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随着时间的推移,居家受限的动态变化:对 2012-2018 年 Medicare 受益人的前瞻性研究。

The dynamics of being homebound over time: A prospective study of Medicare beneficiaries, 2012-2018.

机构信息

Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine, New York, New York, USA.

The Center for Transformative Geriatric Research, Division of Geriatric Medicine and Gerontology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.

出版信息

J Am Geriatr Soc. 2021 Jun;69(6):1609-1616. doi: 10.1111/jgs.17086. Epub 2021 Mar 8.

Abstract

BACKGROUND/OBJECTIVES: Approximately 2 million people, or 6% of older adults in the United States, are homebound. In cross-sectional studies, homebound older adults have high levels of morbidity and mortality, but there is little evidence of longitudinal outcomes after becoming homebound. The aim of this research is to prospectively assess over 6 years the dynamics of homebound status, ongoing community residence, and death in a population of community-dwelling older adults who are newly homebound.

DESIGN/SETTING: Prospective cohort study using 2011-2018 data from the National Health and Aging Trends Study (NHATS), an annual, nationally-representative longitudinal study of aging in the United States.

PARTICIPANTS

Two hundred and sixty seven newly homebound older adults in 2012.

MEASUREMENTS

Homebound status was defined via self-report as living in the community but rarely/never leaving home in the prior month. Semi-homebound was defined as leaving the house only with difficulty or help.

RESULTS

One year after becoming newly homebound, 33.1% remained homebound, 22.8% were completely independent, 23.8% were semi-homebound, 2.2% were in a nursing home, and 18.0% died. Homebound status is highly dynamic; 6 years after becoming homebound, 13.5% remained homebound and 65.0% had died. Recovering from being homebound at 1 year was associated with younger age and lower baseline rates of receiving help with activities of daily living, in particular, with bathing.

CONCLUSION

Homebound status is a dynamic state. Even if transient, becoming homebound is strongly associated with functional decline and death. Identifying newly homebound older adults and developing interventions to mitigate associated negative consequences needs to be prioritized.

摘要

背景/目的:大约有 200 万人,即美国 6%的老年人,行动不便。在横断面研究中,行动不便的老年人发病率和死亡率较高,但关于他们成为行动不便后长期结果的证据很少。本研究的目的是前瞻性评估新出现行动不便的社区居住的老年人群中,6 年以上行动不便状态、持续社区居住和死亡的动态变化。

设计/设置:这是一项使用 2011-2018 年美国国家健康老龄化趋势研究(NHATS)的前瞻性队列研究,这是一项年度的、具有全国代表性的美国老龄化纵向研究。

参与者

2012 年的 267 名新出现行动不便的老年人。

测量

通过自我报告定义行动不便状态,即生活在社区中,但在前一个月很少/从未离开家。半行动不便定义为仅在困难或帮助下离开家。

结果

在新出现行动不便后一年,33.1%的人仍然行动不便,22.8%的人完全独立,23.8%的人半行动不便,2.2%的人在养老院,18.0%的人死亡。行动不便状态是高度动态的;在出现行动不便后 6 年,13.5%的人仍然行动不便,65.0%的人已经死亡。在 1 年时从行动不便中恢复与年龄较小和较低的基线日常生活活动(尤其是洗澡)自理能力有关。

结论

行动不便状态是一种动态状态。即使是短暂的,行动不便也与功能下降和死亡密切相关。需要优先确定新出现行动不便的老年人,并制定干预措施来减轻相关的负面后果。

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