Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, Alabama.
Geriatric Research, Education and Clinical Center, Birmingham Veterans Affairs Medical Center, Birmingham, Alabama.
J Am Geriatr Soc. 2018 Jan;66(1):133-139. doi: 10.1111/jgs.15166. Epub 2017 Oct 26.
BACKGROUND/OBJECTIVES: Social support can prevent or delay long-term nursing home placement (NHP). The purpose of our study was to understand how the availability of a caregiver can affect NHP after ischemic stroke and how this affects different subgroups differently.
Nested cohort study.
Nationally based REasons for Geographic and Racial Differences in Stroke (REGARDS) study.
Stroke survivors aged 65 to 100 (256 men, 304 women).
Data were from Medicare claims from January 2003 to December 2013 and REGARDS baseline interviews conducted from January 2003 to October 2007. Caregiver support was measured by asking, "If you had a serious illness or became disabled, do you have someone who would be able to provide care for you on an on-going basis?" Diagnosis of ischemic stroke was derived from inpatient claims. NHP was determined using a validated claims algorithm for stays of 100 days and longer. Risk was estimated using Cox regression.
Within 5 years of stroke, 119 (21.3%) participants had been placed in a nursing home. Risk of NHP was greater in those lacking available caregivers (log-rank P = .006). After adjustment for covariates, lacking an available caregiver increased the risk of NHP after stroke within 1 year by 70% (hazard ratio (HR) = 1.70, 95% confidence interval (CI) = 0.97-2.99) and within 5 years by 68% (HR = 1.68, 95% CI = 1.10-2.58). The effect of caregiver availability on NHP within 5 years was limited to men (HR = 3.15, 95% CI = 1.49-6.67).
In men aged 65 and older who have survived an ischemic stroke, the lack of an available caregiver is associated with triple the risk of NHP within 5 years.
背景/目的：社会支持可以预防或延迟长期入住养老院（NHP）。我们研究的目的是了解照顾者的可用性如何影响缺血性中风后的 NHP，以及这如何对不同的亚组产生不同的影响。
嵌套队列研究。
基于全国的地理和种族差异中风原因（REGARDS）研究。
年龄在 65 至 100 岁的中风幸存者（256 名男性，304 名女性）。
数据来自 2003 年 1 月至 2013 年 12 月的医疗保险索赔和 2003 年 1 月至 2007 年 10 月进行的 REGARDS 基线访谈。照顾者支持通过询问“如果您患有严重疾病或残疾，您是否有人能够持续为您提供照顾？”来衡量。缺血性中风的诊断源自住院患者的索赔。通过经过验证的用于 100 天及以上住院的索赔算法确定养老院入住情况。使用 Cox 回归估计风险。
在中风后的 5 年内，有 119 名（21.3%）参与者被安置在养老院。缺乏可用照顾者的人发生 NHP 的风险更高（对数秩 P=0.006）。在调整了协变量后，缺乏可用照顾者会使中风后 1 年内 NHP 的风险增加 70%（风险比（HR）=1.70，95%置信区间（CI）=0.97-2.99），5 年内增加 68%（HR=1.68，95%CI=1.10-2.58）。照顾者可用性对 5 年内 NHP 的影响仅限于男性（HR=3.15，95%CI=1.49-6.67）。
在年龄在 65 岁及以上的男性中，如果有缺血性中风幸存者，缺乏可用的照顾者会使他们在 5 年内入住养老院的风险增加三倍。
