Clinical and Research Memory Centre of Lyon (CMRR), Geriatrics Unit, Lyon Institute for Elderly, Hospices civils de Lyon, Lyon, France.
Clinical and Research Memory Centre of Lyon (CMRR), Geriatrics Unit, Lyon Institute for Elderly, Hospices civils de Lyon, Lyon, France.
J Am Med Dir Assoc. 2019 Oct;20(10):1254-1262. doi: 10.1016/j.jamda.2019.03.027. Epub 2019 May 17.
To estimate the attributable fraction of nursing home placement associated with cognitive impairment, neuropsychiatric symptoms, behavioral disorders, functional limitations, and caregiver burden.
Longitudinal study conducted on the "MEMORA cohort" linked with both regional public health insurance and hospital discharge databases.
Memory center at the University Hospital of Lyon, France.
A sample of 2456 outpatients attending the memory center between 2012 and 2017.
Cognitive impairment, functional limitations, neuropsychiatric symptoms/behavioral disorders, and caregiver burden were measured with the Mini-Mental State Examination, the Instrumental Activities of Daily Living scale, the Neuropsychiatric Inventory (NPI), and a short version of the Zarit Burden Inventory, respectively. Sociodemographics characteristics were collected during the first visit. Comorbidities were gathered from the hospital discharge database. Dates of nursing home placement were obtained from the public health insurance database.
More than 38% of nursing home placements were attributable to caregiver burden, and the attributable fraction associated with functional limitations exceeded 35%. Between 20% and 25% of nursing home placements were due to cognitive impairment whereas less than 16% were attributable to neuropsychiatric symptoms or behavioral disorders. The associations between anxiety or agitation and nursing home placement were mediated by caregiver burden. Apathy or aberrant motor behaviors were associated with a higher risk of nursing home placement independently of caregiver burden.
CONCLUSIONS/IMPLICATIONS: Our findings suggest that a high proportion of nursing home placements are attributable to caregiver burden and functional limitations in outpatients attending a memory center. Cognitive impairment and neuropsychiatric symptoms or behavioral disorders contribute less to nursing home placements. Interventions directed to delay nursing home placement should emphasize actions toward reducing caregiver burden and functional limitations of patients.
评估认知障碍、神经精神症状、行为障碍、功能限制和照顾者负担与养老院安置相关的归因分数。
对“MEMORA 队列”进行的纵向研究，该队列与区域公共健康保险和医院出院数据库相关联。
法国里昂大学医院记忆中心。
2012 年至 2017 年间参加记忆中心的 2456 名门诊患者样本。
使用 Mini-Mental State Examination、Instrumental Activities of Daily Living 量表、Neuropsychiatric Inventory（NPI）和 Zarit 负担量表的简短版本分别测量认知障碍、功能限制、神经精神症状/行为障碍和照顾者负担。社会人口统计学特征在第一次就诊时收集。合并症从医院出院数据库中收集。养老院安置日期从公共健康保险数据库中获得。
超过 38%的养老院安置归因于照顾者负担，与功能限制相关的归因分数超过 35%。认知障碍导致的养老院安置比例在 20%至 25%之间，而神经精神症状或行为障碍导致的养老院安置比例不到 16%。焦虑或激越与养老院安置之间的关联是通过照顾者负担介导的。冷漠或异常运动行为与养老院安置的风险增加独立相关，而与照顾者负担无关。
结论/意义：我们的研究结果表明，在参加记忆中心的门诊患者中，很大一部分养老院安置归因于照顾者负担和功能限制。认知障碍和神经精神症状或行为障碍对养老院安置的贡献较小。旨在延迟养老院安置的干预措施应强调采取行动减轻患者的照顾者负担和功能限制。
