1990, we project that 43 percent will enter a nursing home at some time before they die. Of those who enter nursing homes, 55 percent will have total lifetime use of at least one year, and 21 percent will have total lifetime use of five years or more. We also project that more women than men will enter nursing homes (52 percent vs. 33 percent), and among them, more women than men will have total lifetime nursing home use of five years or more (25 percent vs. 13 percent).
Our projections indicate that over a lifetime, the risk of entering a nursing home and spending a long time there is substantial. With the elderly population growing, this has important implications for both medical practice and the financing of long-term care.
尽管美国养老院中的老人数量有所增加，但关于人们在这类机构中度过的总时长的数据却十分有限。我们利用1986年去世的25岁及以上人群的近亲的全国死亡率随访调查数据，估算了普通人一生中在养老院度过的时长（终生养老院使用情况）。基于这些数据，我们估算了美国人在其一生中使用养老院护理的可能性以及此类护理的总时长。随后，利用当前的预期寿命数据对样本进行重新加权，以预测1990年满65岁人群的终生养老院使用情况。
在1986年去世时年龄在25岁及以上的人群中，29%的人曾在某个时间段入住过养老院，而入住养老院的人中，近一半人在养老院累计居住至少一年。随着死亡年龄的增长，使用养老院的概率急剧上升：65至74岁年龄段为17%，75至84岁年龄段为36%，85至94岁年龄段为60%。对于1990年满65岁的人群，我们预测43%的人在去世前的某个时间会入住养老院。在入住养老院的人中，55% 的人终生使用时长至少为一年，21% 的人终生使用时长为五年或更长时间。我们还预测，入住养老院的女性将多于男性（52% 对33%），其中，终生养老院使用时长为五年或更长时间的女性也多于男性（25% 对13%）。
我们的预测表明，一生中入住养老院并在那里度过较长时间的风险很大。随着老年人口的增加,这对医疗实践和长期护理的融资都具有重要意义。
