Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA.
Department of Gerontology, University of Massachusetts Boston, Boston, Massachusetts, USA.
Int J Geriatr Psychiatry. 2022 Nov;37(11). doi: 10.1002/gps.5829.
Identify the health profiles of older nursing home residents with and without at-admission self-reported suicidal ideation (SI) and examine the association between the identified profiles and self-reported SI at 90 days.
Using the Minimum Data Set 3.0 and the ninth Patient Health Questionnaire-9 (PHQ-9) item, we identified 15,277 older residents with and 562,184 without self-reported SI at nursing home admission. Latent class analysis, using frailty, cognitive impairment, palliative care index, pain, and remaining PHQ-9 items as indicators, identified health profiles by at-admission SI and the BCH method estimated their association with SI at 90 days.
Profiles identified for residents without at-admission SI were: (1) frail and depressed (prevalence: 33.9%); (2) frail and severe cognitive impairment (38.1%); (3) pre-frail (28.0%). Residents in the frail and depressed group had greater odds [adjusted OR: 2.80; 95% Confidence Interval: 2.60-3.00] while those in the frail and severe cognitive impairment group had lower odds [aOR: 0.79; 95% CI: 0.71-0.86] of 90-day SI than those in the pre-frail group. Profiles identified for residents with at-admission SI were: (1) frail and all depressive symptoms (22.8%); (2) frail and some depressive symptoms (32.2%); (3) frail and severe cognitive impairment (22.9%); (4) pre-frail (22.0%). Compared to those in the pre-frail group, residents in the frail and all depressive symptoms group had greater odds of continuing reporting SI at 90 days [aOR: 1.22; 95% CI:1.09-1.35].
Findings indicated unique health profiles of nursing home residents at higher risk of new onset of or continued SI.
确定入院时自我报告有自杀意念（SI）和无自杀意念的老年疗养院居民的健康状况，并研究确定的健康状况与 90 天内自我报告 SI 之间的关系。
使用最小数据集 3.0 和第 9 个患者健康问卷-9（PHQ-9）项，我们确定了 15277 名入院时自我报告有 SI 的老年居民和 562184 名无 SI 的居民。使用脆弱性、认知障碍、姑息治疗指数、疼痛和剩余 PHQ-9 项作为指标的潜在类别分析，根据入院时的 SI 确定健康状况，并使用 BCH 方法估计它们与 90 天内 SI 的关联。
确定无入院时 SI 的居民的健康状况有以下几种：（1）脆弱且抑郁（患病率：33.9%）；（2）脆弱且严重认知障碍（38.1%）；（3）预脆弱（28.0%）。脆弱且抑郁组的居民有更高的可能性[调整后的 OR：2.80；95%置信区间：2.60-3.00]，而脆弱且严重认知障碍组的居民则有更低的可能性[调整后的 OR：0.79；95%置信区间：0.71-0.86]出现 90 天 SI。确定有入院时 SI 的居民的健康状况有以下几种：（1）脆弱且有所有抑郁症状（22.8%）；（2）脆弱且有部分抑郁症状（32.2%）；（3）脆弱且严重认知障碍（22.9%）；（4）预脆弱（22.0%）。与预脆弱组相比，脆弱且所有抑郁症状组的居民在 90 天内继续报告 SI 的可能性更大[调整后的 OR：1.22；95%置信区间：1.09-1.35]。
研究结果表明，有更高新发或持续 SI 风险的疗养院居民有独特的健康状况。
