Meinow Bettina, Kåreholt Ingemar, Thorslund Mats, Parker Marti G
Aging Research Center, Karolinska Institute & Stockholm University, Gävlegatan 16, 113 30 Stockholm, Sweden.
Institute of Gerontology, School of Health Sciences, Jönköping University, Jönköping, Sweden.
Eur J Ageing. 2015 Jul 23;12(4):285-297. doi: 10.1007/s10433-015-0351-2. eCollection 2015 Dec.
Studies of health trends in older populations usually focus on single health indicators. We include multiple medical and functional indicators, which together indicate the broader impact of health problems experienced by individuals and the need for integrated care from several providers of medical and long-term care. The study identified severe problems in three health domains (diseases/symptoms, mobility, and cognition/communication) in three nationally representative samples of the Swedish population aged 77+ in 1992, 2002, and 2011 ( ≈ 1900; response rate >85 %). Institutionalized people and proxy interviews were included. People with severe problems in two or three domains were considered to have complex health problems. Results showed a significant increase of older adults with complex health problems from 19 % in 1992 to 26 % in 2002 and no change thereafter. Changes over time remained when controlling for age and sex. When stratified by education, complex health problems increased significantly for people with lower education between 1992 and 2002 and did not change significantly between 2002 and 2011. For higher-educated people, there was no significant change over time. Among the people with severe problems in the symptoms/disease domain, about half had no severe problems in the other domains. People with severe mobility problems, on the other hand, were more likely to also have severe problems in other domains. Even stable rates may imply an increasing number of very old people with complex health problems, resulting in a need for improved coordination between providers of medical care and social services.
对老年人群健康趋势的研究通常聚焦于单一健康指标。我们纳入了多个医学和功能指标，这些指标共同表明了个体所经历的健康问题的更广泛影响，以及来自多个医疗和长期护理提供者的综合护理的必要性。该研究在1992年、2002年和2011年对瑞典77岁及以上具有全国代表性的三个样本（约1900人；回复率>85%）中，确定了三个健康领域（疾病/症状、行动能力和认知/沟通）存在的严重问题。纳入了机构养老人员和代理访谈。在两个或三个领域存在严重问题的人被认为有复杂的健康问题。结果显示，有复杂健康问题的老年人比例从1992年的19%显著增加到2002年的26%，此后没有变化。在控制年龄和性别后，随时间的变化依然存在。按教育程度分层时，1992年至2002年，受教育程度较低的人群中复杂健康问题显著增加，2002年至2011年没有显著变化。对于受过高等教育的人群，随时间没有显著变化。在症状/疾病领域存在严重问题的人群中，约一半在其他领域没有严重问题。另一方面，行动能力严重受限的人在其他领域也更有可能存在严重问题。即使比例稳定，也可能意味着有复杂健康问题的高龄老人数量在增加，这就需要改善医疗服务提供者和社会服务提供者之间的协调。
