Huang Shih-Tsung, Hsiao Fei-Yuan, Lee Wei-Ju, Chou Ming-Yueh, Liang Chih-Kuang, Lin Chu-Sheng, Loh Ching-Hui, Chen Liang-Kung
Department of Pharmacy, National Yang Ming Chiao Tung University, Taipei, Taiwan; Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan; School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan.
J Frailty Aging. 2025 Aug;14(4):100063. doi: 10.1016/j.tjfa.2025.100063. Epub 2025 Jul 2.
Longitudinal trajectories of healthcare utilization, medication prescription, and clinical outcomes among older adults with disabilities receiving home healthcare (HHC) holds significance but remains elusive.
People aged≥65 years who newly received Taiwan's National Health Insurance funded HHC program from January 2005 to December 2013 were identified. Healthcare utilization, life-sustaining treatment, medication prescriptions (polypharmacy, psychotropics, anticholinergic burden and antibiotics), health status (Charlson's comorbidity index, CCI), and mortality were assessed over a 10-year period spanning 5 years before and after initiating HHC.
Overall, 187,547 patients (80.6 ± 7.7 years, 51.2 % females, CCI 3+: 51.2 %) with a high prevalence of dementia (34.0 %), stroke (38.7 %), and pneumonia (49.5 %), and usage of life-sustaining treatment (urinary catheters: 82.8 % and nasogastric feeding: 78.7 %) were obtained. A sudden peak of admission rate at 1 year (91.7 %) before HHC, followed by the 70 % and 60 % admission rate in the first and second year after receiving HHC were found. Quarterly changes of using life-sustaining treatment showed significant increases from as early as 1 year prior to HHC. Gradual increases of polypharmacy, use of psychotropics, and antibiotic (4.5-fold and 3-fold) after HHC further demonstrated the complex needs (both p < 0.01). The 5-year cumulative mortality rate was 81 % (40 % in the first year with an annual rate of 25 %).
HHC recipients embody a confluence of complex care needs and high mortality risk, whereby various interventions aim to alleviate symptoms and sustain life. Engaging in proactive advanced care planning and end-of-life care should be prioritized when home healthcare is being contemplated.
接受家庭医疗保健（HHC）的残疾老年人的医疗保健利用、药物处方和临床结局的纵向轨迹具有重要意义，但仍不明确。
确定了2005年1月至2013年12月期间新接受台湾国民健康保险资助的HHC计划的65岁及以上人群。在开始HHC之前和之后的5年共10年期间，评估了医疗保健利用、维持生命治疗、药物处方（多重用药、精神药物、抗胆碱能负担和抗生素）、健康状况（查尔森合并症指数，CCI）和死亡率。
总体而言，获得了187,547名患者（80.6±7.7岁，51.2%为女性，CCI 3+：51.2%），痴呆症（34.0%）、中风（38.7%）和肺炎（49.5%）患病率高，且使用维持生命治疗（导尿管：82.8%和鼻饲：78.7%）。发现HHC前1年入院率突然达到峰值（91.7%），随后在接受HHC后的第一年和第二年入院率分别为70%和60%。使用维持生命治疗的季度变化显示，早在HHC前1年就有显著增加。HHC后多重用药、精神药物使用和抗生素使用（分别增加4.5倍和翻了3倍）的逐渐增加进一步证明了复杂的需求（均p<0.01）。5年累积死亡率为81%（第一年为40%，年死亡率为25%）。
HHC接受者体现了复杂护理需求和高死亡风险的融合，因此各种干预措施旨在缓解症状和维持生命。在考虑家庭医疗保健时，应优先进行积极的晚期护理规划和临终护理。
