School of Health Policy and Management, Faculty of Health, York University, Toronto, Ontario, Canada.
Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada.
J Am Geriatr Soc. 2023 Nov;71(11):3467-3479. doi: 10.1111/jgs.18499. Epub 2023 Jul 10.
While assisted living (AL) and nursing home (NHs) residents in share vulnerabilities, AL provides fewer staffing resources and services. Research has largely neglected AL, especially during the COVID-19 pandemic. Our study compared trends of practice-sensitive, risk-adjusted quality indicators between AL and NHs, and changes in these trends after the start of the pandemic.
This repeated cross-sectional study used population-based resident data in Alberta, Canada. Using Resident Assessment Instrument data (01/2017-12/2021), we created quarterly cohorts, using each resident's latest assessment in each quarter. We applied validated inclusion/exclusion criteria and risk-adjustments to create nine quality indicators and their 95% confidence intervals (CIs): potentially inappropriate antipsychotic use, pain, depressive symptoms, total dependency in late-loss activities of daily living, physical restraint use, pressure ulcers, delirium, weight loss, urinary tract infections. Run charts compared quality indicators between AL and NHs over time and segmented regressions assessed whether these trends changed after the start of the pandemic.
Quarterly samples included 2015-2710 AL residents and 12,881-13,807 NH residents. Antipsychotic use (21%-26%), pain (20%-24%), and depressive symptoms (17%-25%) were most common in AL. In NHs, they were physical dependency (33%-36%), depressive symptoms (26%-32%), and antipsychotic use (17%-22%). Antipsychotic use and pain were consistently higher in AL. Depressive symptoms, physical dependency, physical restraint use, delirium, weight loss were consistently lower in AL. The most notable segmented regression findings were an increase in antipsychotic use during the pandemic in both settings (AL: change in slope = 0.6% [95% CI: 0.1%-1.0%], p = 0.0140; NHs: change in slope = 0.4% [95% CI: 0.3%-0.5%], p < 0.0001), and an increase in physical dependency in AL only (change in slope = 0.5% [95% CI: 0.1%-0.8%], p = 0.0222).
QIs differed significantly between AL and NHs before and during the pandemic. Any changes implemented to address deficiencies in either setting need to account for these differences and require monitoring to assess their impact.
尽管辅助生活（AL）和养老院（NHs）的居民存在共同的脆弱性，但 AL 提供的人员配备资源和服务较少。研究在很大程度上忽视了 AL，尤其是在 COVID-19 大流行期间。我们的研究比较了 AL 和 NHs 之间具有实践敏感性的、风险调整后的质量指标的趋势，以及大流行开始后这些趋势的变化。
这是一项使用加拿大艾伯塔省基于人群的居民数据的重复横断面研究。使用居民评估工具数据（2017 年 1 月至 2021 年 12 月），我们创建了每季度的队列，每个队列使用每个居民在每个季度的最新评估。我们应用了经过验证的纳入/排除标准和风险调整，创建了九个质量指标及其 95%置信区间（CI）：潜在不适当的抗精神病药物使用、疼痛、抑郁症状、晚期日常生活活动完全依赖、身体约束使用、压疮、谵妄、体重减轻、尿路感染。运行图比较了 AL 和 NHs 之间随时间变化的质量指标，并进行分段回归评估这些趋势在大流行开始后是否发生了变化。
每季度的样本包括 2015 年至 2017 年的 2150 名 AL 居民和 2012 年至 2018 年的 13807 名 NH 居民。抗精神病药物使用（21%-26%）、疼痛（20%-24%）和抑郁症状（17%-25%）在 AL 中最为常见。在 NHs 中，这些情况是身体依赖（33%-36%）、抑郁症状（26%-32%）和抗精神病药物使用（17%-22%）。抗精神病药物使用和疼痛在 AL 中始终较高。抑郁症状、身体依赖、身体约束使用、谵妄、体重减轻在 AL 中始终较低。最显著的分段回归发现是，在两种环境中，抗精神病药物使用在大流行期间都有所增加（AL：斜率变化=0.6%[95%CI：0.1%-1.0%]，p=0.0140；NHs：斜率变化=0.4%[95%CI：0.3%-0.5%]，p<0.0001），并且 AL 中身体依赖的增加（斜率变化=0.5%[95%CI：0.1%-0.8%]，p=0.0222）。
在大流行之前和期间，AL 和 NHs 之间的 QI 存在显著差异。为了解决任何一个环境中的缺陷而实施的任何变革，都需要考虑到这些差异，并需要进行监测以评估其影响。
