Nemmers Natasha, Lai Wenhua, Tsuker Sophia, Haldar Srabani, Freedman Vicki A, Leggett Amanda N
Institute of Gerontology, Wayne State University, Detroit, Michigan, USA.
Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA.
Innov Aging. 2024 Sep 26;8(10):igae087. doi: 10.1093/geroni/igae087. eCollection 2024.
When older adults face increasing care needs or limited support, remaining safely and comfortably at home becomes challenging. Extant research has primarily concentrated on characteristics of the older adult or their primary caregiver on nursing home admission. This study examines the risk of older adults transitioning to residential care (e.g., assisted living, nursing home), focusing on the influence of their care network or involvement of multiple helpers.
Using the National Health and Aging Trends Study, we conducted competing risk regression models that account for mortality, following 7,085 initially community-dwelling older adults across Rounds 1-9 (2011-2019). We assessed network composition, size, shared tasks, and the number of in-network specialists or generalists while controlling for individual sociodemographic and health factors.
Individuals with care networks that shared medical tasks had the highest risk of moving to a residential care setting, followed by those sharing household tasks. Conversely, shared mobility or self-care and transportation responsibilities were associated with lower risks. Having more generalists, but not specialists, increased the risk. Larger networks were associated with heightened risk, although having close family members like a spouse was protective.
The findings underscore that care network characteristics are critical to older adults' ability to age in place. Specifically, older adults with larger networks, lacking a spouse or child, and providing complex care are at greater risk for relocating. Understanding care networks can guide interventions related to care network coordination and resource allocation to help avoid or postpone a residential care move.
当老年人面临日益增长的护理需求或支持有限时，安全舒适地居家养老就变得颇具挑战。现有研究主要集中在老年人或其主要照料者进入养老院的特征上。本研究考察老年人过渡到机构养老（如辅助生活、养老院）的风险，重点关注其护理网络的影响或多个协助者的参与情况。
利用国家健康与老龄化趋势研究，我们针对2011 - 2019年第1 - 9轮中最初居住在社区的7085名老年人，进行了考虑死亡率的竞争风险回归模型分析。我们在控制个体社会人口学和健康因素的同时，评估了网络构成、规模、共享任务以及网络内专科医生或全科医生的数量。
护理网络中分担医疗任务的个体转入机构养老环境的风险最高，其次是分担家务的个体。相反，分担出行或自我护理及交通责任则与较低风险相关。拥有更多全科医生（而非专科医生）会增加风险。更大的网络与更高的风险相关，不过有配偶等亲密家庭成员则具有保护作用。
研究结果强调，护理网络特征对于老年人居家养老的能力至关重要。具体而言，网络规模较大、缺乏配偶或子女且提供复杂护理的老年人搬迁风险更高。了解护理网络可以指导与护理网络协调和资源分配相关的干预措施，以帮助避免或推迟入住机构养老。
