Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway.
Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
BMC Geriatr. 2024 Oct 9;24(1):814. doi: 10.1186/s12877-024-05403-5.
Older people with diabetes who live at home and receive home care services (HCS) are vulnerable, which may result in a need for more care than the HCS can provide. In this study we aimed to explore associations between pharmacologically treated diabetes and the risk of short-term and long-term nursing home stays (NHS) among older people receiving HCS.
This nationwide registry study included older people ≥ 65 years receiving HCS, as registered in the Norwegian Information System for the Nursing and Care Sector (IPLOS) (2010-2014). Data from IPLOS were merged with data from the Norwegian Prescription Database and the Norwegian Patient Registry. Pharmacologically treated diabetes (hereafter referred to as diabetes) was defined based on prescriptions of glucose-lowering drugs (GLD) (≥ 1 prescription in the current or previous year). Persons not prescribed GLD were defined as not having diabetes. Based on Anatomical Therapeutic Chemical (ATC) codes we identified the following subgroups: persons without diabetes, persons using "non-insulin GLD only", "insulin and non-insulin GLD" and "insulin only". An NHS was defined as at least one stay during a given calendar year, where a short-term NHS is temporary, and a long-term NHS is permanent. Log-binomial regression was used to test for differences in NHS and results are reported as risk ratios (RR) with 95% CIs.
Both insulin-treated subgroups had a higher risk of a short-term NHS ("insulin only" users RR 1.06 (CI 1.03-1.09) and "insulin and non-insulin GLD" users RR 1.04 (CI 1.02-1.06)) compared to those without diabetes. In general, persons with diabetes had a lower risk of a long-term NHS than those without diabetes (RR 0.92 (CI 0.89-0.94)). The subgroup using "insulin and non-insulin GLD" had the lowest risk of a long-term NHS (RR 0.86 (CI 0.81-0.91)).
Despite a lower risk of a long-term NHS among older people with diabetes, we found an increased risk of a short-term NHS among persons with insulin-treated diabetes who live at home and receive HCS. This calls for attention when planning health care, in order to provide coordinated and individualized care to prevent short-term NHS's.
在家中接受家庭护理服务（HCS）的老年糖尿病患者易受影响，这可能导致他们需要比 HCS 所能提供的更多的护理。在这项研究中，我们旨在探讨接受 HCS 的老年人中，经药物治疗的糖尿病与短期和长期入住养老院（NHS）风险之间的关联。
这是一项全国性的登记研究，纳入了≥65 岁、正在接受 HCS 的老年人，这些数据来源于挪威护理和保健部门信息系统（IPLOS）（2010-2014 年）。IPLOS 中的数据与挪威处方数据库和挪威患者登记处的数据进行了合并。经药物治疗的糖尿病（以下简称糖尿病）是根据降血糖药物（GLD）的处方（当年或前一年至少有 1 次处方）定义的。未开 GLD 的患者被定义为没有糖尿病。根据解剖治疗化学（ATC）代码，我们确定了以下亚组：无糖尿病者、仅使用“非胰岛素 GLD”者、“胰岛素和非胰岛素 GLD”者以及“仅胰岛素”者。NHS 定义为在特定日历年中至少有一次入住养老院，其中短期 NHS 是临时的，长期 NHS 是永久性的。使用对数二项式回归来检验 NHS 的差异，结果以风险比（RR）和 95%置信区间（CI）表示。
与无糖尿病者相比，胰岛素治疗的两个亚组短期 NHS 的风险更高（“仅胰岛素”使用者 RR 1.06（CI 1.03-1.09）和“胰岛素和非胰岛素 GLD”使用者 RR 1.04（CI 1.02-1.06））。一般来说，与无糖尿病者相比，糖尿病患者长期 NHS 的风险较低（RR 0.92（CI 0.89-0.94））。使用“胰岛素和非胰岛素 GLD”的亚组长期 NHS 的风险最低（RR 0.86（CI 0.81-0.91））。
尽管在家中接受 HCS 的老年糖尿病患者长期 NHS 的风险较低，但我们发现，接受胰岛素治疗的糖尿病患者短期 NHS 的风险增加。这在规划医疗保健时需要引起注意，以便提供协调和个性化的护理，以预防短期 NHS 的发生。
