Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia.
Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia; Dementia Centre for Research Collaboration, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.
J Am Med Dir Assoc. 2020 Jun;21(6):843-850.e5. doi: 10.1016/j.jamda.2019.11.023. Epub 2020 Feb 1.
To assess the impact of home care on length-of-stay within residential care.
A retrospective observational data-linkage study.
In total there were 3151 participants from the 45 and Up Study in New South Wales, Australia with dementia who entered residential care between 2010 and 2014.
Survey data collected from 2006‒2009 were linked to administrative data for 2006‒2016. The highest level of home care a person accessed prior to residential care was defined as no home care, home support, low-level home care, and high-level home care. Multinomial logistic regression and Cox proportional hazards were used to investigate differences in activities of daily living, behavioral, and complex healthcare scales at entering residential care; and length-of-stay in residential care.
People with prior high-level home care entered residential care needing higher assistance compared with the no home care group: activities of daily living [odds ratio (OR) 3.41, 95% confidence interval (CI) 2.14‒5.44], behavior (OR 2.61, 95% CI 1.69‒4.03), and complex healthcare (OR 2.02, 95% CI 1.06‒3.84). They had a higher death rate, meaning shorter length-of-stay in residential care (<2 years after entry: hazard ratio 1.12; 95% CI 0.89‒1.42; 2-4 years: hazard ratio 1.49; 95% CI 1.01‒2.21). Those using low-level home care were less likely to enter residential care needing high assistance compared to the no home care group (activities of daily living: OR 0.61, 95% CI 0.45‒0.81; behavioral: OR 0.72, 95% CI 0.54‒0.95; complex healthcare: OR 0.51, 95% CI 0.33‒0.77). There was no difference between the home support and no home care groups.
High-level home care prior to residential care may help those with dementia stay at home for longer, but the low-level care group entered residential care at low assistance levels, possibly signaling lack of informal care and barriers in accessing higher-level home care.
Better transition options from low-level home care, including more timely availability of high-level care packages, may help people with dementia remain at home longer.
评估家庭护理对养老院入住时间的影响。
回顾性观察性数据链接研究。
共有 3151 名来自澳大利亚新南威尔士州 45 岁及以上研究的患有痴呆症的参与者，他们在 2010 年至 2014 年间进入养老院。
2006 年至 2009 年收集的调查数据与 2006 年至 2016 年的行政数据相链接。在进入养老院之前，一个人获得的最高级别家庭护理被定义为没有家庭护理、家庭支持、低级别家庭护理和高级别家庭护理。使用多项逻辑回归和 Cox 比例风险模型来研究进入养老院时日常生活活动、行为和复杂医疗护理量表的差异；以及养老院的入住时间。
与无家庭护理组相比，之前接受过高水平家庭护理的人进入养老院时需要更高的帮助：日常生活活动（优势比 3.41，95%置信区间 2.14-5.44）、行为（优势比 2.61，95%置信区间 1.69-4.03）和复杂医疗护理（优势比 2.02，95%置信区间 1.06-3.84）。他们的死亡率更高，这意味着他们在养老院的入住时间更短（入住后<2 年：风险比 1.12；95%置信区间 0.89-1.42；2-4 年：风险比 1.49；95%置信区间 1.01-2.21）。与无家庭护理组相比，使用低级别家庭护理的人进入养老院时需要高等级帮助的可能性较低（日常生活活动：优势比 0.61，95%置信区间 0.45-0.81；行为：优势比 0.72，95%置信区间 0.54-0.95；复杂医疗护理：优势比 0.51，95%置信区间 0.33-0.77）。家庭支持组与无家庭护理组之间没有差异。
养老院入住前的高级家庭护理可能有助于痴呆症患者在家中生活更长时间，但低级别护理组进入养老院时的帮助水平较低，这可能表明缺乏非正式护理和获得高级家庭护理的障碍。
更好的从低级别家庭护理过渡的选择，包括更及时地提供高级护理套餐，可能有助于痴呆症患者更长时间地留在家里。
