Rokstad Anne Marie Mork, Engedal Knut, Kirkevold Øyvind, Benth Jūratė Šaltytė, Selbæk Geir
Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Postbox 2136, 3103, Tønsberg, Norway.
Faculty of Health Sciences and Social care, Molde University College, Molde, Norway.
BMC Health Serv Res. 2018 Nov 16;18(1):864. doi: 10.1186/s12913-018-3686-5.
Day care services offer meaningful activities, a safe environment for attendees and respite for family caregivers while being expected to delay the need for nursing home (NH) admission. However, previous research has shown inconsistent results regarding postponement of NH admission. The objective of the study was to explore the influence of a day care programme designed for home-dwelling people with dementia on NH admission.
A quasi-experimental trial explored the proportion of patients permanently admitted to nursing homes after 24 months as the main outcome by comparing a group of day care attendees (DG) and a group of participants without day care (CG). In all, 257 participants were included (181 in DG and 76 in CG). A logistic regression model was developed with NH admission as the outcome. Participant group (DG or CG) was the main predictor, baseline patient and family caregiver characteristics and interactions were used as covariates.
The mean age of participants was 81.5 (SD 6.4), 65% were women and 53% lived alone. The mean MMSE score was 20.4 (SD 3.5). In all, 128 (50%) of the participants were admitted to a nursing home by the 24-month follow-up, 63 participants (25%) completed the follow-up assessment and 66 (26%) dropped out due to death (8%) and other reasons (18%). In the logistic unadjusted regression model for NH admission after 24 months, participant group (DG or CG) was not found to be a significant predictor of NH admission. The results from the adjusted model revealed that the participant group was associated with NH admission through the interactions with age, living conditions, affective symptoms, sleep symptoms and practical functioning, showing a higher probability for NH admission in DG compared to CG.
The study reveals no evidence to confirm that day care services designed for people with dementia postpone the need for NH admission. Admission to nursing homes seems to be based on a complex mix of personal and functional characteristics both in the person with dementia and the family caregivers. The findings should be considered in accordance with the limitation of inadequate power and the high drop-out rate.
The study is registered in Clinical Trials ( NCT01943071 ).
日托服务为参与者提供了有意义的活动、安全的环境，并为家庭护理人员提供了喘息机会，同时期望能延缓入住养老院（NH）的需求。然而，先前的研究表明，在延缓入住养老院方面，结果并不一致。本研究的目的是探讨为居家痴呆患者设计的日托项目对入住养老院的影响。
一项准实验性试验通过比较一组日托参与者（DG）和一组未参加日托的参与者（CG），将24个月后永久入住养老院的患者比例作为主要结果进行研究。总共纳入了257名参与者（DG组181名，CG组76名）。以入住养老院作为结果建立了逻辑回归模型。参与者组（DG或CG）是主要预测因素，基线患者和家庭护理人员的特征及相互作用用作协变量。
参与者的平均年龄为81.5岁（标准差6.4），65%为女性，53%独自生活。平均简易精神状态检查表（MMSE）评分为20.4（标准差3.5）。到24个月随访时，共有128名（50%）参与者入住了养老院，63名（25%）参与者完成了随访评估，66名（26%）因死亡（8%）和其他原因（18%）退出。在24个月后入住养老院的逻辑未调整回归模型中，未发现参与者组（DG或CG）是入住养老院的显著预测因素。调整模型的结果显示，参与者组通过与年龄、生活条件、情感症状、睡眠症状和实际功能的相互作用与入住养老院相关，表明DG组入住养老院的可能性高于CG组。
该研究没有证据证实为痴呆患者设计的日托服务能延缓入住养老院的需求。入住养老院似乎基于痴呆患者及其家庭护理人员个人和功能特征的复杂组合。应结合研究效能不足和高退出率的局限性来考虑这些研究结果。
该研究已在临床试验注册库注册（NCT01943071）。
