Paúl Constança, Teixeira Laetitia, Azevedo Maria João, Alves Sara, Duarte Mafalda, O'Caoimh Rónán, Molloy William
Research and Education Unit on Ageing, Institute of Biomedical Sciences Abel Salazar, University of Porto Porto, Portugal.
Centre for Gerontology and Rehabilitation, St Finbarrs Hospital - University College Cork Cork City, Ireland ; COLLaboration on AGEing, University College Cork, Cork, and NetwellCASALA - Dundalk Institute of Technology Dundalk, Ireland ; Health Research Board, Clinical Research Facility Galway, National University of Ireland Galway, Ireland.
Front Aging Neurosci. 2015 Nov 17;7:212. doi: 10.3389/fnagi.2015.00212. eCollection 2015.
In the face of limited resources and an aging population with increasingly care needs, healthcare systems must identify community-dwelling older adults with mental health problems at higher risk of adverse outcomes such as institutionalization, hospitalization and death, in order to deliver timely and efficient care. The objectives of this study were to assess the prevalence of mental health concerns and the associated perceived risk of adverse outcomes in a large sample of older patients in primary care (PC). We trained general practitioners and nurses to use the Risk Instrument for Screening in the Community to rank perceived risk of mental health concerns (including neurocognitive and mood disorders) from 1 (mild) to 3 (severe). The mean age of the 4499 people assessed was 76.3 years (SD = 7.3) and 2645 (58.8%) were female. According to the PC team 1616 (35.9%) were perceived to have mental health concerns of whom 847 (52.4%) were mild, 559 (34.6%) were moderate and 210 (13%) were severe. Patients with mental health concerns had higher odds of perceived risk of adverse outcomes (OR = 2.22, 95% CI 1.83-2.69 for institutionalization; OR = 1.66, 95% CI 1.41-1.94 for hospitalization; OR = 1.69, 95% CI 1.42-2.01 for death). These results suggest a high prevalence of mental health concerns among older adults and supports the need for early identification of patients at high-risk of adverse healthcare outcomes.
面对资源有限以及人口老龄化且护理需求日益增加的情况，医疗保健系统必须识别出心理健康存在问题、面临诸如入住养老院、住院和死亡等不良后果风险较高的社区居家老年人，以便提供及时有效的护理。本研究的目的是评估初级保健（PC）中大量老年患者心理健康问题的患病率以及与之相关的不良后果感知风险。我们培训全科医生和护士使用社区筛查风险工具，将心理健康问题（包括神经认知和情绪障碍）的感知风险从1（轻度）到3（重度）进行排序。接受评估的4499人的平均年龄为76.3岁（标准差 = 7.3），其中2645人（58.8%）为女性。根据初级保健团队的评估，1616人（35.9%）被认为存在心理健康问题，其中847人（52.4%）为轻度，559人（34.6%）为中度，210人（13%）为重度。存在心理健康问题的患者出现不良后果感知风险的几率更高（入住养老院的比值比 = 2.22，95%置信区间为1.83 - 2.69；住院的比值比 = 1.66，95%置信区间为1.41 - 1.94；死亡的比值比 = 1.69，95%置信区间为1.42 - 2.01）。这些结果表明老年人心理健康问题的患病率较高，并支持有必要尽早识别出具有不良医疗保健后果高风险的患者。
