Service of Geriatric Medicine and Geriatric Rehabilitation, Department of Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
J Am Med Dir Assoc. 2012 Oct;13(8):692-7. doi: 10.1016/j.jamda.2012.05.006. Epub 2012 Jun 13.
To investigate the relationship between levels of cognitive impairment and health services utilization in older patients undergoing post-acute rehabilitation.
Cross-sectional study.
Post-acute rehabilitation facility.
Patients (N = 1764) aged 70 years and older admitted over 3 years.
Sociodemographic, medical, and functional data were collected upon admission. Based on discharge diagnoses, patients were classified as cognitively intact, cognitively impaired with no dementia (CIND), and demented.
Dementia and CIND were diagnosed in 425 (24.1%) and 301 (17.1%) patients, respectively. Gradients from cognitively intact to cognitively impaired to demented patients were observed in median length of stay (19, 22, and 25 days, P < .001), and institutionalization rates at discharge (4.2%, 7.6%, and 28.8%, P < .001). Among patients discharged home, similar gradients were observed in utilization of home care (68.2%, 79.7%, and 83.3%, P < .001) and day care (3.1%, 7.1%, and 14.3%, P < .001). After adjustment, compared with cognitively intact patients, only those with dementia still had longer stays (+2.7 days) and increased odds of institutionalization (adjOR 6.1, 95% CI 4.0-9.3, P < .001). Among patients discharged home, use of home and day care remained higher in those with dementia (adjOR 1.8, 95% CI 1.2-2.7, P = .005, and adjOR 1.8, 95% CI 1.2-2.7, P = .005, respectively), while CIND patients had higher odds of using home care (adjOR 1.6, 95% CI 1.1-2.4, P = .028).
Among patients undergoing post-acute rehabilitation, those with dementia had increased use of both institutional and community care, whereas those with CIND had increased use of home care services only. Future studies should investigate specific strategies susceptible to reduce the related burden on health care systems.
调查认知障碍程度与老年患者接受康复后护理服务利用之间的关系。
横断面研究。
康复后护理机构。
3 年内入院的 1764 名 70 岁及以上的患者。
入院时收集人口统计学、医学和功能数据。根据出院诊断，患者被分为认知正常、认知障碍但无痴呆（CIND）和痴呆。
分别诊断出痴呆和 CIND 患者 425 例（24.1%）和 301 例（17.1%）。从中认知正常到认知障碍到痴呆患者的中位数住院时间（19、22 和 25 天，P <.001）和出院时的机构化率（4.2%、7.6%和 28.8%，P <.001）呈梯度分布。在出院回家的患者中，在家护理（68.2%、79.7%和 83.3%，P <.001）和日间护理（3.1%、7.1%和 14.3%，P <.001）的使用率也呈现类似的梯度。调整后，与认知正常的患者相比，只有痴呆患者的住院时间更长（+2.7 天），机构化的可能性更高（调整后优势比 6.1，95%置信区间 4.0-9.3，P <.001）。在出院回家的患者中，痴呆患者在家和日间护理的使用率仍然较高（调整后优势比 1.8，95%置信区间 1.2-2.7，P =.005，和调整后优势比 1.8，95%置信区间 1.2-2.7，P =.005），而 CIND 患者在家护理的可能性更高（调整后优势比 1.6，95%置信区间 1.1-2.4，P =.028）。
在接受康复后护理的患者中，痴呆患者使用机构和社区护理的比例增加，而 CIND 患者仅增加了家庭护理服务的使用。未来的研究应探讨具体策略，以减轻对医疗保健系统的相关负担。
