Columbia University School of Nursing, New York, NY, USA.
Center for Home Care Policy & Research, Visiting Nurse Service of New York, USA.
Clin Nurs Res. 2023 Sep;32(7):1021-1030. doi: 10.1177/10547738231183026. Epub 2023 Jun 22.
One-third of home healthcare patients are hospitalized or visit emergency departments during a 60-day episode of care. Among all risk factors, psychological, cognitive, and behavioral symptoms often remain underdiagnosed or undertreated in older adults. Little is known on subgroups of older adults receiving home healthcare services with similar psychological, cognitive, and behavioral symptom profiles and an at-risk subgroup for future hospitalization and emergency department visits. Our cross-sectional study used data from a large, urban home healthcare organization ( = 87,943). Latent class analysis was conducted to identify meaningful subgroups of older adults based on their distinct psychological, cognitive, and behavioral symptom profiles. Adjusted multiple logistic regression was used to understand the association between the latent subgroup and future hospitalization and emergency department visits. Descriptive and inferential statistics were conducted to describe the individual characteristics and to test for significant differences. The three-class model consisted of Class 1: "Moderate psychological symptoms without behavioral issues," Class 2: "Severe psychological symptoms with behavioral issues," and Class 3: "Mild psychological symptoms without behavioral issues." Compared to Class 3, Class 1 patients had 1.14 higher odds and Class 2 patients had 1.26 higher odds of being hospitalized or visiting emergency departments. Significant differences were found in individual characteristics such as age, gender, race/ethnicity, and insurance. Home healthcare clinicians should consider the different latent subgroups of older adults based on their psychological, cognitive, and behavioral symptoms. In addition, they should provide timely assessment and intervention especially to those at-risk for hospitalization and emergency department visits.
在 60 天的护理期间，有三分之一的家庭保健患者住院或前往急诊部。在所有风险因素中，心理、认知和行为症状在老年人中常常被漏诊或治疗不足。对于接受家庭保健服务且具有相似心理、认知和行为症状特征且存在未来住院和急诊就诊风险的亚组老年人，人们知之甚少。我们的横断面研究使用了一家大型城市家庭保健组织的数据（ = 87,943）。采用潜在类别分析根据老年人的不同心理、认知和行为症状特征来识别有意义的亚组。采用调整后的多项逻辑回归来了解潜在亚组与未来住院和急诊就诊之间的关联。采用描述性和推断性统计来描述个体特征并检验显著差异。三类别模型由 Class 1：“有中度心理症状但无行为问题”、Class 2：“有严重心理症状伴行为问题”和 Class 3：“有轻度心理症状但无行为问题”组成。与 Class 3 相比，Class 1 患者的住院或急诊就诊的可能性高 1.14 倍，Class 2 患者的住院或急诊就诊的可能性高 1.26 倍。在个体特征（如年龄、性别、种族/民族和保险）方面存在显著差异。家庭保健临床医生应根据老年人的心理、认知和行为症状考虑不同的潜在亚组。此外，他们应及时评估和干预，特别是对那些有住院和急诊就诊风险的患者。
