衰弱、潜在健康状况与抗逆转录病毒疗法：预测HIV人群熟练护理设施护理的成功情况
Frailty, Latent Health Profiles, and Antiretroviral Therapy: Predicting Success of Skilled Nursing Facility Care in an HIV Population.
作者信息
Olivieri-Mui Brianne L, McCarthy Ellen P, Shi Sandra M, Wilson Ira B, Jang Jieun, Oh Gahee, Ratnayake Aneeka, Park Chan Mi, Kim Dae Hyun
机构信息
The Department of Public Health and Health Sciences, Northeastern University, Boston, MA, USA; The Roux Institute, Northeastern University, Portland, ME, USA; The Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, MA, USA.
The Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, MA, USA.
出版信息
J Am Med Dir Assoc. 2025 Jun 24;26(8):105714. doi: 10.1016/j.jamda.2025.105714.
OBJECTIVES
People with HIV (PWH) likely need short-term skilled nursing facility (SNF) care more than people with greater financial and social support to remain home. Therefore, we sought to understand how frailty among health profiles with distinct driving conditions, antiretroviral therapy (ART), and sociodemographic factors relate to success of short-term SNF for PWH.
DESIGN
Retrospective cohort study.
SETTING AND PARTICIPANTS
Short-term SNF stays for PWH.
METHODS
Stays (n = 1640) were identified in a 2014-2019 Medicare 5% random sample. Zero-Inflated Poisson regression estimated rate ratios for home time lost in 1-year post-discharge by age (<65 vs 65+), health profiles established by latent profile analysis, frailty, and days covered by ART.
RESULTS
Overall, 716 (44%) SNF stays were aged 65+, 1154 (70%) were male, 764 (47%) were Black, 321 (20%) were frail, and 784 (48%) had ART ≥80% of days before admission. There were 3 health profiles: substance use (SU; n = 467), cardiovascular and pulmonary (CV/PULM; n = 665), or multisystem including SU, CV, PULM, and mental health (MULTI; n = 508). Among stays aged <65, SU [rate ratio (95% confidence interval), 1.12 (1.09-1.15)] had more and MULTI [0.87 (0.85-0.89)] had fewer days lost than the CV/PULM group, but any ART carried higher rates of days lost compared with none. Among those aged 65+, SU [0.89 (0.85-0.92)] had fewer days lost, but MULTI [0.97 (0.94-1.00)] was similar in home time loss compared with the CV/PULM group. Having ART <80% of days [1.10 (1.06-1.13)], frailty [1.07 (1.03-1.11)], or pre-frailty [1.07 (1.04-1.10)] had higher rates of days lost.
CONCLUSIONS AND IMPLICATIONS
Although health profiles may help identify conditions most likely impacting health of PWH, frailty may be key to identifying those having the highest needs and at risk for greater home time loss following SNF stays, with this impact varying by age.
目的
与那些有更多经济和社会支持从而能够居家的人相比，感染艾滋病毒者（PWH）可能更需要短期的专业护理机构（SNF）护理。因此，我们试图了解在具有不同驱动条件、抗逆转录病毒疗法（ART）和社会人口学因素的健康状况中，虚弱如何与PWH短期SNF护理的成功相关。
设计
回顾性队列研究。
设置与参与者
PWH的短期SNF住院情况。
方法
在2014 - 2019年医疗保险5%随机样本中确定住院情况（n = 1640）。零膨胀泊松回归估计了出院后1年内按年龄（<65岁与65岁以上）、通过潜在类别分析确定的健康状况、虚弱程度以及ART覆盖天数计算的居家时间损失率比。
结果
总体而言，716例（44%）SNF住院患者年龄在65岁以上，1154例（70%）为男性，764例（47%）为黑人，321例（20%）虚弱，784例（48%）在入院前ART覆盖天数≥80%。有3种健康状况：物质使用（SU；n = 467）、心血管和肺部（CV/PULM；n = 665）或包括SU、CV、PULM和心理健康的多系统（MULTI；n = 508）。在年龄<65岁的住院患者中，与CV/PULM组相比，SU组[率比（95%置信区间），1.12（1.09 - 1.15）]居家时间损失更多，MULTI组[0.87（0.85 - 0.89）]居家时间损失更少，但接受任何ART治疗的患者与未接受治疗的患者相比，居家时间损失率更高。在65岁以上的患者中，SU组[0.89（0.85 - 0.92）]居家时间损失更少，但与CV/PULM组相比，MULTI组[0.97（0.94 - 1.00）]居家时间损失相似。ART覆盖天数<80%[1.10（1.06 - 1.13）]、虚弱[1.07（1.03 - 1.11）]或衰弱前期[1.07（1.04 - 1.10）]的患者居家时间损失率更高。
结论与启示
尽管健康状况可能有助于识别最有可能影响PWH健康的情况，但虚弱可能是识别那些需求最高且在SNF住院后有更大居家时间损失风险的人的关键，这种影响因年龄而异。
Zotero 插件