Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.
BMC Geriatr. 2018 Oct 22;18(1):254. doi: 10.1186/s12877-018-0943-8.
Dementia and physical morbidity are primary reasons for nursing home admission globally. However, data on physical morbidity in nursing home residents with and without dementia are scarce. The first aim of the present study was to explore whether presence and severity of dementia were related to the number of physical diagnoses in nursing home residents. The second aim was to explore if the severity of dementia was associated with having registered the most frequent complexes of physical diagnoses when controlling for physical health and demographic factors.
A total of 2983 Norwegian nursing home residents from two cross-sectional samples from 2004/2005 and 2010/2011 were included in the analysis. By the use of assessment scales, the severity of dementia (Clinical Dementia Rating), physical health (General Medical Health Rating), activities of daily living (Physical Self-Maintenance Scale) and neuropsychiatric symptoms (Neuropsychiatric Inventory Nursing Home) were determined. Physical diagnoses and medications were assembled from the medical records. The physical diagnoses were categorized into complexes, using the ICD-10 chapters. Linear mixed models and generalized linear mixed models were estimated.
Residents with dementia were registered with fewer physical diagnoses than residents without dementia. The frequency of physical diagnoses decreased with increasing severity of dementia. Cardiovascular, musculoskeletal and endocrine, nutritional and metabolic diagnoses were the most common complexes of physical diagnoses in individuals with and without dementia. The odds of having cardiovascular and musculoskeletal diagnoses increased for males and decreased for females with increasing severity of dementia, in contrast to endocrine diagnoses where the odds increased for both genders.
Increasing severity of dementia in nursing home residents may complicate the diagnostics of physical disease. This might reflect a need for more attention to the registration of physical diagnoses in nursing home residents with dementia.
痴呆症和身体疾病是全球导致入住疗养院的主要原因。然而，关于痴呆症和非痴呆症疗养院居民身体疾病的数据却很少。本研究的首要目的是探讨痴呆症的存在和严重程度是否与疗养院居民的身体诊断数量有关。其次，我们还探讨了在控制身体健康和人口统计学因素的情况下，痴呆症的严重程度是否与最常见的身体诊断组合的登记有关。
本研究共纳入了来自 2004/2005 年和 2010/2011 年两个横断面样本的 2983 名挪威疗养院居民。通过使用评估量表，确定了痴呆症的严重程度（临床痴呆评定量表）、身体健康状况（一般医疗健康评定量表）、日常生活活动能力（身体自我维护量表）和神经精神症状（神经精神疾病护理院评定量表）。从病历中收集了身体诊断和药物治疗信息。使用 ICD-10 章节对身体诊断进行了分类，并构建了诊断组合。使用线性混合模型和广义线性混合模型进行了估计。
患有痴呆症的居民比没有痴呆症的居民登记的身体诊断更少。身体诊断的频率随着痴呆症严重程度的增加而降低。心血管、肌肉骨骼和内分泌、营养和代谢诊断是痴呆症和非痴呆症个体中最常见的身体诊断组合。与内分泌诊断相反，随着痴呆症严重程度的增加，男性出现心血管和肌肉骨骼诊断的几率增加，而女性则减少。
疗养院居民痴呆症严重程度的增加可能会使身体疾病的诊断复杂化。这可能反映出需要更加关注痴呆症疗养院居民身体诊断的登记。
