Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY.
Health Services, Policy & Practice, Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, RI.
J Am Med Dir Assoc. 2019 Apr;20(4):497-502. doi: 10.1016/j.jamda.2019.01.126. Epub 2019 Mar 4.
OBJECTIVE(S): To examine the change in physical functional status among persons living with HIV (PLWH) in nursing homes (NHs) and how change varies with age and dementia.
Retrospective cohort study.
NHs in 14 states in the United States.
PLWH who were admitted to NHs between 2001 and 2010 and had stays of ≥90 days (N = 3550).
We linked Medicaid Analytic eXtract (MAX) and Minimum Data Set (MDS) data for NH residents in the sampled states and years and used them to determine HIV infection. The main outcome was improvement in physical functional status, defined as a decrease of at least 4 points in the activities of daily living (ADL) score within 90 days of NH admission. Independent variables of interest were age and dementia (Alzheimer's disease or other dementia). Multivariate logistic regression was used, adjusting for individual-level covariates.
The average age on NH admission of PLWH was 58. Dementia prevalence ranged from 14.5% in the youngest age group (age <40 years) to 38.9% in the oldest group (age ≥70 years). Overall, 44% of the PLWH experienced ADL improvement in NHs. Controlling for covariates, dementia was related to a significantly lower likelihood of ADL improvement among PLWH in the oldest age group only: the adjusted probability of improvement was 40.6% among those without dementia and 29.3% among those with dementia (P < .01).
CONCLUSIONS/RELEVANCE: PLWH, especially younger persons, may be able to improve their ADL function after being admitted into NHs. However, with older age, PLWH with dementia are more physically dependent and vulnerable to deterioration of physical functioning in NHs. More and/or specialized care may be needed to maintain physical functioning among this population. Findings from this study provide NHs with information on care needs of PLWH and inform future research on developing interventions to improve care for PLWH in NHs.
研究养老院（NH）中 HIV 感染者（PLWH）的身体功能状态变化，以及这种变化如何随年龄和痴呆症而变化。
回顾性队列研究。
美国 14 个州的 NH。
2001 年至 2010 年间入住 NH 且住院时间≥90 天的 PLWH（N=3550）。
我们将样本州和年份的 Medicaid Analytic eXtract（MAX）和最小数据集中 NH 居民的数据进行链接，并使用这些数据来确定 HIV 感染情况。主要结果是身体功能状态的改善，定义为 NH 入院后 90 天内日常生活活动（ADL）评分至少下降 4 分。感兴趣的自变量为年龄和痴呆症（阿尔茨海默病或其他痴呆症）。采用多变量逻辑回归，调整个体水平的协变量。
PLWH 入住 NH 时的平均年龄为 58 岁。痴呆症的患病率在年龄最小的组（<40 岁）为 14.5%，在年龄最大的组（≥70 岁）为 38.9%。总体而言，44%的 PLWH 在 NH 中 ADL 得到改善。在控制协变量的情况下，痴呆症与 PLWH 中年龄最大组 ADL 改善的可能性显著降低有关：无痴呆症者的调整后改善概率为 40.6%，痴呆症者为 29.3%（P<.01）。
结论/相关性：PLWH，尤其是较年轻者，在入住 NH 后可能能够改善其 ADL 功能。然而，随着年龄的增长，患有痴呆症的 PLWH 身体依赖性更强，更容易在 NH 中身体功能恶化。可能需要更多和/或专门的护理来维持这一人群的身体功能。这项研究的结果为 NH 提供了有关 PLWH 护理需求的信息，并为未来研究开发改善 NH 中 PLWH 护理的干预措施提供了信息。
