Emerson Jane A, Smith Carin Y, Long Kirsten H, Ransom Jeanine E, Roberts Rosebud O, Hass Steven L, Duhig Amy M, Petersen Ronald C, Leibson Cynthia L
Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.
K Long Health Economics Consulting LLC, St. Paul, Minnesota.
J Am Geriatr Soc. 2017 Oct;65(10):2235-2243. doi: 10.1111/jgs.15022. Epub 2017 Sep 11.
BACKGROUND/OBJECTIVES: Objective, complete estimates of nursing home (NH) use across the spectrum of cognitive decline are needed to help predict future care needs and inform economic models constructed to assess interventions to reduce care needs.
Retrospective longitudinal study.
Olmsted County, MN.
Mayo Clinic Study of Aging participants assessed as cognitively normal (CN), mild cognitive impairment (MCI), previously unrecognized dementia, or prevalent dementia (age = 70-89 years; N = 3,545).
Participants were followed in Centers for Medicare and Medicaid Services (CMS) Minimum Data Set (MDS) NH records and in Rochester Epidemiology Project provider-linked medical records for 1-year after assessment of cognition for days of observation, NH use (yes/no), NH days, NH days/days of observation, and mortality.
In the year after cognition was assessed, for persons categorized as CN, MCI, previously unrecognized dementia, and prevalent dementia respectively, the percentages who died were 1.0%, 2.6%, 4.2%, 21%; the percentages with any NH use were 3.8%, 8.7%, 19%, 40%; for persons with any NH use, median NH days were 27, 38, 120, 305, and median percentages of NH days/days of observation were 7.8%, 12%, 33%, 100%. The year after assessment, among persons with prevalent dementia and any NH use, >50% were a NH resident all days of observation. Pairwise comparisons revealed that each increase in cognitive impairment category exhibited significantly higher proportions with any NH use. One-year mortality was especially high for persons with prevalent dementia and any NH use (30% vs 13% for those with no NH use); 58% of all deaths among persons with prevalent dementia occurred while a NH resident.
Findings suggest reductions in NH use could result from quality alternatives to NH admission, both among persons with MCI and persons with dementia, together with suitable options for end-of-life care among persons with prevalent dementia.
背景/目的：需要对认知功能衰退各阶段的养老院（NH）使用情况进行客观、全面的评估，以帮助预测未来的护理需求，并为构建用于评估减少护理需求干预措施的经济模型提供依据。
回顾性纵向研究。
明尼苏达州奥尔姆斯特德县。
梅奥诊所衰老研究中被评估为认知正常（CN）、轻度认知障碍（MCI）、既往未识别的痴呆症或现患痴呆症的参与者（年龄 = 70 - 89岁；N = 3545）。
在认知评估后的1年里，对参与者进行医疗保险和医疗补助服务中心（CMS）最小数据集（MDS）养老院记录以及罗切斯特流行病学项目与医疗机构相关的医疗记录的跟踪，记录观察天数、养老院使用情况（是/否）、养老院居住天数、养老院居住天数/观察天数以及死亡率。
在认知评估后的一年中，分别被归类为CN、MCI、既往未识别的痴呆症和现患痴呆症的人群中，死亡百分比分别为1.0%、2.6%、4.2%、21%；使用过任何养老院服务的百分比分别为3.8%、8.7%、19%、40%；对于使用过任何养老院服务的人群，养老院居住天数中位数分别为27天、38天、120天、305天，养老院居住天数/观察天数的中位数百分比分别为7.8%、12%、33%、100%。评估后的一年中，在现患痴呆症且使用过任何养老院服务的人群中，超过50%在所有观察日都是养老院居民。两两比较显示，认知障碍类别每增加一级，使用过任何养老院服务的比例就显著更高。对于现患痴呆症且使用过任何养老院服务的人群，1年死亡率特别高（使用过养老院服务的人群为30%，未使用过的人群为13%）；现患痴呆症人群中58%的死亡发生在养老院居民期间。
研究结果表明，对于MCI患者和痴呆症患者，减少养老院使用可能源于替代养老院入院的优质选择，以及为现患痴呆症患者提供合适的临终关怀选择。
