Yuan Yiyang, Lapane Kate L, Tjia Jennifer, Baek Jonggyu, Liu Shao-Hsien, Ulbricht Christine M
Clinical and Population Health Research PhD Program, Graduate School of Biomedical Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA.
Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA.
BMC Geriatr. 2022 Apr 19;22(1):339. doi: 10.1186/s12877-022-03012-8.
U.S. nursing homes provide long-term care to over 1.2 million older adults, 60% of whom were physically frail and 68% had moderate or severe cognitive impairment. Limited research has examined the longitudinal experience of these two conditions in older nursing home residents.
This national longitudinal study included newly-admitted non-skilled nursing care older residents who had Minimum Data Set (MDS) 3.0 (2014-16) assessments at admission, 3 months, and 6 months (n = 266,001). Physical frailty was measured by FRAIL-NH and cognitive impairment by the Brief Interview for Mental Status. Separate sets of group-based trajectory models were fitted to identify the trajectories of physical frailty and trajectories of cognitive impairment, and to estimate the association between older residents' characteristics at admission with each set of trajectories. A dual trajectory model was used to quantify the association between the physical frailty trajectories and cognitive impairment trajectories.
Over the course of the first six months post-admission, five physical frailty trajectories ["Consistently Frail" (prevalence: 53.0%), "Consistently Pre-frail" (29.0%), "Worsening Frailty" (7.6%), "Improving Frailty" (5.5%), and "Consistently Robust" (4.8%)] and three cognitive impairment trajectories ["Consistently Severe Cognitive Impairment" (35.5%), "Consistently Moderate Cognitive Impairment" (31.8%), "Consistently Intact/Mild Cognitive Impairment" (32.7%)] were identified. One in five older residents simultaneously followed the trajectories of "Consistently Frail" and "Consistently Severe Cognitive Impairment". Characteristics associated with higher odds of the "Improving Frailty", "Worsening Frailty", "Consistently Pre-frail" and "Consistently Frail" trajectories included greater at-admission cognitive impairment, age ≥ 85 years, admitted from acute hospitals, cardiovascular/metabolic diagnoses, neurological diagnoses, hip or other fractures, and presence of pain. Characteristics associated with higher odds of the "Consistently Moderate Cognitive Impairment" and "Consistently Severe Cognitive Impairment" included worse at-admission physical frailty, neurological diagnoses, hip fracture, and receipt of antipsychotics.
Findings provided information regarding the trajectories of physical frailty, the trajectories of cognitive impairment, the association between the two sets of trajectories, and their association with residents' characteristics in older adults' first six months post-admission to U.S. nursing homes. Understanding the trajectory that the residents would most likely follow may provide information to develop a comprehensive care approach tailored to their specific healthcare goals.
美国养老院为超过120万老年人提供长期护理服务，其中60%身体虚弱，68%患有中度或重度认知障碍。针对养老院老年居民这两种状况的纵向研究有限。
这项全国性纵向研究纳入了新入住的非熟练护理老年居民，他们在入院时、3个月和6个月时接受了最低数据集（MDS）3.0（2014 - 2016年）评估（n = 266,001）。身体虚弱程度通过FRAIL - NH量表测量，认知障碍通过简易精神状态访谈评估。分别拟合基于群组的轨迹模型，以识别身体虚弱轨迹和认知障碍轨迹，并估计入院时老年居民特征与每组轨迹之间的关联。使用双轨迹模型量化身体虚弱轨迹与认知障碍轨迹之间的关联。
在入院后的前六个月中，识别出了五条身体虚弱轨迹["持续虚弱"（患病率：53.0%）、"持续虚弱前期"（29.0%）、"虚弱加重"（7.6%）、"虚弱改善"（5.5%）和"持续强健"（4.8%）]以及三条认知障碍轨迹["持续重度认知障碍"（35.5%）、"持续中度认知障碍"（31.8%）、"持续完好/轻度认知障碍"（32.7%）]。五分之一的老年居民同时遵循"持续虚弱"轨迹和"持续重度认知障碍"轨迹。与"虚弱改善"、"虚弱加重"、"持续虚弱前期"和"持续虚弱"轨迹几率较高相关的特征包括入院时认知障碍程度更高、年龄≥85岁、从急症医院入院、心血管/代谢诊断、神经诊断、髋部或其他骨折以及存在疼痛。与"持续中度认知障碍"和"持续重度认知障碍"几率较高相关的特征包括入院时身体虚弱程度更差、神经诊断、髋部骨折以及接受抗精神病药物治疗。
研究结果提供了有关美国养老院老年居民入院后前六个月身体虚弱轨迹、认知障碍轨迹、两组轨迹之间的关联以及它们与居民特征之间关联的信息。了解居民最可能遵循的轨迹可能为制定针对其特定医疗保健目标的综合护理方法提供信息。
