Cepoiu-Martin Monica, Tam-Tham Helen, Patten Scott, Maxwell Colleen J, Hogan David B
Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Schools of Pharmacy and Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada.
Int J Geriatr Psychiatry. 2016 Nov;31(11):1151-1171. doi: 10.1002/gps.4449. Epub 2016 Apr 4.
The main objective of this study was to summarize the effects of various individual, caregiver, and system-related factors on the risk of long-term care (LTC) placement for persons with dementia.
We searched electronic databases for longitudinal studies reporting on predictors of LTC placement for persons with dementia residing in the community or supportive care settings. We performed meta-analyses with hazard ratios (HRs) of various predictors using random effects models and stratified the HRs with several study variables. Data on predictors not included in the meta-analyses were summarized descriptively.
Full-text reviews of 360 papers were performed with data from 37 papers used to calculate pooled HRs for LTC placement of select person with dementia (age, sex, race, marital status, type of dementia, living arrangement, and relationship to caregiver) and caregiver (age, sex, and depressive symptoms) characteristics. White race [HR = 1.67, 95% confidence intervals (CI): 1.41-1.99], greater dementia severity (HR = 1.05, 95% CI: 1.03-1.06), and older age (HR = 1.02, 95% CI: 1.01-1.03) increased the risk of LTC placement. Married persons with dementia (HR = 0.38, 95% CI: 0.16-0.86) and living with their caregiver (HR = 0.72, 95% CI: 0.56-0.92) had a lower risk. Behavioral and psychological symptoms of dementia, the degree of functional impairment, and caregiver burden had a consistent effect on the risk of LTC placement in our descriptive review.
We quantified the predictive effect of several risk factors for LTC placement. These estimates could be used to more precisely categorize the risk of institutionalization and potentially link those at higher risk to appropriate services. Copyright © 2016 John Wiley & Sons, Ltd.
本研究的主要目的是总结各种个体、照料者及系统相关因素对痴呆症患者长期护理（LTC）安置风险的影响。
我们在电子数据库中检索了关于社区或支持性护理环境中痴呆症患者LTC安置预测因素的纵向研究。我们使用随机效应模型对各种预测因素的风险比（HRs）进行荟萃分析，并根据几个研究变量对HRs进行分层。对荟萃分析中未包括的预测因素数据进行描述性总结。
对360篇论文进行了全文综述，37篇论文的数据用于计算特定痴呆症患者（年龄、性别、种族、婚姻状况、痴呆类型、居住安排及与照料者的关系）和照料者（年龄、性别及抑郁症状）特征的LTC安置汇总HRs。白人种族[HR = 1.67，95%置信区间（CI）：1.41 - 1.99]、痴呆严重程度更高（HR = 1.05，95% CI：1.03 - 1.06）及年龄更大（HR = 1.02，95% CI：1.01 - 1.03）会增加LTC安置风险。患有痴呆症的已婚者（HR = 0.38，95% CI：0.16 - 0.86）及与照料者同住（HR = 0.72，95% CI：0.56 - 0.92）风险较低。在我们的描述性综述中，痴呆的行为和心理症状、功能损害程度及照料者负担对LTC安置风险有一致影响。
我们量化了LTC安置的几个风险因素的预测作用。这些估计值可用于更精确地对机构化风险进行分类，并可能将高风险者与适当服务联系起来。版权所有© 2016约翰威立父子有限公司。
