Nijsten Johanna M H, Leontjevas Ruslan, Pat-El Ron, Smalbrugge Martin, Koopmans Raymond T C M, Gerritsen Debby L
Archipel Landrijt, Knowledge Center for Specialized Care, Eindhoven, the Netherlands.
Department of Primary and Community Care, Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, the Netherlands.
J Am Geriatr Soc. 2017 Oct;65(10):2182-2189. doi: 10.1111/jgs.15007. Epub 2017 Aug 9.
To determine the prognostic value of apathy for mortality in patients of somatic (SC) and dementia special care (DSC) nursing home (NH) units.
Longitudinal design, secondary analyses of a 2-year, cluster-randomized trial with six measurements, approximately 4 months in between.
SC and DSC-units of Dutch NHs.
NH-patients of seventeen SC-units (n = 342) and sixteen DCS-units (n = 371).
Data were available for 713 NH-patients, 266 of whom died during the study. Apathy was assessed using the 10-item Apathy Evaluation Scale (AES-10) and applied as categorical variable using known cut-off scores as well as dimensional variable. Additionally, depressive symptoms were assessed using the Cornell Scale for Depression in Dementia.
Mixed effects cox models using the coxme package in R revealed a higher risk of mortality between two measurements, if apathy was present (hazard ratio (HR) = 1.77; 95% confidence interval (CI] = 1.35-2.31, P < .001). Results remained significant (HR = 1.64; 95% CI = 1.23-2.19, P < .001) when controlled for depressive symptoms. DSC-units and SC-units did not differ (P > .05) in the effect of apathy on mortality. Male gender (HR = 1.67; 95% CI = 1.23-2.27, P < .001), and higher age in years (HR = 1.06; 95% CI = 1.04-1.08, P < .001) were also predictors of mortality. Regarding apathy as a dimensional construct, one standard deviation increase of AES-10 scores was associated with a 62% increase of mortality risk (HR = 1.62, 95% CI = 1.40-1.88, P < .001).
Apathy was associated with mortality over a 4-month period in NH patients, even when controlling for depression. These data suggest that screening and treatment strategies for apathy should be developed for this patient population.
确定冷漠对躯体疾病（SC）护理院和痴呆症特殊护理（DSC）护理院患者死亡率的预后价值。
纵向设计，对一项为期2年的整群随机试验进行二次分析，共进行6次测量，间隔约4个月。
荷兰护理院的SC和DSC单元。
17个SC单元的护理院患者（n = 342）和16个DCS单元的护理院患者（n = 371）。
713名护理院患者的数据可用，其中266人在研究期间死亡。使用10项冷漠评估量表（AES - 10）评估冷漠，并将其作为分类变量，使用已知的临界值以及连续变量。此外，使用康奈尔痴呆抑郁量表评估抑郁症状。
使用R语言中的coxme包进行的混合效应cox模型显示，如果存在冷漠，两次测量之间的死亡风险更高（风险比（HR）= 1.77；95%置信区间（CI）= 1.35 - 2.31，P <.001）。在控制抑郁症状后，结果仍然显著（HR = 1.64；95% CI = 1.23 - 2.19，P <.001）。冷漠对死亡率的影响在DSC单元和SC单元之间没有差异（P >.05）。男性（HR = 1.67；95% CI = 1.23 - 2.27，P <.001）和年龄较大（HR = 1.06；95% CI = 1.04 - 1.08，P <.001）也是死亡的预测因素。将冷漠视为连续结构时，AES - 10评分每增加一个标准差，死亡风险增加62%（HR = 1.62，95% CI = 1.40 - 1.88，P <.001）。
即使在控制抑郁的情况下，冷漠与护理院患者4个月期间的死亡率相关。这些数据表明，应为该患者群体制定冷漠的筛查和治疗策略。
