Institute of Medical Sociology, Charité-Universitätsmedizin, Berlin, Germany.
ZQP-Center for Quality in Care, Berlin, Germany.
J Am Med Dir Assoc. 2018 Jun;19(6):535-540.e1. doi: 10.1016/j.jamda.2018.02.010. Epub 2018 Apr 13.
A large proportion of the oldest old and centenarians live in long-term care facilities. Although there may be distinct care patterns in centenarians compared with other cohorts of oldest old, the exact development concerning prevalence, length of stay, and factors that are associated with long-term care status in the last years before death is unknown.
Longitudinal analyses of health insurance data across 6 years before death.
In all, 1398 institutionalized and noninstitutionalized oldest old [deceased at 80-89 (octogenarians), 90-99 (nonagenarians), or over 100 years of age (centenarians)] from Germany were included. Long-term care status and transition from home care into long-term care over 6 years (34,740 person-quarters).
Dementia, musculoskeletal diseases, multimorbidity, hospital admission, gender, and age at death were derived from administrative data and analyzed using binary generalized estimating equations.
Although the initial level of long-term care (6 years before death) was higher among centenarians (65.1% vs 53.6% in nonagenarians; 36.2% in octogenarians), the rate of increase was stronger in the younger cohorts. Distinguishing between long-term care escapers, delayers, and survivors, the proportion of those who escaped, delayed, or survived the entire 6 years of observation in long-term care was 33.4%/40.4%/26.2% in centenarians, 45.0%/45.1%/9.9% in nonagenarians, and 62.7%/33.7%/3.6% in octogenarians. Age, hospital admissions, and dementia were positively associated with being in long-term care, whereas musculoskeletal disorders were negatively associated with long-term care. The association with dementia was significantly weaker in centenarians.
For centenarians, although they are more often in long-term care, the transition rate to long-term care progressed more slowly than the rates of the younger comparison cohorts of oldest old. The high proportion of long stays of centenarians in long-term care facilities require different concepts of long-term care.
很大一部分最年长的老年人和百岁老人居住在长期护理机构中。尽管百岁老人与其他最年长老年人群体相比可能存在明显的护理模式，但在去世前的最后几年中，有关长期护理状态的流行率、持续时间以及与长期护理状态相关的因素的确切发展情况尚不清楚。
在去世前 6 年的健康保险数据进行纵向分析。
共纳入了来自德国的 1398 名居住在机构中和非机构中的最年长老年人（80-89 岁为 80 岁组，90-99 岁为 90 岁组，100 岁以上为 100 岁组）。在 6 年（34740 人/季）期间，评估了长期护理状态和从家庭护理转为长期护理的情况。
从行政数据中提取痴呆症、肌肉骨骼疾病、多种合并症、住院、性别和死亡年龄，并使用二元广义估计方程进行分析。
尽管百岁老人的初始长期护理水平较高（6 年前为 65.1%，90 岁组为 53.6%，80 岁组为 36.2%），但年轻组的增长率更高。在区分长期护理逃脱者、延迟者和幸存者时，百岁老人组中在整个 6 年观察期内逃脱、延迟或幸存于长期护理的比例分别为 33.4%/40.4%/26.2%，90 岁组分别为 45.0%/45.1%/9.9%，80 岁组分别为 62.7%/33.7%/3.6%。年龄、住院和痴呆与长期护理呈正相关，而肌肉骨骼疾病与长期护理呈负相关。百岁老人痴呆症与长期护理的相关性明显较弱。
对于百岁老人，尽管他们更经常处于长期护理中，但他们向长期护理的过渡率比其他最年长老年人的年轻比较队列的过渡率进展更缓慢。百岁老人在长期护理机构中长时间逗留的高比例需要不同的长期护理概念。
