Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
J Am Med Dir Assoc. 2012 Jun;13(5):487.e9-17. doi: 10.1016/j.jamda.2012.02.005. Epub 2012 Apr 5.
Nursing home (NH) residents have various needs that affect the care they require. This article describes the diverse needs that new NH residents have, emphasizing the proportion of people with milder needs in multiple areas.
Research was conducted on all older adults newly admitted to not-for-profit NHs in the Winnipeg Health Region, between April 1, 2005, and March 31, 2007, provided that they were assessed using the Resident Assessment Instrument Minimum Data Set (RAI/MDS 2.0) within 30 days of admission (n = 1061). Using the Activities of Daily Living (ADL) Hierarchy scale, residents were first defined as low, intermediate, or high ADL dependent. Residents' needs were also defined using the RAI/MDS 2.0 cognitive performance (CPS) and pain scales, by their degree of behavioral problems and visual challenges, and by their frequency of bladder and bowel incontinence. Cluster analysis was used to create subgroups of residents by their severity of clinical challenges.
Of our cohort, 26.8% were low ADL dependent. Although some of these residents had moderate to severe needs in another area, many (46.8% of low ADL-dependent residents; 12.5% of our entire cohort) had milder needs across all clinical domains. Conversely, about one-third of our cohort was high ADL dependent; 31.7% of these residents had moderate to severe challenges in one clinical domain, and 35.5% had moderate to severe comorbid challenges.
Overall, 12.5% of our cohort had lower needs, demonstrating the capacity for community-based programs to offset NH demands. Also, the diversity of residents' needs highlights the importance of having both the appropriate resources and strategies available to provide quality NH care. Future research is discussed for both low- and higher-need NH residents.
养老院（NH）居民有各种需求，这些需求会影响他们所需的护理。本文描述了新入住 NH 的居民的各种需求，重点强调了在多个领域需求较轻的人群比例。
对 2005 年 4 月 1 日至 2007 年 3 月 31 日期间在温尼伯卫生区非营利性 NH 新入住的所有老年人进行了研究，前提是他们在入住后 30 天内使用居民评估工具最低数据集（RAI/MDS 2.0）进行了评估（n=1061）。根据日常生活活动（ADL）层次结构量表，居民首先被定义为 ADL 低度、中度或高度依赖。居民的需求也通过 RAI/MDS 2.0 认知表现（CPS）和疼痛量表、行为问题和视觉挑战程度以及膀胱和肠道失禁频率来定义。使用聚类分析根据临床挑战的严重程度为居民创建亚组。
在我们的队列中，26.8%的居民 ADL 依赖程度较低。尽管这些居民中的一些在其他领域存在中度到重度需求，但许多人（低 ADL 依赖居民的 46.8%；我们整个队列的 12.5%）在所有临床领域的需求都较轻。相反，我们队列中有大约三分之一的居民 ADL 依赖程度较高；这些居民中有 31.7%在一个临床领域存在中度到重度挑战，有 35.5%存在中度到重度合并症挑战。
总体而言，我们队列中有 12.5%的居民需求较低，这表明社区为基础的项目有能力缓解 NH 的需求。此外，居民需求的多样性强调了拥有适当的资源和策略来提供高质量 NH 护理的重要性。还讨论了针对低需求和高需求 NH 居民的未来研究。
