Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr. 110, 70376, Stuttgart, Germany.
BMC Geriatr. 2020 Oct 31;20(1):439. doi: 10.1186/s12877-020-01847-7.
A growing number of older people are care dependent and live in nursing homes, which accounts for the majority of long-term-care spending. Specific medical conditions and resident characteristics may serve as risk factors predicting negative health outcomes. We investigated the association between the risk of increasing care need and chronic medical conditions among nursing home residents, allowing for the competing risk of mortality.
In this retrospective longitudinal study based on health insurance claims data, we investigated 20,485 older adults (≥65 years) admitted to German nursing homes between April 2007 and March 2014 with care need level 1 or 2 (according to the three level classification of the German long-term care insurance). This classification is based on required daily time needed for assistance. The outcome was care level change. Medical conditions were determined according to 31 Charlson and Elixhauser conditions. Competing risks analyses were applied to identify chronic medical conditions associated with risk of care level change and mortality.
The probability for care level change and mortality acted in opposite directions. Dementia was associated with increased probability of care level change compared to other conditions. Patients who had cancer, myocardial infarction, congestive heart failure, cardiac arrhythmias, renal failure, chronic pulmonary disease, weight loss, or recent hospitalization were more likely to die, as well as residents with paralysis and obesity when admitted with care level 2.
This paper identified risk groups of nursing home residents which are particularly prone to increasing care need or mortality. This enables focusing on these risk group to offer prevention or special treatment. Moreover, residents seemed to follow specific trajectories depending on their medical conditions. Some were more prone to increased care need while others had a high risk of mortality instead. Several conditions were neither related to increased care need nor mortality, e.g., valvular, cerebrovascular or liver disease, peripheral vascular disorder, blood loss anemia, depression, drug abuse and psychosis. Knowledge of functional status trajectories of residents over time after nursing home admission can help decision-makers when planning and preparing future care provision strategies (e.g., planning of staffing, physical equipment and financial resources).
越来越多的老年人需要护理，并且居住在养老院中，这占据了大部分长期护理的支出。特定的医疗条件和居民特征可能是预测健康结果不良的风险因素。我们研究了养老院居民中护理需求增加的风险与慢性医疗条件之间的关系，同时考虑了死亡的竞争风险。
在这项基于健康保险索赔数据的回顾性纵向研究中，我们调查了 20485 名年龄在 65 岁及以上、2007 年 4 月至 2014 年 3 月期间入住德国养老院、护理需求水平为 1 或 2 级（根据德国长期护理保险的三级分类）的老年人。该分类基于所需的日常帮助时间。结果是护理水平的变化。医疗条件根据 31 项 Charlson 和 Elixhauser 条件确定。应用竞争风险分析来确定与护理水平变化和死亡率相关的慢性医疗条件。
护理水平变化和死亡率的概率作用方向相反。与其他条件相比，痴呆与增加护理水平变化的概率相关。患有癌症、心肌梗死、充血性心力衰竭、心律失常、肾衰竭、慢性肺病、体重减轻或近期住院的患者更有可能死亡，入院时护理水平为 2 级的居民还伴有瘫痪和肥胖。
本文确定了养老院居民中特别容易增加护理需求或死亡率的风险群体。这使我们能够关注这些风险群体，提供预防或特殊治疗。此外，居民似乎根据他们的医疗条件遵循特定的轨迹。一些人更容易增加护理需求，而另一些人则面临更高的死亡风险。有些条件既与增加护理需求无关，也与死亡率无关，例如瓣膜、脑血管或肝脏疾病、周围血管疾病、失血贫血、抑郁、药物滥用和精神病。了解居民在入住养老院后随时间推移的功能状态轨迹，可以帮助决策者在规划和准备未来的护理提供策略时（例如，规划人员配备、物理设备和财务资源）。
