Faculty of Social Sciences, The University of Hong Kong, Hong Kong, China.
J Am Med Dir Assoc. 2012 Feb;13(2):169-75. doi: 10.1016/j.jamda.2010.07.011. Epub 2010 Oct 16.
To estimate the 12-month institutionalization rate and to identify the associated predictors among functionally impaired elders with or without cognitive impairment.
A cohort of Hong Kong community-dwelling elders aged 65 or older with functional and/or cognitive impairments was recruited and interviewed from 2007 to 2008. Twelve months after the baseline interview, the family caregivers or elders were interviewed to update the residence status of the elders. Logistic regressions were used to examine the association between institutionalization and the baseline variables.
Eighty elders (of 749 respondents) had been institutionalized within 12 months from baseline. The institutionalization rates were 6.2% (95% confidence interval (CI): 4.0%-8.5%) for elders with functional impairment only and 17.3% (95% CI: 13.0%-21.6%) for elders with both functional and cognitive impairments. Stepwise multiple logistic regressions found that more usage of community services was the single predictor to institutionalization in 1 year for the elders with functional impairment only. The risk was doubled (odd ratio = 2.166, 95% CI: 1.286-3.647) for usage in 1 more community service. For elders with both functional and cognitive impairments, the institutionalization risk was reduced by about 70% with employment of a domestic helper (odd ratio = 0.268, 95% CI: 0.120-0.598), despite increased risk being associated with advancing age of caregiver, caregiver being male, and deteriorating functional status of the elder.
Among the functionally impaired elders, more usage of community services predicted increased institutionalization, whereas among the functionally and cognitively impaired elders, employment of a domestic helper predicted reduced institutionalization. Innovative services and care models are needed to prevent unnecessary institutionalization and to postpone premature institutionalization. Further research needs to be conducted to investigate the long term care needs of the elders from the perspective of both the elders and their caregivers.
评估有或无认知障碍的功能受损老年人 12 个月的机构化率，并确定相关的预测因素。
从 2007 年至 2008 年，招募了一个由香港社区居住的 65 岁或以上有功能和/或认知障碍的老年人组成的队列，并对他们进行了访谈。在基线访谈后 12 个月，对家庭照顾者或老年人进行了访谈，以更新老年人的居住状况。使用逻辑回归检查机构化与基线变量之间的关联。
80 名老年人（749 名应答者中的 80 名）在基线后 12 个月内被机构化。功能障碍老年人的机构化率为 6.2%（95%置信区间：4.0%-8.5%），而功能和认知障碍老年人的机构化率为 17.3%（95%置信区间：13.0%-21.6%）。逐步多因素逻辑回归发现，对于只有功能障碍的老年人，更多地使用社区服务是 1 年内机构化的唯一预测因素。使用 1 项以上社区服务，风险增加 2 倍（优势比=2.166，95%置信区间：1.286-3.647）。对于有功能和认知障碍的老年人，雇用家庭佣工可使机构化风险降低约 70%（优势比=0.268，95%置信区间：0.120-0.598），尽管与照顾者年龄较大、照顾者为男性以及老年人功能状态恶化相关的风险增加。
在功能障碍老年人中，更多地使用社区服务预示着更高的机构化风险，而在功能和认知障碍老年人中，雇用家庭佣工预示着较低的机构化风险。需要创新服务和护理模式，以防止不必要的机构化和推迟过早的机构化。需要进一步研究从老年人及其照顾者的角度来研究老年人的长期护理需求。
