Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway.
Centre for Old Age Psychiatry Research, Innlandet Hospital Trust, Ottestad, Norway.
Int J Geriatr Psychiatry. 2019 Feb;34(2):337-351. doi: 10.1002/gps.5026. Epub 2018 Dec 10.
To evaluate the trend in the use of direct care in a cohort of nursing home (NH) residents and explore its association with resident characteristics and organizational factors.
METHODS/DESIGN: A total of 696 NH residents from 47 Norwegian NHs were included at admissions at NH. In 537 residents, the use of direct care was assessed every 6 months over a course of 3 years. A multiple model was estimated to identify demographic, clinical, and organizational characteristics associated with the use of direct care time.
Six months after admission, on average, 76.2 hours of direct care were rendered to each resident per month, while this number was reduced to 50.3 hours per month at the end of the study period. Most residents (92%) showed a stable use of direct care time, while a small group of residents displayed a much higher and varying use of direct care time. Increasing dementia, neuropsychiatric symptoms, and decreasing function in activities of daily living were associated with higher use of direct care time. Direct care time constituted about 50% of the staff's working time.
In Norwegian NHs, high use of direct care time was associated with younger age, more severe dementia, and severe neuropsychiatric symptoms. By identifying factors that impact on direct care time, preventive measures might be put in place to the benefit of the residents and possibly to improve resource use. Further research should explore the association between direct care time, quality of care, and the residents' quality of life.
评估护理院（NH）居民队列中直接护理的使用趋势，并探讨其与居民特征和组织因素的关系。
方法/设计：共有 696 名来自挪威 47 家 NH 的居民在 NH 入住时被纳入。在 537 名居民中，在 3 年的时间里，每 6 个月评估一次直接护理的使用情况。采用多模型来确定与直接护理时间使用相关的人口统计学、临床和组织特征。
入住后 6 个月，平均每位居民每月接受 76.2 小时的直接护理，而在研究结束时，这一数字减少到每月 50.3 小时。大多数居民（92%）的直接护理时间使用稳定，而一小部分居民的直接护理时间使用则高得多且变化不定。痴呆、神经精神症状的增加和日常生活活动功能的下降与直接护理时间的增加有关。直接护理时间约占员工工作时间的 50%。
在挪威 NH 中，直接护理时间的大量使用与年龄较小、痴呆程度更严重和严重的神经精神症状有关。通过识别影响直接护理时间的因素，可以采取预防措施，使居民受益，并可能改善资源利用。进一步的研究应探讨直接护理时间、护理质量和居民生活质量之间的关联。
