Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
J Am Med Dir Assoc. 2021 Oct;22(10):2184-2189.e1. doi: 10.1016/j.jamda.2020.12.040. Epub 2021 Feb 6.
The aim was to evaluate patterns of multimorbidity that increase the risk of institutionalization in older persons, also exploring the potential buffering effect of formal and informal care.
Prospective cohort study.
The population-based Swedish National study on Aging and Care in Kungsholmen, Stockholm, Sweden.
In total, 2571 community-dwelling older adults were grouped at baseline according to their underlying multimorbidity patterns, using a fuzzy c-means cluster algorithm, and followed up for 6 years to test the association between multimorbidity patterns and institutionalization.
Six patterns of multimorbidity were identified: psychiatric diseases; cardiovascular diseases, anemia, and dementia; metabolic and sleep disorders; sensory impairments and cancer; musculoskeletal, respiratory, and gastrointestinal diseases; and an unspecific pattern including diseases of which none were overrepresented. In total, 110 (4.3%) participants were institutionalized during the follow-up, ranging from 1.7% in the metabolic and sleep disorders pattern to 8.4% in the cardiovascular diseases, anemia, and dementia pattern. Compared with the unspecific pattern, only the cardiovascular diseases, anemia, dementia pattern was significantly associated with institutionalization [relative risk ratio (RRR) = 2.23; 95% confidence interval (CI) 1.07‒4.65)], after adjusting for demographic characteristics and disability status at baseline. In stratified analyses, those not receiving formal care in the psychiatric diseases pattern (RRR 3.34; 95% CI 1.20‒9.32) and those not receiving formal or informal care in the 'cardiovascular diseases, anemia, dementia' pattern (RRR 2.99; 95% CI 1.20‒7.46; RRR 2.79; 95% CI 1.16‒6.71, respectively) had increased risks of institutionalization.
Older persons suffering from specific multimorbidity patterns have a higher risk of institutionalization, especially if they lack formal or informal care. Interventions aimed at preventing the clustering of diseases could reduce the associated burden on residential long-term care. Formal and informal care provision may be effective strategies in reducing the risk of institutionalization.
评估增加老年人机构化风险的多种疾病模式，并探讨正规和非正规护理的潜在缓冲作用。
前瞻性队列研究。
基于人群的瑞典斯德哥尔摩 Kungsholmen 老龄化和护理全国研究，瑞典。
共 2571 名居住在社区的老年人在基线时根据其潜在的多种疾病模式进行分组，使用模糊 c 均值聚类算法，随访 6 年，以检验多种疾病模式与机构化之间的关联。
确定了六种多种疾病模式：精神疾病；心血管疾病、贫血和痴呆；代谢和睡眠障碍；感觉障碍和癌症；肌肉骨骼、呼吸和胃肠道疾病；以及一种非特异性模式，其中没有一种疾病占主导地位。在随访期间，共有 110 名（4.3%）参与者被机构化，从代谢和睡眠障碍模式的 1.7%到心血管疾病、贫血和痴呆模式的 8.4%不等。与非特异性模式相比，只有心血管疾病、贫血和痴呆模式与机构化显著相关[相对风险比（RRR）=2.23；95%置信区间（CI）1.07-4.65]，在调整了基线时的人口统计学特征和残疾状况后。在分层分析中，在精神疾病模式中未接受正规护理的人群（RRR 3.34；95%CI 1.20-9.32）和在“心血管疾病、贫血、痴呆”模式中未接受正规或非正规护理的人群（RRR 2.99；95%CI 1.20-7.46；RRR 2.79；95%CI 1.16-6.71）机构化的风险增加。
患有特定多种疾病模式的老年人机构化风险更高，尤其是在缺乏正规或非正规护理的情况下。旨在预防疾病聚集的干预措施可能会降低与居住长期护理相关的负担。正规和非正规护理的提供可能是降低机构化风险的有效策略。
