Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
J Am Med Dir Assoc. 2010 Oct;11(8):567-71. doi: 10.1016/j.jamda.2009.11.012. Epub 2010 Jun 26.
Accurate prediction of life expectancy in long-term care facilities (LTCFs) is important, but previous studies emphasized demographic characteristics, disease diagnosis, or comorbidity. The purpose of this study was to evaluate the roles of geriatric care problems and comorbidity in predicting 12-month mortality in LTCFs.
Prospective, observational.
Veterans Care Home.
Residents of Banciao Veterans Care Home.
A minimum data set (MDS) was implemented, and resident assessment protocol (RAP) triggers were collected as geriatric care problems. Comorbidity of the residents was evaluated using Charlson's comorbidity index (CCI).
A total of 559 residents (mean age = 80.9 ± 5.3 years, all males) were successfully followed, and 50 residents (7.9%) died during the study period. Compared with survivors, deceased subjects had a higher sum of RAP triggers (4.9 ± 2.0 versus 4.1 ± 2.0, P = .004) and CCI (1.2 ± 1.2 versus 0.7 ± 0.9, P = .014), and were more likely to be hospitalized (1.6 ± 1.9 versus 0.4 ± 0.9, P < .001) and visit the emergency department (0.9 ± 1.2 versus 0.5 ± 1.2, P = .012). Moreover, deceased subjects were more prone to have cognitive loss, urinary incontinence, and behavioral symptoms than survivors (P all < .05). A Cox proportional hazards model showed that both CCI (HR = 1.44, 95% CI: 1.13-1.82, P = .003) and the sum of RAP triggers (HR = 2.03, 95% CI: 1.08-3.82, P = .028) were significantly associated with 12-month mortality.
Independent of comorbidity, the sum of geriatric care problems is a significant predictor of 12-month mortality in a veterans care home. Further intervention studies are needed to evaluate whether elimination of these care problems can improve survival in the long-term care setting.
准确预测长期护理机构（LTCF）中的预期寿命很重要，但以往的研究强调了人口统计学特征、疾病诊断或合并症。本研究旨在评估老年护理问题和合并症在预测 LTCF 中 12 个月死亡率方面的作用。
前瞻性、观察性。
板桥退伍军人护理院。
板桥退伍军人护理院的居民。
实施最小数据集（MDS），并收集居民评估协议（RAP）触发因素作为老年护理问题。使用 Charlson 合并症指数（CCI）评估居民的合并症。
共对 559 名居民（平均年龄=80.9±5.3 岁，均为男性）进行了成功随访，研究期间有 50 名居民（7.9%）死亡。与幸存者相比，死亡患者的 RAP 触发总数更高（4.9±2.0 与 4.1±2.0，P=.004），CCI 更高（1.2±1.2 与 0.7±0.9，P=.014），住院治疗（1.6±1.9 与 0.4±0.9，P<.001）和急诊就诊（0.9±1.2 与 0.5±1.2，P=.012）的可能性更高。此外，与幸存者相比，死亡患者更容易出现认知障碍、尿失禁和行为症状（均 P<.05）。Cox 比例风险模型显示，CCI（HR=1.44，95%CI：1.13-1.82，P=.003）和 RAP 触发总数（HR=2.03，95%CI：1.08-3.82，P=.028）均与 12 个月死亡率显著相关。
独立于合并症，老年护理问题的总和是退伍军人护理院 12 个月死亡率的重要预测因素。需要进一步的干预研究来评估消除这些护理问题是否可以改善长期护理环境中的生存。
