Boaz R F, Muller C F
Graduate Center, City University of New York, NY 10036-8099.
Health Serv Res. 1994 Oct;29(4):391-414.
This study examines the difference between permanent and transitory residence in a nursing home with special emphasis on the extent to which the risk of a long nursing home stay is reduced by the availability of informal help in the community.
Secondary data were used, taken from the National Long-Term Care Surveys of 1982 and 1984. The 1982 NLTCS samples disabled elderly living in the community. For these community dwellers, the 1984 NLTCS provides information on continued residence in the community and on their nursing home episodes between 1982 and 1984. METHOD OF ANALYSIS: The analysis is based on estimates from a multinomial logit regression with three explicit categories: persons with at least one long nursing home stay (n = 292), persons with only short stays (n = 227), and persons who died without ever having had a nursing home stay (n = 945). The implicit category: persons living in the community in 1984 without having had any nursing home stay (n = 3,368).
This study demonstrates the systematic differences in the personal characteristics that predict the risk of long stays from those that predict short stays in a nursing home. Controlling for limitations in physical and cognitive functioning, the regression analysis shows that indicators of informal help in the community have a statistically significant and relatively large effect on the risk of long stays; but the effects of these indicators on the risk of short stays is numerically smaller and not statistically significant. Specifically, when the burden of caregiving is shared by a spouse and children, the risk of a long stay in a nursing home is reduced by 9.3 percentage points; in contrast, the risk is increased by 18 percentage points for childless elders who are living alone and by 45.8 percentage points for elders living with adults other than a spouse or children.
The relatively strong effects of family helpers and living arrangements on the risk of long nursing home stays confirm the hypothesis that, after controlling for the effects of physical and cognitive functioning, adequate help in the community reduces the risk of permanent nursing home residence. But help in the community has no effect on the risk of short nursing home episodes because these episodes are likely to be extensions of acute hospital care. The findings provide essential information for designing a long-term care program because they suggest the magnitudes of the effects that such a program can have on reducing the risk of permanent nursing home residence.
本研究考察了养老院长期居住与短期居住的差异，特别关注社区中非正式帮助的可获得性在多大程度上降低了长期入住养老院的风险。
使用的是二手数据，取自1982年和1984年的全国长期护理调查。1982年的全国长期护理调查样本为居住在社区中的残疾老年人。对于这些社区居民，1984年的全国长期护理调查提供了他们在1982年至1984年间继续居住在社区的情况以及养老院入住情况的信息。分析方法：分析基于多项逻辑回归估计，有三个明确类别：至少有一次长期养老院入住经历的人（n = 292）、只有短期入住经历的人（n = 227）以及从未入住过养老院就去世的人（n = 945）。隐含类别为：1984年居住在社区且从未入住过养老院的人（n = 3368）。
本研究表明，预测养老院长期居住风险的个人特征与预测短期居住风险的个人特征存在系统性差异。在控制了身体和认知功能的限制后，回归分析表明，社区中非正式帮助的指标对长期居住风险有统计学显著且相对较大的影响；但这些指标对短期居住风险的影响在数值上较小且无统计学显著性。具体而言，当配偶和子女分担护理负担时，养老院长期居住风险降低9.3个百分点；相比之下，独居无子女的老年人风险增加18个百分点，与配偶或子女以外的成年人同住的老年人风险增加45.8个百分点。
家庭帮助者和居住安排对养老院长期居住风险的影响相对较强，这证实了以下假设：在控制了身体和认知功能的影响后，社区中的充分帮助可降低长期入住养老院的风险。但社区帮助对短期养老院入住风险没有影响，因为这些短期入住可能是急性医院护理的延续。这些发现为设计长期护理项目提供了重要信息，因为它们表明了这样一个项目在降低长期入住养老院风险方面可能产生的影响程度。
