Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, 1Medical Center Blvd, Winston-Salem, NC, 27157, USA.
Department of Biostatistics and Data Science, School of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA.
BMC Geriatr. 2021 Oct 18;21(1):561. doi: 10.1186/s12877-021-02506-1.
Being homebound is independently associated with increased mortality but the homebound population is heterogeneous. In order to improve precision medicine, we analyzed potentially modifiable factors that contribute to homebound progression (from independent to needing assistance, to homebound), stratified by dementia status.
Using National Aging and Trends Survey (NHATS), a nationally-representative, longitudinal annual survey from 2011 to 2017 (n = 11,528), we categorized homebound progression if one transitioned from independent or needing assistance to homebound, including competing risks of institutionalization or death between 2011 and last year of data available for each unique respondent. Using proportional hazards regression, we calculated hazard ratios of potentially modifiable risk factors on homebound progression.
Depressive symptoms, mobility impairment, and pain increased risk of homebound progression regardless of dementia status. Social isolation increased risk of homebound progression only among those without dementia at baseline.
Future clinical care and research should focus on the treatment of depressive symptoms, mobility, and pain to potentially delay progression to homebound status.
居家受限与死亡率的增加独立相关，但居家受限人群存在异质性。为了提高精准医学水平，我们分析了可能导致居家受限进展（从独立到需要帮助，再到居家受限）的可修正因素，并按痴呆症状况进行了分层。
我们使用全国老龄化和趋势调查（NHATS），这是一项具有全国代表性的、纵向的年度调查，时间跨度为 2011 年至 2017 年（n=11528）。如果一个人从独立或需要帮助转变为居家受限，我们就将其归类为居家受限进展，包括在每个独特受访者的可用数据的最后一年期间，存在机构化或死亡的竞争风险。我们使用比例风险回归，计算了潜在可修正风险因素对居家受限进展的风险比。
无论是否存在痴呆症，抑郁症状、行动障碍和疼痛都会增加居家受限进展的风险。社会隔离仅在基线时没有痴呆症的人群中增加了居家受限进展的风险。
未来的临床护理和研究应侧重于治疗抑郁症状、行动能力和疼痛，以潜在地延缓向居家受限状态的进展。
