Ennis Stephanie K, Larson Eric B, Grothaus Louis, Helfrich Christian D, Balch Steven, Phelan Elizabeth A
Department of Health Services, School of Public Health, University of Washington, Box 357230, Seattle, WA, 98195, USA,
J Gen Intern Med. 2014 Nov;29(11):1451-9. doi: 10.1007/s11606-014-2904-z. Epub 2014 Jun 4.
Older persons account for the majority of hospitalizations in the United States.1 Identifying risk factors for hospitalization among elders, especially potentially preventable hospitalization, may suggest opportunities to improve primary care. Certain factors-for example, living alone-may increase the risk for hospitalization, and their effect may be greater among persons with dementia and the old-old (aged 85+).
To determine the association of living alone and risk for hospitalization, and see if the observed effect is greater among persons with dementia or the old-old.
Retrospective longitudinal cohort study.
2,636 participants in the Adult Changes in Thought (ACT) study, a longitudinal cohort study of dementia incidence. Participants were adults aged 65+ enrolled in an integrated health care system who completed biennial follow-up visits to assess for dementia and living situation.
Hospitalization for all causes and for ambulatory care sensitive conditions (ACSCs) were identified using automated data.
At baseline, the mean age of participants was 75.5 years, 59 % were female and 36 % lived alone. Follow-up time averaged 8.4 years (SD 3.5), yielding 10,431 approximately 2-year periods for analysis. Living alone was positively associated with being aged 85+, female, and having lower reported social support and better physical function, and negatively associated with having dementia. In a regression model adjusted for age, sex, comorbidity burden, physical function and length of follow-up, living alone was not associated with all-cause (OR = 0.93; 95 % CI 0.84, 1.03) or ambulatory care sensitive condition (ACSC) hospitalization (OR = 0.88; 95 % CI 0.73, 1.07). Among participants aged 85+, living alone was associated with a lower risk for all-cause (OR = 0.76; 95 % CI 0.61, 0.94), but not ACSC hospitalization. Dementia did not modify any observed associations.
Living alone in later life did not increase hospitalization risk, and in this population may be a marker of healthy aging in the old-old.
在美国，老年人占住院患者的大多数。确定老年人住院的风险因素，尤其是潜在可预防的住院情况，可能会为改善初级保健提供机会。某些因素，例如独居，可能会增加住院风险，并且在患有痴呆症的人和高龄老人（85岁及以上）中其影响可能更大。
确定独居与住院风险之间的关联，并观察在患有痴呆症的人或高龄老人中观察到的影响是否更大。
回顾性纵向队列研究。
成人思维变化（ACT）研究中的2636名参与者，这是一项关于痴呆症发病率的纵向队列研究。参与者是年龄在65岁及以上、参加综合医疗保健系统的成年人，他们每两年完成一次随访，以评估痴呆症和生活状况。
使用自动化数据确定所有原因导致的住院以及门诊护理敏感疾病（ACSC）导致的住院情况。
在基线时，参与者的平均年龄为75.5岁，59%为女性，36%独居。随访时间平均为8.4年（标准差3.5），产生了约10431个为期2年的时间段用于分析。独居与85岁及以上、女性、报告的社会支持较低和身体功能较好呈正相关，与患有痴呆症呈负相关。在调整了年龄、性别、合并症负担、身体功能和随访时间的回归模型中，独居与全因住院（比值比=0.93；95%置信区间0.84，1.03）或门诊护理敏感疾病（ACSC）住院（比值比=0.88；95%置信区间0.73，1.07）无关。在85岁及以上的参与者中，独居与全因住院风险较低（比值比=0.76；95%置信区间0.61，0.94）相关，但与ACSC住院无关。痴呆症并未改变任何观察到的关联。
晚年独居不会增加住院风险，在该人群中可能是高龄老人健康老龄化的一个标志。
