Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.
Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.
J Am Geriatr Soc. 2020 Nov;68(11):2643-2649. doi: 10.1111/jgs.16772. Epub 2020 Aug 15.
BACKGROUND/OBJECTIVES: Despite high prevalence of behavioral health (BH) manifestations among nursing home (NH) residents, availability of BH services in this care setting is often inadequate. Our objective was to examine associations between availability of BH services and the presence of severe depression, suicidal ideation (SI), and severe aggressive behaviors (ABs) among NH residents.
Cross-sectional.
SETTING/PARTICIPANTS: This study used 2017 survey data about BH service availability obtained from 1,051 NHs. The Minimum Data Set (MDS) was used to identify long-stay residents in these facilities (N = 101,238) and the prevalence of BH manifestations. Descriptive statistics and multivariable logistic regressions were used.
We constructed measures of three severe BH manifestations based on the MDS: presence of depression, SI, and ABs. Three independent measures of service availability based on survey items asked about degrees of inadequate (1) staff BH education, (2) coordination/collaboration between facility/community providers, and (3) facility infrastructure (ie, ability to make referrals/transport residents to services).
Odds of severe depression were 21% higher (odds ratio [OR] = 1.21; P < .001) when NHs reported inadequate BH staff education. Residents with SI had 13% higher odds (OR = 1.13; P = .027) of living in NHs that reported inadequate coordination between facility and community providers. Severe ABs were 10% more likely among residents in NHs reporting inadequate facility infrastructure (OR = 1.10; P = .002) and 7% more likely in facilities with self-reported inadequate coordination between facility/community providers (OR = 1.07; P = .019). Several facility-level factors (eg, staffing, training, turnover) were also statistically significantly associated with these severe BH manifestations.
Residents in NHs reporting inadequate BH services were more likely to experience adverse severe BH manifestations even after controlling for individual and facility-level risk factors. Higher nurse staffing and more staff psychiatric training were associated with lower prevalence of severe BH manifestations. Policy changes and modifications to Medicaid NH reimbursements may be warranted to better incentivize NHs to improve provision of BH services.
背景/目的：尽管养老院（NH）居民中行为健康（BH）表现的患病率很高，但这种护理环境中 BH 服务的提供往往不足。我们的目的是研究 BH 服务的提供与 NH 居民中严重抑郁、自杀意念（SI）和严重攻击行为（ABs）的存在之间的关联。
横断面研究。
地点/参与者：本研究使用了 2017 年从 1051 家 NH 获得的关于 BH 服务可用性的调查数据。最小数据集（MDS）用于识别这些设施中的长期居住者（N=101238）和 BH 表现的患病率。使用描述性统计和多变量逻辑回归进行分析。
我们根据 MDS 构建了三种严重 BH 表现的测量指标：抑郁、SI 和 ABs 的存在。基于调查项目询问了三种独立的服务可用性测量指标：（1）员工 BH 教育程度不足，（2）设施/社区提供者之间的协调/合作程度不足，以及（3）设施基础设施（即，向服务机构转介/运输居民的能力）。
当 NH 报告 BH 员工教育不足时，严重抑郁的可能性增加 21%（比值比 [OR] = 1.21；P<.001）。报告设施和社区提供者之间协调不足的 NH 中，有 SI 的居民的可能性增加 13%（OR = 1.13；P=.027）。报告设施基础设施不足的 NH 中，严重 ABs 的可能性增加 10%（OR = 1.10；P=.002），报告设施/社区提供者之间自我报告协调不足的 NH 中，严重 ABs 的可能性增加 7%（OR = 1.07；P=.019）。一些设施层面的因素（例如，人员配备、培训、人员流动）也与这些严重 BH 表现显著相关。
即使控制了个人和设施层面的风险因素，报告 BH 服务不足的 NH 居民更有可能经历不良的严重 BH 表现。更高的护士配备和更多的员工精神科培训与较低的严重 BH 表现患病率相关。可能需要对医疗保险 NH 报销政策进行修改，以更好地激励 NH 改善 BH 服务的提供。
