Callahan Christopher M, Tu Wanzhu, Unroe Kathleen T, LaMantia Michael A, Stump Timothy E, Clark Daniel O
Center for Aging Research, Indiana University, Indianapolis, Indiana.
Department of Medicine, Indiana University, Indianapolis, Indiana.
J Am Geriatr Soc. 2015 Aug;63(8):1495-502. doi: 10.1111/jgs.13540. Epub 2015 Jul 22.
To describe transitions in care for older adults with dementia identified from a nationally representative cohort and to describe transition rates in those with more-severe levels of cognitive and functional impairment.
Longitudinal cohort study.
Health and Retirement Study (HRS).
HRS respondents aged 65 and older whose survey data were linked with Medicare claims from 1999 to 2008 (N = 16,186).
Transitions in care between home, home with formal services, hospital, and nursing facility care; cognitive function; activities of daily living; and mortality.
The 3,447 (21.3%) HRS subjects who were ever diagnosed with dementia experienced frequent transitions. Of subjects transitioning from a hospital stay, 52.2% returned home without home care services, and 33.8% transitioned to a nursing facility. Of subjects transitioning from a nursing facility, 59.2% transitioned to the hospital, and 25.3% returned home without services. There were 2,139 transitions to death, and 58.7% of HRS subjects with dementia died at home. Even in persons with moderate to severe dementia, multiple transitions in care were documented, including transitions from the hospital to home and back to the hospital.
In this nationally representative sample of older adults, subjects diagnosed with dementia experience frequent transitions. Persons with dementia who are cared for at home and who transition back to home often have moderate to severe impairments in function and cognition.
描述从全国代表性队列中识别出的老年痴呆患者的护理转变情况，并描述认知和功能障碍程度更严重者的转变率。
纵向队列研究。
健康与退休研究（HRS）。
年龄在65岁及以上的HRS受访者，其1999年至2008年的调查数据与医疗保险理赔记录相关联（N = 16,186）。
家庭护理、接受正规服务的家庭护理、医院护理和护理机构护理之间的护理转变；认知功能；日常生活活动能力；以及死亡率。
3447名（21.3%）曾被诊断患有痴呆症的HRS受试者经历了频繁的护理转变。在从住院状态转变的受试者中，52.2%在没有家庭护理服务的情况下回家，33.8%转至护理机构。在从护理机构转变的受试者中，59.2%转至医院，25.3%在没有服务的情况下回家。有2139次转变至死亡，58.7%的患有痴呆症的HRS受试者在家中死亡。即使在患有中度至重度痴呆症的患者中，也记录到多次护理转变，包括从医院到家再回到医院的转变。
在这个具有全国代表性的老年人群样本中，被诊断患有痴呆症的受试者经历频繁的护理转变。在家中接受护理且转回家庭的痴呆症患者通常在功能和认知方面存在中度至重度损害。
