Australian Institute of Health Innovation, Macquarie University, Macquarie Park, NSW, 2109, Australia.
Dementia Collaborative Research Centre - Assessment and Better Care, University of New South Wales, Sydney, Australia.
Osteoporos Int. 2019 Oct;30(10):1995-2008. doi: 10.1007/s00198-019-05096-2. Epub 2019 Jul 24.
This study identified group-based trajectories of hospitalisation for older adults who were living in residential aged care facilities (RACF) or the community for up to 4 years after an index fall injury hospitalisation. Greater than 3 subsequent fall injury hospitalisations and time until move to a RACF were key predictors of RACF and community-living trajectory group memberships, respectively.
To examine hospital service use trajectories of people aged ≥ 65 years who had a fall injury hospitalisation and were either living in a residential aged care facility (RACF) or the community at the time of the index fall and to identify factors predictive of their trajectory group membership.
A group-based trajectory analysis of hospitalisations of people aged ≥ 65 years who had a fall injury hospitalisation during 2008-2009 in New South Wales, Australia, was conducted. Linked hospitalisation and RACF data were examined for a 5-year period. Group-based trajectory models were derived based on number of subsequent hospital admissions following the index fall injury hospitalisation. Multinominal logistic regression examined predictors of trajectory group membership.
There were 24,729 fall injury hospitalisations; 78.8% of fallers were living in the community and 21.2% in a RACF. Five distinct trajectory groups were identified for community-living and four trajectory groups for RACF residents. Key predictors of trajectory group membership for both community-living and RACF residents were age group, number of comorbidities and dementia status. For RACF residents, depression, assistance with activities of daily living and number of subsequent fall injury admissions were also predictors of group membership, with time to move to a RACF a predictor of group membership for community living.
Identifying trajectories of ongoing hospital use informs targeting of strategies to reduce hospital admissions and design of services to allow community-living individuals to remain as long as possible within their own residence.
本研究确定了在索引跌倒损伤住院后长达 4 年的时间内，居住在养老院（RACF）或社区的老年人住院的基于群体的轨迹。随后超过 3 次跌倒损伤住院和搬入 RACF 的时间分别是 RACF 和社区居住轨迹群体成员资格的关键预测指标。
检查年龄在 65 岁以上的人因跌倒受伤住院的住院服务使用轨迹，这些人在索引跌倒时要么居住在养老院（RACF），要么居住在社区，并确定其轨迹群体成员资格的预测因素。
对 2008-2009 年在澳大利亚新南威尔士州因跌倒受伤住院的年龄在 65 岁以上的人进行了基于群体的住院轨迹分析。对索引跌倒损伤住院后 5 年内的住院和养老院数据进行了关联。基于索引跌倒损伤住院后随后的住院次数，得出了基于群体的轨迹模型。多变量逻辑回归检查了轨迹群体成员资格的预测因素。
有 24729 例跌倒损伤住院治疗；78.8%的跌倒者居住在社区，21.2%居住在养老院。为居住在社区的人群确定了 5 个不同的轨迹群体，为居住在养老院的人群确定了 4 个轨迹群体。社区居住和养老院居住者轨迹群体成员资格的主要预测因素是年龄组、合并症数量和痴呆症状况。对于养老院居民，抑郁、日常生活活动的协助和随后跌倒损伤住院的次数也是群体成员资格的预测因素，搬入养老院的时间是社区居住群体成员资格的预测因素。
确定持续住院使用的轨迹为减少住院人数的策略提供了信息，并为设计服务提供了信息，以使社区居住的人尽可能长时间地留在自己的住所。
