Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA.
Department of Gerontology, University of Massachusetts Boston, Boston, Massachusetts, USA.
Int J Geriatr Psychiatry. 2024 Oct;39(10):e70003. doi: 10.1002/gps.70003.
In older U.S. nursing home residents with suicidal ideation (SI), limited studies have longitudinally investigated their health changes as related to cognitive function. This study aimed to identify the health profiles and the transitions between profiles at admission and 90-days and examine the associations with cognitive impairment.
Using Minimum Data Set 3.0 (2011-15), we identified 10,079 older residents without severe cognitive impairment who reported SI on Patient Health Questionnaire-9. Health profile indicators included at-admission and 90-day post-admission depressive symptoms, frailty, and pain frequency and intensity. Using latent transition analysis, we identified distinct health profiles, examined the transitions between profiles over time, and estimated their associations with cognitive impairment.
One third of residents continued to report SI at 90 days. The five health profiles identified at admission were distinctive with varying levels of frailty, depressive symptoms, and pain, from the most severe Profile 1 characterized by frailty, all depressive symptoms, and horrible or frequent pain, to the least severe Profile 5 characterized by pre-frailty, depressed mood, and no pain. The 90-day profiles were mostly consistent. Most residents remained in a similar profile over time. Relative to residents with intact cognition/mild cognitive impairment, those with moderate impairment were less likely to belong to profiles characterized by more depressive symptoms and pain.
Residents with SI had heterogeneous health profiles, which varied by cognitive impairment levels, but showed minimal changes despite being in a medically supervised setting. Findings highlighted the critical need for adequate recognition and management of SI in nursing homes.
在美国有自杀意念（SI）的老年养老院居民中，很少有研究从纵向角度研究他们的认知功能相关的健康变化。本研究旨在确定入院时和 90 天时的健康特征，并探讨其与认知障碍的关系。
使用最低数据集 3.0（2011-15 年），我们确定了 10079 名没有严重认知障碍的老年居民，他们在患者健康问卷-9 上报告了 SI。健康特征指标包括入院时和入院后 90 天的抑郁症状、衰弱和疼痛频率及强度。使用潜在转变分析，我们确定了不同的健康特征，检查了随着时间的推移在特征之间的转变，并估计了它们与认知障碍的关系。
三分之一的居民在 90 天内继续报告有 SI。入院时确定的五个健康特征各不相同，衰弱、抑郁症状和疼痛程度不同，最严重的特征 1 表现为衰弱、所有抑郁症状和可怕或频繁的疼痛，最轻微的特征 5 表现为轻度衰弱、抑郁情绪和没有疼痛。90 天的特征大多一致。大多数居民随着时间的推移保持相似的特征。与认知功能正常/轻度认知障碍的居民相比，中度认知障碍的居民不太可能属于抑郁症状和疼痛程度较高的特征。
有 SI 的居民有不同的健康特征，这些特征因认知障碍水平而异，但在医疗监督环境下变化很小。研究结果强调了在养老院中充分认识和管理 SI 的迫切需要。
