Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Faculty of Medicine, Lund University, Lund, Sweden.
Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden.
J Intellect Disabil Res. 2019 Jun;63(6):593-602. doi: 10.1111/jir.12601. Epub 2019 Feb 8.
Older people with intellectual disability have high multimorbidity and poor physical and mental health compared with the general population. Consequently, they have a greater need for health care. Hospital readmissions may be an indicator of the quality of health care. However, so far, only a few studies have investigated this outcome in populations of people with intellectual disability. None has focused on older people.
We identified a cohort of people with intellectual disability aged 55+ years and alive at the end of 2012 (n = 7936). Moreover, we established a reference cohort from the general population, one-to-one matched by sex and year of birth. Data on hospital visits during the period 2002-2012 were collected from the Swedish National Patient Register. Readmissions were defined as unplanned visits with the same diagnosis occurring within 30 days of discharge and with no planned visit for the same diagnosis during this time.
Compared with the general population, people with intellectual disability had increased risk of readmissions for diseases of the nervous system [relative risk (RR) 2.62], respiratory system (RR 1.48), digestive system (RR 1.40) and musculoskeletal system and connective tissue (RR 2.10). Within these diagnostic groups, increased risks were found for arthropathies (RR 3.73), disorders of gallbladder, biliary tract and pancreas (RR 1.78), other diseases of intestines (RR 1.30), and other forms of heart disease (RR 1.23). Decreased risk of readmissions was found for mental and behavioural disorders (RR 0.78) and diseases of the circulatory system (RR 0.64).
The increased risk for readmissions related to diseases of the nervous and musculoskeletal systems has a clear relation to the prevalence of comorbidities in these areas. People with intellectual disability often also have inborn limitations and damages in these systems which with time lead to complications and risk for diseases, which can be difficult to discover. The increased risk for readmissions for disease of the respiratory system, together with the already known increased prevalence of such diagnoses and their occurrence as a cause for death, warrants further investigations and considerations of potential preventive measures. The pattern of readmissions among older people with intellectual disability cannot be explained solely by a higher prevalence of disorders in this group. Our finding of increased risks for readmissions for diseases in the digestive system could be interpreted as communication problems, which sometimes result in too rapid discharges and their consequential early readmissions.
与一般人群相比，老年智障人士的多病共存率较高，身心健康状况较差。因此，他们对医疗保健的需求更大。住院再入院可能是医疗质量的一个指标。然而，到目前为止，只有少数研究调查了智障人群的这一结果。没有研究关注老年人。
我们确定了一个年龄在 55 岁及以上且在 2012 年底仍在世的智障人士队列（n=7936）。此外，我们还从一般人群中建立了一个参考队列，通过性别和出生年份进行一对一匹配。2002 年至 2012 年期间的住院就诊数据从瑞典国家患者登记处收集。再入院定义为出院后 30 天内以相同诊断计划外就诊，且在此期间无相同诊断的计划就诊。
与一般人群相比，智障人士因神经系统疾病（相对风险 2.62）、呼吸系统疾病（相对风险 1.48）、消化系统疾病（相对风险 1.40）和肌肉骨骼系统及结缔组织疾病（相对风险 2.10）再入院的风险增加。在这些诊断组中，发现关节炎（相对风险 3.73）、胆囊、胆道和胰腺疾病（相对风险 1.78）、其他肠道疾病（相对风险 1.30）和其他形式心脏病（相对风险 1.23）的风险增加。精神和行为障碍（相对风险 0.78）以及循环系统疾病（相对风险 0.64）的再入院风险降低。
与神经系统和肌肉骨骼系统疾病相关的再入院风险增加，与这些领域的共病患病率有明确关系。智障人士通常在这些系统中也存在先天的局限性和损伤，随着时间的推移，这些系统会导致并发症和患病风险，这可能难以发现。呼吸系统疾病再入院风险增加，加上已知此类诊断的患病率增加以及此类诊断作为死亡原因的出现，需要进一步调查和考虑潜在的预防措施。智障老年人的再入院模式不能仅用该人群中疾病的更高患病率来解释。我们发现消化系统疾病的再入院风险增加，这可能可以解释为沟通问题，有时导致出院过快，随后早期再入院。
