Godin Judith, Theou Olga, Black Karen, McNeil Shelly A, Andrew Melissa K
Division of Geriatric Medicine, Nova Scotia Health Authority, Dalhousie University, 5955 Veterans' Memorial Lane, Halifax, NS B3H 2E1, Canada.
Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS B3H 4R2, Canada.
Healthcare (Basel). 2019 Jul 15;7(3):91. doi: 10.3390/healthcare7030091.
We sought to understand the association between social vulnerability and the odds of long-term care (LTC) placement within 30 days of discharge following admission to an acute care facility and whether this association varied based on age, sex, or pre-admission frailty. Patients admitted to hospital with acute respiratory illness were enrolled in the Canadian Immunization Research Network's Serious Outcomes Surveillance Network during the 2011/2012 influenza season. Participants (N = 475) were 65 years or older (mean = 78.6, SD = 7.9) and over half were women (58.9%). Incident LTC placement was rare (N = 15); therefore, we used penalized likelihood logistic regression analysis. Social vulnerability and frailty indices were built using a deficit accumulation approach. Social vulnerability interacted with frailty and age, but not sex. At age 70, higher social vulnerability was associated with lower odds of LTC placement at high levels of frailty (frailty index (FI) = 0.35; odds ratio (OR) = 0.32, 95% confidence interval (CI) = 0.09-0.94), but not at lower levels of frailty. At age 90, higher social vulnerability was associated with greater odds of LTC placement at lower levels of frailty (FI = 0.05; OR = 14.64, 95%CI = 1.55, 127.21 and FI = 0.15; OR = 7.26, 95%CI = 1.06, 41.84), but not at higher levels of frailty. Various sensitivity analyses yielded similar results. Although younger, frailer participants may need LTC, they may not have anyone advocating for them. In older, healthier patients, social vulnerability was associated with increased odds of LTC placement, but there was no difference among those who were frailer, suggesting that at a certain age and frailty level, LTC placement is difficult to avoid even within supportive social situations.
我们试图了解社会脆弱性与急性护理机构入院后30天内长期护理（LTC）安置几率之间的关联，以及这种关联是否因年龄、性别或入院前虚弱程度而异。在2011/2012流感季节，因急性呼吸道疾病入院的患者被纳入加拿大免疫研究网络的严重后果监测网络。参与者（N = 475）年龄在65岁及以上（平均 = 78.6，标准差 = 7.9），超过一半为女性（58.9%）。LTC安置事件很少见（N = 15）；因此，我们使用了惩罚似然逻辑回归分析。社会脆弱性和虚弱指数采用缺陷累积法构建。社会脆弱性与虚弱和年龄相互作用，但与性别无关。在70岁时，较高的社会脆弱性与高虚弱水平下LTC安置几率较低相关（虚弱指数（FI） = 0.35；优势比（OR） = 0.32，95%置信区间（CI） = 0.09 - 0.94），但在低虚弱水平下并非如此。在90岁时，较高的社会脆弱性与低虚弱水平下LTC安置几率较高相关（FI = 0.05；OR = 14.64，95%CI = 1.55，127.21和FI = 0.15；OR = 7.26，95%CI = 1.06，41.84），但在高虚弱水平下并非如此。各种敏感性分析得出了相似的结果。虽然年轻、虚弱的参与者可能需要LTC，但可能没有人替他们争取。在年龄较大、健康状况较好的患者中，社会脆弱性与LTC安置几率增加相关，但在更虚弱的患者中没有差异，这表明在一定年龄和虚弱水平下，即使在支持性社会环境中，LTC安置也难以避免。
