Lam Kenneth, Cenzer Irena, Ankuda Claire K, Levy Cari R, Smith Alexander K, Covinsky Kenneth E, Kotwal Ashwin A
Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora.
Division of Geriatrics, Department of Medicine, University of California, San Francisco.
JAMA Intern Med. 2025 Aug 4. doi: 10.1001/jamainternmed.2025.3684.
Social participation is essential throughout life and is associated with decreased mortality and increased quality of life. It is unknown whether long-term care facility (LTCF) entry disrupts or facilitates it.
To determine longitudinal trends in social participation before and after entry into nursing homes (NHs) and assisted living facilities (ALs) and to explore factors associated with participation.
DESIGN, SETTING, AND PARTICIPANTS: This nationally representative longitudinal cohort study using prospectively collected annual data from the US National Health and Aging Trends Study from 2011 to 2019 included community-dwelling Medicare beneficiaries entering LTCFs. Interviews conducted 4 years before and 2 years after NH or AL entry (index date) were included. Data analysis was performed from September 16, 2022, to May 25, 2025.
Two categories of social participation comprising 5 activities were assessed: socialization (visiting with friends or family and going out for enjoyment) and community participation (attending religious services, participating in clubs or other organized activities, and volunteering). Participation over time was modeled using linear splines before, upon, and after LTCF entry. Modified Poisson regressions were used to explore associations with maintaining and starting activities, adjusted for age, sex, race and ethnicity, and proxy response were used.
The total sample included 606 LTCF entrants (weighted mean [SD] age 85 [7.4] years, 404 female [66% weighted]), of whom 104 individuals were Black (7%), 23 Hispanic (4%), 464 White (86%); and 15 of any other race and ethnicity (3%). Before entry, social participation decreased in all activities (-4.7 to -2.0% annually). Of the total, 275 (44%) entered a NH and 331 (56%) entered an AL facility. Upon entry, going out for enjoyment decreased (-14.1%), but club participation and religious attendance increased (15.6% and 12.6%, respectively). Before LTCF entry, social participation decreased in all activities (-4.7 to -2.0% annually). After entry, going out for enjoyment decreased (-14.1%), but club participation and religious attendance (12.6%) increased (15.6% and 12.6%, respectively). In exploratory analyses, women were more likely to maintain visits (adjust risk ratio [aRR], 1.3; 95% CI, 1.1-1.5) and start attending religious services (aRR, 1.6; 95% CI, 1.0-2.8). NH residents were less likely to go out for enjoyment (aRR, 0.6; 95% CI, 0.5-0.8 for maintaining; aRR, 0.6; 95% CI, 0.4-1.0 for starting) and keep attending religious services (aRR, 0.7; 95% CI, 0.6-0.9). Black, Hispanic, and residents of other race or ethnicity were much less likely to start going out for enjoyment (aRR, 0.3; 95% CI, 0.1-0.8).
This cohort study found that LTCF entry generally promoted community participation and reduced socialization. Benefits may be less likely among men, NH entrants, and residents of racial and ethnic minority groups.
社会参与在整个人生中都至关重要，且与死亡率降低和生活质量提高相关。长期护理机构（LTCF）的入住是会干扰还是促进社会参与尚不清楚。
确定进入养老院（NHs）和辅助生活设施（ALs）前后社会参与的纵向趋势，并探讨与参与相关的因素。
设计、设置和参与者：这项具有全国代表性的纵向队列研究使用了从2011年到2019年美国国家健康与老龄化趋势研究中前瞻性收集的年度数据，纳入了入住LTCFs的社区居住医疗保险受益人。包括在进入NH或AL之前4年和之后2年（索引日期）进行的访谈。数据分析于2022年9月16日至2025年5月25日进行。
评估了包括5项活动的两类社会参与：社交（与朋友或家人拜访以及外出娱乐）和社区参与（参加宗教仪式、参加俱乐部或其他有组织的活动以及志愿服务）。使用线性样条对LTCF入住之前、入住时和入住之后的参与情况随时间进行建模。使用修正泊松回归来探讨与维持和开始活动的关联，并对年龄、性别、种族和民族进行了调整，且使用了代理应答。
总样本包括606名入住LTCF的人（加权平均[标准差]年龄85[7.4]岁，404名女性[加权66%]），其中104人为黑人（7%），23人为西班牙裔（4%），464人为白人（86%）；以及15人为其他种族和民族（3%）。入住之前，所有活动中的社会参与均有所下降（每年下降4.7%至2.0%）。其中，275人（44%）进入了NH，331人（56%）进入了AL设施。入住时，外出娱乐活动减少（-14.1%），但俱乐部参与和宗教活动参与增加（分别为15.6%和12.6%）。在LTCF入住之前，所有活动中的社会参与均有所下降（每年下降4.7%至2.0%）。入住之后，外出娱乐活动减少（-14.1%），但俱乐部参与和宗教活动参与（12.6%）增加（分别为15.6%和12.6%）。在探索性分析中，女性更有可能维持拜访（调整风险比[aRR]，1.3；95%置信区间，1.1-1.5）并开始参加宗教仪式（aRR，1.6；95%置信区间，1.0-2.8）。NH居民外出娱乐的可能性较小（维持的aRR，0.6；95%置信区间，0.5-0.8；开始的aRR，0.6；95%置信区间，0.4-1.0），且继续参加宗教仪式的可能性较小（aRR，0.7；95%置信区间，0.6-0.9）。黑人、西班牙裔以及其他种族或民族的居民开始外出娱乐的可能性要小得多（aRR，0.3；95%置信区间，0.1-0.8）。
这项队列研究发现，LTCF入住总体上促进了社区参与并减少了社交活动。男性、NH入住者以及少数种族和民族群体的居民可能较少受益。
