Van Ness Peter H, MacNeil Vroomen Janet, Leo-Summers Linda, Vander Wyk Brent, Allore Heather G
Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.
Department of Internal Medicine, Section of Geriatric Medicine, Academic University Medical Center, Amsterdam, The Netherlands.
Innov Aging. 2019 Jul 2;3(2):igz018. doi: 10.1093/geroni/igz018. eCollection 2019 May.
To assess whether medically supportive care partners modify the associations of symptomatic chronic conditions with the number of functional disabilities in a cohort of multimorbid older adults with cognitive impairment.
The research design is a prospective study of a nationally representative cohort of Medicare beneficiaries. National Health and Aging Trends Study (NHATS) data were linked with Medicare claims for years 2011-2015. Participants were aged 65 or older and had cognitive impairment with at least 2 chronic conditions ( = 1,003). Annual in-person interviews obtained sociodemographic information at baseline and time-varying variables for caregiving, hospitalization, and 6 activities of daily living (ADL); these variables were merged with Center for Medicare and Medicaid Services data to ascertain 16 time-varying chronic conditions. A care partner was defined as a person who sat with their care recipient during doctor visits in the past year and/or who helped them with prescribed medications in the last month. Chronic condition associations and their potential effect modifications by care partner status were assessed using weighted generalized estimating equations accounting for the complex survey design of the longitudinal analytical sample.
Chronic kidney disease, depression, and heart failure were associated with an increased number of functional disabilities. Among these, only the association of chronic kidney disease with the number of functional disabilities (interaction value = .001) was weakened by the presence of a care partner.
The presence of care partners showed limited modification of the associations of symptomatic chronic conditions with functional disability.
评估在患有认知障碍的多病共存老年人群体中，医疗支持护理伙伴是否会改变症状性慢性病与功能残疾数量之间的关联。
本研究设计为对具有全国代表性的医疗保险受益人群体进行的前瞻性研究。将国家健康与老龄化趋势研究（NHATS）数据与2011 - 2015年的医疗保险索赔数据相链接。参与者年龄在65岁及以上，患有认知障碍且至少患2种慢性病（n = 1003）。每年进行的面对面访谈在基线时获取社会人口学信息以及关于护理、住院和6项日常生活活动（ADL）的随时间变化的变量；这些变量与医疗保险和医疗补助服务中心的数据合并，以确定16种随时间变化的慢性病。护理伙伴定义为在过去一年中在医生就诊时与护理对象坐在一起和/或在过去一个月中帮助他们服用处方药的人。使用加权广义估计方程评估慢性病关联及其因护理伙伴状态而产生的潜在效应修正，该方程考虑了纵向分析样本的复杂调查设计。
慢性肾病、抑郁症和心力衰竭与功能残疾数量增加相关。其中，只有慢性肾病与功能残疾数量之间的关联（交互作用p值 = 0.001）因护理伙伴的存在而减弱。
护理伙伴的存在对症状性慢性病与功能残疾之间关联的改变作用有限。
