Bloomfield Katherine, Wu Zhenqiang, Broad Joanna B, Tatton Annie, Calvert Cheryl, Hikaka Joanna, Boyd Michal, Peri Kathy, Bramley Dale, Higgins Ann-Marie, Connolly Martin J
Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand.
Older Adults' Health, Waitematā District Health Board, Auckland, New Zealand.
J Am Geriatr Soc. 2022 Mar;70(3):754-765. doi: 10.1111/jgs.17602. Epub 2021 Dec 15.
To study healthcare utilization and trajectories, and associated factors, in older adults in retirement villages (RVs), also known as continuing care retirement communities.
Prospective cohort study of 578 cognitively intact residents from 34 RVs in Auckland, New Zealand (NZ).
InterRAI-Community Health Assessment (includes core items that may trigger functional supplement (FS) completion in those with higher needs, and generates clinical assessment protocols (CAPs) in those with potential unmet needs).
time to acute hospitalization, long-term care (LTC), and death during average 2.5 years follow-up.
Three hundred seven (53%) residents had acute hospitalizations, 65 (11%) moved to LTC, and 51 (9%) died over a mean of 2.5 years. Factors associated with increased risk of acute hospitalization included CAP-falls (high risk) triggered, number of comorbidities, not having left RV in 2 weeks prior, moderate/severe hearing impairment, CAP-cardiorespiratory conditions triggered, acute hospitalization in year prior and age, with significant hazard ratios (HR) ranging between 1.03 and 2.90. Factors associated with reduced risk of hospitalization included other (non-NZ) European ethnicity (HR 0.73, 95% CI 0.55-0.98, p = 0.04), presence of on-site clinic (HR 0.62, 95% CI 0.45-0.85, p = 0.003), no influenza vaccination (HR 0.56, 95% CI 0.38-0.83, p = 0.004). Factors associated with LTC transition included FS triggered (HR 3.84, 95% CI 1.92-7.66, p < 0.001), CAP-instrumental activities of daily living (IADL) (HR 2.62, 95% CI 1.22-5.62, p = 0.01), CAP-social relationship triggered (HR 2.00, 95% CI 1.13-3.55, p = 0.02), and age (HR 1.13, 95% CI 1.07-1.18 p < 0.001). Factors associated with mortality included number of comorbidities (HR 3.75, 95% CI 1.54-9.10, p = 0.004 for 3-5 comorbidities), CAP-IADL triggered (HR 3.05, 95% CI 1.30-7.16, p = 0.01), and age (HR 1.11, 95% CI 1.05-1.18, p < 0.001).
A large proportion of cognitively intact RV residents are admitted to hospital in mean 2.5 years of follow-up. Multiple factors were associated with acute hospitalization risk. On-site clinics were associated with reduced risk and should be considered in RV development.
研究退休村（RVs）（也称为持续照料退休社区）中老年人的医疗保健利用情况、轨迹及其相关因素。
对来自新西兰奥克兰34个退休村的578名认知功能完好的居民进行前瞻性队列研究。
InterRAI社区健康评估（包括可能促使高需求者完成功能补充（FS）的核心项目，并为潜在需求未得到满足者生成临床评估方案（CAPs））。
在平均2.5年的随访期间，307名（53%）居民发生急性住院，65名（11%）居民转入长期护理（LTC）机构，51名（9%）居民死亡。与急性住院风险增加相关的因素包括触发的CAP-跌倒（高风险）、合并症数量、在之前2周内未离开退休村、中度/重度听力障碍、触发的CAP-心肺疾病、前一年的急性住院情况以及年龄，显著风险比（HR）在1.03至2.90之间。与住院风险降低相关的因素包括其他（非新西兰）欧洲族裔（HR 0.73，95%置信区间0.55-0.98，p = 0.04）、设有现场诊所（HR 0.62，95%置信区间0.45-0.85，p = 0.003）、未接种流感疫苗（HR 0.56，95%置信区间0.38-0.83，p = 0.004）。与转入长期护理机构相关的因素包括触发的FS（HR 3.84，95%置信区间1.92-7.66，p < 0.001）、CAP-日常生活活动能力（IADL）（HR 2.62，95%置信区间1.22-5.62，p = 0.01）、触发的CAP-社会关系（HR 2.00，95%置信区间1.13-3.55，p = 0.02）以及年龄（HR 1.13，95%置信区间1.07-1.18，p < 0.001）。与死亡相关的因素包括合并症数量（3-5种合并症时，HR 3.75，95%置信区间1.54-9.10，p = 0.004）、触发的CAP-IADL（HR 3.05，95%置信区间1.30-7.16，p = 0.01）以及年龄（HR 1.11，95%置信区间1.05-1.18，p < 0.001）。
在平均2.5年的随访中，很大一部分认知功能完好的退休村居民入院治疗。多种因素与急性住院风险相关。现场诊所与较低风险相关，在退休村建设中应予以考虑。
