孤独和不孤独老年人基于性别的卫生系统使用轨迹：一项基于人群的队列研究。

Sex-based trajectories of health system use in lonely and not lonely older people: A population-based cohort study.

作者信息

Savage Rachel D, Sutradhar Rinku, Luo Jin, Strauss Rachel, Guan Jun, Rochon Paula A, Gruneir Andrea, Sanmartin Claudia, Goel Vivek, Rosella Laura C, Stall Nathan M, Chamberlain Stephanie A, Yu Christina, Bronskill Susan E

机构信息

Women's Age Lab, Women's College Hospital, Toronto, Ontario, Canada.

Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.

出版信息

J Am Geriatr Soc. 2024 Apr;72(4):1100-1111. doi: 10.1111/jgs.18833. Epub 2024 Feb 26.

DOI:10.1111/jgs.18833

PMID:38407328

Abstract

BACKGROUND

There is growing interest in understanding the care needs of lonely people but studies are limited and examine healthcare settings separately. We estimated and compared healthcare trajectories in lonely and not lonely older female and male respondents to a national health survey.

METHODS

We conducted a retrospective cohort study of community-dwelling, Ontario respondents (65+ years) to the 2008/2009 Canadian Community Health Survey-Healthy Aging. Respondents were classified at baseline as not lonely, moderately lonely, or severely lonely using the Three-Item Loneliness Scale and then linked with health administrative data to assess healthcare transitions over a 12 -year observation period. Annual risks of moving from the community to inpatient, long-stay home care, long-term care settings-and death-were estimated across loneliness levels using sex-stratified multistate models.

RESULTS

Of 2684 respondents (58.8% female sex; mean age 77 years [standard deviation: 8]), 635 (23.7%) experienced moderate loneliness and 420 (15.6%) severe loneliness. Fewer lonely respondents remained in the community with no transitions (not lonely, 20.3%; moderately lonely, 17.5%; and severely lonely, 12.6%). Annual transition risks from the community to home care and long-term care were higher in female respondents and increased with loneliness severity for both sexes (e.g., 2-year home care risk: 6.1% [95% CI 5.5-6.6], 8.4% [95% CI 7.4-9.5] and 9.4% [95% CI 8.2-10.9] in female respondents, and 3.5% [95% CI 3.1-3.9], 5.0% [95% CI 4.0-6.0], and 5.4% [95% CI 4.0-6.8] in male respondents; 5-year long-term care risk: 9.2% [95% CI 8.0-10.8], 11.1% [95% CI 9.3-13.6] and 12.2% [95% CI 9.9-15.3] [female], and 5.3% [95% CI 4.2-6.7], 9.1% [95% CI 6.8-12.5], and 10.9% [95% CI 7.9-16.3] [male]).

CONCLUSIONS

Lonely older female and male respondents were more likely to need home care and long-term care, with severely lonely female respondents having the highest probability of moving to these settings.

摘要

背景

人们对了解孤独者的护理需求兴趣日益浓厚，但相关研究有限，且分别考察了医疗保健环境。我们对一项全国性健康调查中孤独和不孤独的老年女性及男性受访者的医疗保健轨迹进行了估计和比较。

方法

我们对安大略省参加2008/2009年加拿大社区健康调查-健康老龄化的社区居住受访者（65岁及以上）进行了一项回顾性队列研究。在基线时，使用三项孤独量表将受访者分为不孤独、中度孤独或重度孤独，然后与健康管理数据相链接，以评估12年观察期内的医疗保健转变情况。使用按性别分层的多状态模型，估计了不同孤独程度下从社区转移到住院、长期家庭护理、长期护理机构以及死亡的年度风险。

结果

在2684名受访者中（女性占58.8%；平均年龄77岁[标准差：8]），635人（23.7%）经历了中度孤独，420人（15.6%）经历了重度孤独。较少孤独的受访者留在社区且没有转变（不孤独者为20.3%；中度孤独者为17.5%；重度孤独者为12.6%）。女性受访者从社区转移到家庭护理和长期护理的年度转变风险更高，且两性的风险均随孤独严重程度增加（例如，女性受访者2年家庭护理风险：6.1%[95%置信区间5.5 - 6.6]、8.4%[95%置信区间7.4 - 9.5]和9.4%[95%置信区间8.2 - 10.9]，男性受访者为3.5%[95%置信区间3.1 - 3.9]、5.0%[95%置信区间4.0 - 6.0]和5.4%[95%置信区间4.0 - 6.8]；5年长长期护理风险：9.2%[95%置信区间8.0 - 10.8]、11.1%[95%置信区间9.3 - 13.6]和12.2%[95%置信区间9.9 - 15.3][女性]，以及5.3%[95%置信区间4.2 - 6.7]、9.1%[95%置信区间6.8 - 12.5]和10.9%[95%置信区间7.9 - 16.3][男性]）。