Branch L G, Wetle T T, Scherr P A, Cook N R, Evans D A, Hebert L E, Masland E N, Keough M E, Taylor J O
Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Am J Public Health. 1988 Mar;78(3):255-9. doi: 10.2105/ajph.78.3.255.
This prospective study directly examines, in a defined community population, the extent to which a wide array of characteristics predict utilization of an important long-term care (LTC) service--medical home care--over a two-year interval among the cohort of 3,706 people aged 65 or older. The overall age-sex adjusted rate of two-year incident home care use was 3.2 per cent. For both men and women, the rates among the aged 85 or older group were approximately 12 times the rates of those aged 65 to 74. The multivariate predictors of incident home care, adjusted for age and sex, were five: receiving help with at least one activity of daily living (ADL), being dependent in Rosow-Breslau functional health areas, being homebound, more errors in mental status items, and no involvement with social groups. The dominance of indicators of frailty in physical function and cognitive function are consistent with the predictors of another group of LTC clients, those who subsequently enter nursing homes. However, in the present study the ratios of medical home care use were similar for those living alone and for those living with others in the multivariate model, suggesting the possibility of differences between home care and institutional LTC clients.
这项前瞻性研究在一个特定的社区人群中，直接考察了一系列特征在两年时间间隔内对3706名65岁及以上人群队列中一项重要的长期护理（LTC）服务——医疗居家护理——使用情况的预测程度。两年期间家庭护理新使用者的总体年龄性别调整率为3.2%。对于男性和女性来说，85岁及以上年龄组的使用率大约是65至74岁年龄组使用率的12倍。经年龄和性别调整后，家庭护理新使用者的多变量预测因素有五个：在至少一项日常生活活动（ADL）方面接受帮助、在罗索-布雷斯劳功能健康领域存在依赖、居家不出、精神状态项目存在更多错误以及未参与社会群体活动。身体功能和认知功能方面虚弱指标的主导地位与另一组长期护理客户（即随后进入养老院的客户）的预测因素一致。然而，在本研究中，多变量模型中独居者和与他人同住者的医疗居家护理使用率相似，这表明居家护理客户和机构长期护理客户之间可能存在差异。
