Harrison Jennifer Kirsty, Walesby Katherine E, Hamilton Lorna, Armstrong Carolyn, Starr John M, Reynish Emma L, MacLullich Alasdair M J, Quinn Terry J, Shenkin Susan D
Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK.
Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK.
Age Ageing. 2017 Jul 1;46(4):547-558. doi: 10.1093/ageing/afx047.
moving into long-term institutional care is a significant life event for any individual. Predictors of institutional care admission from community-dwellers and people with dementia have been described, but those from the acute hospital setting have not been systematically reviewed. Our aim was to establish predictive factors for discharge to institutional care following acute hospitalisation.
we registered and conducted a systematic review (PROSPERO: CRD42015023497). We searched MEDLINE; EMBASE and CINAHL Plus in September 2015. We included observational studies of patients admitted directly to long-term institutional care following acute hospitalisation where factors associated with institutionalisation were reported.
from 9,176 records, we included 23 studies (n = 354,985 participants). Studies were heterogeneous, with the proportions discharged to a care home 3-77% (median 15%). Eleven studies (n = 12,642), of moderate to low quality, were included in the quantitative synthesis. The need for institutional long-term care was associated with age (pooled odds ratio (OR) 1.02, 95% confidence intervals (CI): 1.00-1.04), female sex (pooled OR 1.41, 95% CI: 1.03-1.92), dementia (pooled OR 2.14, 95% CI: 1.24-3.70) and functional dependency (pooled OR 2.06, 95% CI: 1.58-2.69).
discharge to long-term institutional care following acute hospitalisation is common, but current data do not allow prediction of who will make this transition. Potentially important predictors evaluated in community cohorts have not been examined in hospitalised cohorts. Understanding these predictors could help identify individuals at risk early in their admission, and support them in this transition or potentially intervene to reduce their risk.
对于任何个人而言，入住长期机构护理都是一件重大的人生事件。已有研究描述了社区居民和痴呆患者入住机构护理的预测因素，但对于急性医院环境下的预测因素尚未进行系统综述。我们的目的是确定急性住院后转至机构护理的预测因素。
我们注册并进行了一项系统综述（国际前瞻性系统评价注册库：CRD42015023497）。2015年9月，我们检索了MEDLINE、EMBASE和CINAHL Plus数据库。我们纳入了关于急性住院后直接入住长期机构护理患者的观察性研究，这些研究报告了与机构化相关的因素。
从9176条记录中，我们纳入了23项研究（n = 354985名参与者）。研究具有异质性，转至养老院的比例为3% - 77%（中位数为15%）。11项质量中等至低的研究（n = 12642）纳入了定量综合分析。长期机构护理需求与年龄（合并比值比（OR）1.02，95%置信区间（CI）：1.00 - 1.04）、女性（合并OR 1.41，95% CI：1.03 - 1.92）、痴呆（合并OR 2.14，95% CI：1.24 - 3.70）和功能依赖（合并OR 2.06，95% CI：1.58 - 2.69）相关。
急性住院后转至长期机构护理很常见，但目前的数据无法预测谁会进行这种转变。在社区队列中评估的潜在重要预测因素尚未在住院队列中进行研究。了解这些预测因素有助于在入院早期识别有风险的个体，并在这种转变过程中为他们提供支持，或者可能进行干预以降低其风险。
