按人类免疫缺陷病毒状况划分的养老院居民：特征、痴呆诊断和抗精神病药物使用。
Nursing Home Residents by Human Immunodeficiency Virus Status: Characteristics, Dementia Diagnoses, and Antipsychotic Use.
机构信息
Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island.
Department of Public Health Sciences, School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, New York.
出版信息
J Am Geriatr Soc. 2019 Jul;67(7):1353-1360. doi: 10.1111/jgs.15949. Epub 2019 May 7.
OBJECTIVES
Given an aging human immunodeficiency virus (HIV) population, we aimed to determine the prevalence of HIV for long-stay residents in US nursing homes (NHs) between 2001 and 2010 and to compare characteristics and diagnoses of HIV-positive (HIV+) and negative (HIV-) residents. Also, for residents with dementia diagnoses, we compared antipsychotic (APS) medication receipt by HIV status.
DESIGN
A cross-sectional comparative study.
SETTING
NHs in the 14 states accounting for 75% of persons living with HIV.
PARTICIPANTS
A total of 9 245 009 long-stay NH residents.
MEASUREMENTS
Using Medicaid fee-for-service claims data in the years 2001 to 2010, together with Medicare resident assessment and Chronic Condition Warehouse data, we identified long-stay (more than 89 days) NH residents by HIV status and dementia presence. We examined dementia presence by age groups and APS medication receipt by younger (aged younger than 65 years) vs older (aged 65 years or older) residents, using logistic regression.
RESULTS
Between 2001 and 2010, the prevalence of long-stay residents with HIV in NHs increased from 0.7% to 1.2%, a 71% increase. Long-stay residents with HIV were younger and less often female or white. For younger NH residents, rates of dementia were 20% and 16% for HIV+ and HIV- residents, respectively; they were 53% and 57%, respectively, for older residents. In adjusted analyses, younger HIV+ residents with dementia had greater odds of APS medication receipt than did HIV- residents (AOR = 1.3; 95% confidence interval [CI] = 1.2-1.4), but older HIV residents had lower odds (AOR = 0.9; 95% CI = 0.8-0.9).
CONCLUSION
The prevalence of long-stay HIV+ NH residents has increased over time, and given the rapid aging of the HIV population, this increase is likely to have continued. This study raises concern about potential differential quality of care for (younger) residents with HIV in NHs, but not for those aged 65 years and older. These findings contribute to the evidence base needed to ensure high-quality care for younger and older HIV+ residents in NHs.
目的
鉴于艾滋病毒（HIV）感染者老龄化，我们旨在确定 2001 年至 2010 年美国养老院（NH）中长期居住者 HIV 的流行率，并比较 HIV 阳性（HIV+）和阴性（HIV-）居民的特征和诊断。此外，对于痴呆症诊断的居民，我们比较了 HIV 状态下抗精神病药物（APS）的使用情况。
设计
一项横断面比较研究。
地点
占 HIV 感染者 75%的 14 个州的 NH。
参与者
共 9245009 名长期 NH 居民。
测量
使用 2001 年至 2010 年 Medicaid 按服务收费数据，以及 Medicare 居民评估和慢性疾病仓库数据，我们根据 HIV 状态和痴呆症的存在确定了长期（超过 89 天）NH 居民。我们通过年龄组检查痴呆症的存在，并通过逻辑回归检查年龄较小（年龄小于 65 岁）和年龄较大（年龄大于等于 65 岁）居民中 APS 药物的使用情况。
结果
2001 年至 2010 年间，NH 中 HIV 长期居住者的比例从 0.7%增加到 1.2%，增长了 71%。NH 中 HIV 长期居住者年龄较小，女性和白人的比例较低。对于年龄较小的 NH 居民，HIV+和 HIV-居民的痴呆症发生率分别为 20%和 16%；对于年龄较大的居民，分别为 53%和 57%。在调整后的分析中，患有痴呆症的年轻 HIV+居民接受 APS 药物治疗的可能性是 HIV-居民的 1.3 倍（95%置信区间[CI]为 1.2-1.4），但老年 HIV 患者的可能性较小（OR = 0.9；95%CI = 0.8-0.9）。
结论
长期居住的 HIV+NH 居民的比例随着时间的推移而增加，鉴于 HIV 人群的快速老龄化，这种增加可能仍在继续。这项研究引起了人们对 NH 中（年轻）HIV 感染者潜在护理质量差异的关注，但对年龄在 65 岁及以上的患者没有关注。这些发现为确保 NH 中年轻和年长 HIV+居民获得高质量护理提供了必要的证据基础。
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