Young Yuchi, Kalamaras John, Kelly Lindsay, Hornick David, Yucel Recai
Department of Health Policy, Management, and Behavior, School of Public Health, State University of New York at Albany, Albany, NY.
Department of Epidemiology and Biostatistics, School of Public Health, State University of New York at Albany, Albany, NY.
J Am Med Dir Assoc. 2015 Oct 1;16(10):900.e1-6. doi: 10.1016/j.jamda.2015.07.017.
This study examines whether aging in place (community-based living before admission to a nursing home) delays nursing home admission among New York State home health care recipients.
Retrospective cohort study (January 2007-December 2012).
New York State.
Adults age 65+ who received home health services for at least 2 months before permanent nursing home admission.
Permanent transition is defined as home care patients who are discharged to and stay at a nursing home for more than 3 months. Data were abstracted from the Minimum Data Set (MDS) and Outcome and Assessment Information Set (OASIS). Descriptive and bivariate Kruskal-Wallis and χ(2) tests were performed.
The average age of nursing home residents at admission remained steady at 83 years between 2007 and 2012. The proportion of minority populations (Asian, black, Hispanic/Latino) increased, whereas the white population declined (P < .0001). The average length of stay at home increased 8 months, from 17 months in 2007 to 25 months in 2012 (P < .0001). Chronic conditions with significant increases in prevalence during the study period were hypertension (P < .0009), dementia (P < .0001), heart failure (P = .05), urinary incontinence (P < .0001), and bowel incontinence (P < .0001). Increases in functional disabilities requiring extensive human assistance included toileting, dressing, personal hygiene, and transferring (all P < .001).
Home health services enabled recipients to remain at home 8 months longer, thus delaying nursing home entry. Given the increase in prevalence of comorbidities and disability, we anticipate a concomitant increase in support services at the nursing home. These results may inform policy and staffing decisions regarding adjustments in required caregivers' credentials and nurse-patient ratios.
本研究探讨就地养老（入住疗养院之前在社区生活）是否会延迟纽约州接受家庭医疗保健服务者入住疗养院的时间。
回顾性队列研究（2007年1月至2012年12月）。
纽约州。
65岁及以上成年人，在永久入住疗养院之前接受了至少2个月的家庭医疗服务。
永久转变定义为出院后入住疗养院并停留超过3个月的家庭护理患者。数据从最小数据集（MDS）和结果与评估信息集（OASIS）中提取。进行了描述性和双变量Kruskal-Wallis检验及χ²检验。
2007年至2012年期间，疗养院居民入院时的平均年龄稳定在83岁。少数族裔（亚裔、黑人、西班牙裔/拉丁裔）人口比例增加，而白人人口比例下降（P <.0001）。在家平均停留时间增加了8个月，从2007年的17个月增至2012年的25个月（P <.0001）。在研究期间患病率显著增加的慢性病包括高血压（P <.0009）、痴呆症（P <.0001）、心力衰竭（P =.05）、尿失禁（P <.0001）和大便失禁（P <.0001）。需要大量人力协助的功能障碍增加包括如厕、穿衣、个人卫生和转移（均P <.001）。
家庭医疗服务使接受者能够在家多停留8个月，从而延迟了入住疗养院的时间。鉴于合并症和残疾患病率的增加，我们预计疗养院的支持服务也会相应增加。这些结果可能为有关调整所需护理人员资质和护士与患者比例的政策及人员配置决策提供参考。
