Schluter Philip J, Lacey Cameron, Porter Richard J, Jamieson Hamish A
School of Health Sciences, University of Canterbury - Te Whare Wānanga o Waitaha, Christchurch, New Zealand.
School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Australia.
Bipolar Disord. 2017 Aug;19(5):375-385. doi: 10.1111/bdi.12511. Epub 2017 Jul 5.
Research on bipolar disorder (BD) among community-living older adults is scant and often suffers from important methodological limitations. Using a national database, this study presents an epidemiological profile of BD in older community residents within New Zealand.
Since 2012, all New Zealand community care recipients have undergone a standardized needs assessment using the Home Care International Residential Assessment Instrument (interRAI-HC). The interRAI-HC elicits information using 236 questions over 20 domains, including BD diagnosis. Those who were assessed between 1 September 2012 and 31 January 2016, who were aged ≥65 years, and who provided consent were included. Statistical investigations employed bivariable and multivariable logistic regression models.
Overall, 71 859 people were eligible; their average age was 82.7 years (range 65-105 years), with 43 802 (61.0%) being female and 798 (1.1%) having a BD diagnosis. Participants' sex, age and ethnic identification were significantly related to BD (all P<.001). Participants with a higher number of comorbidities had greater odds of BD; for those with at least six comorbidities, the adjusted odds ratio (AOR) was 2.32 (95% confidence interval [CI] 1.37-3.92). Almost all considered social and environmental variables were significantly and detrimentally associated with BD, such as living in squalid conditions (2.7% for those with DB vs 1.1% for those without DB; AOR=1.60 [95% CI 1.06-2.42]).
BD among older adults is not uncommon, and numbers will increase as populations age. Increasingly, health services are moving to home-based integrated models of care. Clinicians and decision-makers need to be aware in their planning and service delivery that significant deficits in environment quality and exposure to stressful living circumstances remain for older adults with BD.
针对社区居住的老年人双相情感障碍（BD）的研究较少，且常常存在重要的方法学局限性。本研究利用一个全国性数据库，呈现了新西兰老年社区居民中BD的流行病学概况。
自2012年以来，所有新西兰社区护理接受者都使用国际家庭护理居住评估工具（interRAI-HC）进行了标准化需求评估。interRAI-HC通过20个领域的236个问题获取信息，包括BD诊断。纳入2012年9月1日至2016年1月31日期间接受评估、年龄≥65岁且提供了知情同意的人。统计调查采用双变量和多变量逻辑回归模型。
总体而言，71859人符合条件；他们的平均年龄为82.7岁（范围65 - 105岁），其中43802人（61.0%）为女性，798人（1.1%）被诊断为BD。参与者的性别、年龄和种族身份与BD显著相关（均P<0.001）。合并症数量较多的参与者患BD的几率更高；对于那些至少有六种合并症的人，调整后的优势比（AOR）为2.32（95%置信区间[CI] 1.37 - 3.92）。几乎所有考虑的社会和环境变量都与BD显著且不利相关，例如生活在肮脏环境中（患BD者为2.7%，未患BD者为1.1%；AOR = 1.60 [95% CI 1.06 - 2.42]）。
老年人中的BD并不罕见，且随着人口老龄化数量将会增加。卫生服务越来越多地转向以家庭为基础的综合护理模式。临床医生和决策者在规划和提供服务时需要意识到，患有BD的老年人在环境质量和面临压力性生活环境方面仍存在显著不足。
