老年人复杂生物心理社会医疗保健需求的意义及成本：一项基于人群的研究结果
Significance and costs of complex biopsychosocial health care needs in elderly people: results of a population-based study.
作者信息
Wild Beate, Heider Dirk, Maatouk Imad, Slaets Joris, König Hans-Helmut, Niehoff Dorothea, Saum Kai-Uwe, Brenner Hermann, Söllner Wolfgang, Herzog Wolfgang
机构信息
From the Department of General Internal Medicine and Psychosomatics (B.W., I.M., D.N., W.H.), Medical University Hospital, Heidelberg, Germany; Division of Clinical Epidemiology and Aging Research (K.-U.S., H.B.), German Cancer Research Center, Heidelberg, Germany; Departments of Internal Medicine and Geriatrics (J.S.), University Hospital, Groningen, the Netherlands; Department of Psychosomatics and Psychotherapy (W.S.), General Hospital, Nürnberg, Germany; and Department of Health Economics and Health Services Research (D.H., H.-H.K.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
出版信息
Psychosom Med. 2014 Sep;76(7):497-502. doi: 10.1097/PSY.0000000000000080.
OBJECTIVE
To improve health care for the elderly, a consideration of biopsychosocial health care needs may be of particular importance-especially because of the prevalence of multiple conditions, mental disorders, and social challenges facing elderly people. The aim of the study was to investigate significance and costs of biopsychosocial health care needs in elderly people.
METHODS
Data were derived from the 8-year follow-up of the ESTHER study-a German epidemiological study in the elderly population. A total of 3124 participants aged 57 to 84 years were visited at home by trained medical doctors. Biopsychosocial health care needs were assessed using the INTERMED for the Elderly (IM-E) interview. Health-related quality of life (HRQOL) was measured by the 12-Item Short-Form Health Survey, and psychosomatic burden was measured by the Patient Health Questionnaire.
RESULTS
The IM-E correlated with decreased mental (mental component score: r = -0.38, p < .0001) and physical HRQOL (physical component score: r = -0.45, p < .0001), increased depression severity (r = 0.53, p < .0001), and costs (R = 0.41, p < .0001). The proportion of the participants who had an IM-E score of at least 21 was 8.2%; according to previous studies, they were classified as complex patients (having complex biopsychosocial health care needs). Complex patients showed a highly reduced HRQOL compared with participants without complex health care needs (mental component score: 37.0 [10.8] versus 48.7 [8.8]; physical component score: 33.0 [9.1] versus 41.6 [9.5]). Mean health care costs per 3 months of complex patients were strongly increased (1651.1 &OV0556; [3192.2] versus 764.5 &OV0556; [1868.4]).
CONCLUSIONS
Complex biopsychosocial health care needs are strongly associated with adverse health outcomes in elderly people. It should be evaluated if interdisciplinary treatment plans would improve the health outcomes for complex patients.
目的
为改善老年人的医疗保健状况，考虑生物心理社会保健需求可能尤为重要，特别是鉴于老年人中多种疾病、精神障碍的普遍存在以及他们面临的社会挑战。本研究的目的是调查老年人生物心理社会保健需求的重要性和成本。
方法
数据来自ESTHER研究的8年随访，这是一项针对老年人群的德国流行病学研究。共有3124名年龄在57至84岁之间的参与者接受了经过培训的医生的家访。使用老年人综合中级访谈（IM-E）评估生物心理社会保健需求。通过12项简短健康调查问卷测量健康相关生活质量（HRQOL），并通过患者健康问卷测量身心负担。
结果
IM-E与心理（心理成分得分：r = -0.38，p <.0001）和身体HRQOL降低（身体成分得分：r = -0.45，p <.0001）、抑郁严重程度增加（r = 0.53，p <.0001）以及成本增加（R = 0.41，p <.0001）相关。IM-E得分至少为21的参与者比例为8.2%；根据先前的研究，他们被归类为复杂患者（具有复杂的生物心理社会保健需求）。与没有复杂保健需求的参与者相比，复杂患者的HRQOL显著降低（心理成分得分：37.0 [10.8] 对48.7 [8.8]；身体成分得分：33.0 [9.1] 对41.6 [9.5]）。复杂患者每3个月的平均医疗保健成本大幅增加（1651.1欧元 [3192.2] 对764.5欧元 [1868.4]）。
结论
复杂的生物心理社会保健需求与老年人不良健康结局密切相关。应评估跨学科治疗计划是否会改善复杂患者的健康结局。
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