Division of Geriatrics and Gerontology, Department of Medicine, University of California San Diego School of Medicine, La Jolla, CA, 92093, USA.
Bureau of Alcohol and Drug Use Prevention, Care, and Treatment, New York City Department of Health and Mental Hygiene, 42-09 28th Street, 19th Floor, Queens, NY, 11101, USA.
Harm Reduct J. 2020 Dec 10;17(1):99. doi: 10.1186/s12954-020-00450-8.
Recent research shows an increase in drug and alcohol-related hospitalizations in the USA, especially among older adults. However, no study examines trends in discharges to a skilled nursing facility (SNF) after a drug or alcohol-related hospitalization. Older adults are more likely to need post-hospital care in a SNF after a hospitalization due to an increased presence of chronic diseases and functional limitations. Therefore, the objective of this study was to estimate trends in drug or alcohol-related hospitalizations with discharge to a SNF among adults age 55 and older.
We analyzed data from New York State's Statewide Planning and Research Cooperative System to calculate the number of cannabis, cocaine, opioid, and alcohol-related hospitalizations in New York City that resulted in discharge to a SNF from 2008 to 2014 among adults age 55 and older. Using New York City population estimates modified from US Census Bureau, we calculated age-specific rates per 100,000 adults. Trend tests were estimated using joinpoint regressions to calculate annual percentage change (APC) with 95% confidence intervals (CI) and stratified by adults age 55-64 and adults age 65 and older.
During the study period, among adults age 55-64, there were significant increases in cocaine, cannabis, and opioid-related hospitalizations that resulted in discharge to a SNF. For adults ≥ 65 years, there were sharp increases across all substances with larger increases in opioids (APC of 10.66%) compared to adults 55-64 (APC of 6.49%). For both age groups and among the four substances, alcohol-related hospitalizations were the leading cause of discharge to a SNF.
We found an increase in hospital discharges to SNFs for patients age 55 and older admitted with alcohol or drug-related diagnoses. Post-acute and long-term care settings should prepare to care for an increase in older patients with substance use disorders by integrating a range of harm reduction interventions into their care settings.
最近的研究表明，美国与药物和酒精相关的住院治疗有所增加，尤其是在老年人中。然而，尚无研究专门探讨与药物或酒精相关的住院治疗后，患者被转至专门护理机构（SNF）的出院趋势。由于慢性病和功能限制的增加，老年人在住院治疗后更有可能需要在 SNF 接受后续护理。因此，本研究的目的是评估 55 岁及以上成年人中，与药物或酒精相关的住院治疗并转至 SNF 的出院趋势。
我们分析了纽约州全州规划和研究合作系统的数据，以计算 2008 年至 2014 年期间，55 岁及以上成年人中因与药物或酒精相关的住院治疗而转至 SNF 的大麻、可卡因、阿片类药物和酒精相关住院治疗的数量。利用美国人口普查局修正的纽约市人口估计数，我们计算了每 10 万成年人中特定年龄组的发病率。使用 Joinpoint 回归估计趋势检验，计算年度百分比变化（APC）及其 95%置信区间（CI），并按 55-64 岁和 65 岁及以上的成年人进行分层。
在研究期间，55-64 岁成年人中可卡因、大麻和阿片类药物相关的住院治疗导致 SNF 转院的人数明显增加。对于 65 岁及以上的成年人，所有物质的急剧增加，与 55-64 岁成年人相比（APC 为 6.49%），阿片类药物的增加幅度更大（APC 为 10.66%）。对于两个年龄组和四种物质，酒精相关的住院治疗是导致 SNF 转院的主要原因。
我们发现，55 岁及以上因酒精或药物相关诊断而住院的患者，被转至 SNF 的人数有所增加。急性后期和长期护理机构应通过将一系列减少伤害的干预措施纳入其护理环境，为患有物质使用障碍的老年患者人数增加做好准备。
