搬入长期护理机构后重返社区生活与死亡率：一项全国代表性队列研究。
Return to community living and mortality after moving to a long-term care facility: A nationally representative cohort study.
机构信息
Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA.
出版信息
J Am Geriatr Soc. 2023 Feb;71(2):569-576. doi: 10.1111/jgs.18144. Epub 2022 Nov 24.
BACKGROUND
Recent long-term care facility (LTCF) policy has focused on transitioning nursing home (NH) residents back to community settings, yet we lack recent descriptions of this phenomenon and how it compares in assisted living (AL).
METHODS
Using the National Health and Aging Trends Study, we studied adults over age 65 who had moved from community living into an LTCF between 2011 and 2018. Persons or their proxies reported residence in annual interviews. NH was defined by facility staff. ALs were multi-unit buildings helping with activities of daily living. We excluded temporary short-stay NH patients and independent AL residents. Our primary outcome was cumulative incidence of return to community living, with death as co-primary outcome and modeled as a competing risk, stratified by NH versus AL entry. We identified covariates (age, gender, race/ethnicity, dementia, activity limitations, and prior living arrangement) associated with return to community living through bivariate and multivariable logistic regression.
RESULTS
Among 739 participants, weighted mean age was 84 years (SD 7.5), 66% were women, 13% were non-White, 57% had dementia, and 41% entered NH. At 1, 2, and 4 years, the cumulative incidence of return to community living was 2.9% (95% CIs: 1.9%-4.3%), 6.4% (4.7%-8.4%), and 7.4% (5.5%-9.8%); the cumulative incidence of death was 28% (95% CIs: 24%-31%), 44% (40%-48%) and 66% (61%-70%). Outcomes were similar in persons entering NH versus AL. Older persons (aOR 0.88, 95% CI 0.83-0.94), those with dementia (aOR 0.33, 95% CI 0.12-0.88), and those previously living alone (aOR 0.39, 95% CI 0.17-0.89) were less likely to return.
CONCLUSIONS
Few returned to community living after entering either NH or AL. Mortality was similar. Results highlight limits in transitioning persons out of LTCFs and the need to observe AL use to ensure policies do not merely displace persons between institutional care sectors.
背景
最近的长期护理机构（LTCF）政策侧重于将疗养院（NH）居民转移回社区环境，但我们缺乏对这一现象的最新描述，以及它在辅助生活（AL）中的比较情况。
方法
我们使用国家健康与老龄化趋势研究，研究了 2011 年至 2018 年间从社区生活进入 LTCF 的年龄在 65 岁以上的成年人。人员或其代理人在年度访谈中报告居住情况。NH 由机构工作人员定义。AL 是帮助日常生活活动的多单元建筑。我们排除了临时短期 NH 患者和独立 AL 居民。我们的主要结果是返回社区生活的累积发生率，以死亡为共同主要结果，并作为竞争风险进行建模，按 NH 与 AL 入院分层。我们通过双变量和多变量逻辑回归确定了与返回社区生活相关的协变量（年龄、性别、种族/民族、痴呆、活动能力受限和先前的生活安排）。
结果
在 739 名参与者中，加权平均年龄为 84 岁（标准差为 7.5），66%为女性，13%为非白人，57%患有痴呆症，41%进入 NH。在 1、2 和 4 年时，返回社区生活的累积发生率分别为 2.9%（95%CI：1.9%-4.3%）、6.4%（4.7%-8.4%）和 7.4%（5.5%-9.8%）；死亡的累积发生率分别为 28%（95%CI：24%-31%）、44%（40%-48%）和 66%（61%-70%）。NH 与 AL 入院的患者结局相似。年龄较大的患者（OR 0.88，95%CI 0.83-0.94）、患有痴呆症的患者（OR 0.33，95%CI 0.12-0.88）和独居的患者（OR 0.39，95%CI 0.17-0.89）不太可能返回。
结论
进入 NH 或 AL 后，很少有人返回社区生活。死亡率相似。结果强调了将人员从长期护理机构转移出去的局限性，需要观察辅助生活的使用情况，以确保政策不会仅仅在机构护理部门之间转移人员。
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