Centre for Age-related Medicine, Stavanger University Hospital, Stavanger, Norway.
Centre for Old Age Psychiatry Research, Innlandet Hospital Trust, Brumunddal, Norway.
PLoS One. 2018 Sep 18;13(9):e0203480. doi: 10.1371/journal.pone.0203480. eCollection 2018.
Nursing home (NH) stay is the highest level of formal care. With the expected demographic changes ahead, the need for NH placement will put an increasing socioeconomic strain on the society. Survival in NHs and factors predicting survival are important knowledge in order to evaluate NH admission policies and plan future NH capacity.
We followed 690 NH residents included at admission to NH over a period of three years. Participants were examined at baseline (BL) and every six months. Demographic and clinical data were collected, including comorbidity, severity of cognitive impairment, dependency in activities of daily living (ADL) and neuropsychiatric symptoms. Median survival was calculated by the Kaplan-Meier analysis, and factors associated with mortality were identified by Cox models with baseline and time-dependent covariates.
Median survival in NH was 2.2 years (95% confidence interval [CI]: 1.9-2.4). Yearly mortality rate throughout the three-year observation period was 31.8%. Mortality was associated with higher age and comorbidity at BL, and more severe dementia, higher ADL-dependency, less severe psychotic symptoms, and a lower BMI throughout the study period. Of the organizational variables, living on a ward with more residents resulted in a higher risk of mortality.
In conclusion, the NH mortality rate remained stable throughout the three-year study period with about one third of the residents deceasing each year. Individual resident characteristics appeared to be more important than organizational variables for predicting mortality risk. The finding of an association between ward size and mortality risk deserves further investigation in future studies.
养老院（NH）入住是最高级别的正式护理。随着未来预期的人口结构变化，NH 入住的需求将给社会带来越来越大的社会经济压力。在 NH 中的生存和预测生存的因素是评估 NH 入院政策和规划未来 NH 能力的重要知识。
我们对在三年内入住 NH 的 690 名 NH 居民进行了随访。参与者在基线（BL）和每六个月进行检查。收集了人口统计学和临床数据，包括合并症、认知障碍严重程度、日常生活活动（ADL）依赖和神经精神症状。通过 Kaplan-Meier 分析计算中位生存期，并用 Cox 模型识别与死亡率相关的因素，该模型具有基线和时变协变量。
NH 的中位生存期为 2.2 年（95%置信区间 [CI]：1.9-2.4）。在三年观察期内，每年的死亡率为 31.8%。死亡率与 BL 时较高的年龄和合并症、更严重的痴呆症、更高的 ADL 依赖性、较轻的精神病症状以及整个研究期间较低的 BMI 相关。在组织变量中，居住在居民较多的病房会增加死亡风险。
总之，在三年的研究期间，NH 的死亡率保持稳定，每年约有三分之一的居民死亡。个人居民特征似乎比组织变量更能预测死亡风险。病房规模与死亡风险之间的关联值得在未来的研究中进一步调查。
