Stearns S C, Kovar M G, Hayes K, Koch G G
Department of Health Policy and Administration, University of North Carolina, Chapel Hill 27599-7400, USA.
Health Serv Res. 1996 Apr;31(1):49-69.
High levels of hospital expenditures for older people during their last year of life are widely documented. However, evidence of the association between prospectively measured indicators and subsequent hospitalization is sparse. This article investigates the pattern of hospitalization for a sample of Medicare enrollees during their last year of life.
Data from the Longitudinal Study of Aging, a national study of persons age 70 and older, are used. Only data on decedents are used.
We determine individual characteristics (including functional status, evidence of disease, living arrangement, and prior hospitalization) shortly before the last year of life. A distinction is made between terminal and nonterminal admissions. National estimates and regression analyses using survey weights are conducted.
The likelihood of any use is high regardless of age, functional status, or the presence of major diseases. Although only a few indicators are associated with having a terminal stay, a number of indicators are associated with nonterminal use. Nonterminal stays and total nights hospitalized are positively associated with prior evidence of disease, prior hospitalization, and age, although the probability of nonterminal use decreases with age for persons over 82 years old. The relationship between use and functional status depends on whether persons lived alone, were institutionalized, or had private health insurance.
This study demonstrates that while it is difficult to predict who will be admitted to the hospital at the time of death, a number of characteristics existing before the last year of life are associated with nonterminal hospitalization and total nights hospitalized during the last year of life.
老年人在生命最后一年的高额住院费用有大量记录。然而，前瞻性测量指标与随后住院之间关联的证据却很少。本文调查了医疗保险参保者样本在生命最后一年的住院模式。
使用来自全国70岁及以上人群的老龄化纵向研究的数据。仅使用死者的数据。
我们在生命最后一年前不久确定个体特征（包括功能状态、疾病证据、生活安排和既往住院情况）。区分终末期和非终末期入院。使用调查权重进行全国估计和回归分析。
无论年龄、功能状态或是否患有重大疾病，任何使用的可能性都很高。虽然只有少数指标与终末期住院有关，但许多指标与非终末期使用有关。非终末期住院天数和总住院天数与既往疾病证据、既往住院情况和年龄呈正相关，不过82岁以上人群非终末期使用的概率随年龄下降。使用与功能状态之间的关系取决于个体是独居、住在养老院还是拥有私人医疗保险。
本研究表明，虽然很难预测谁会在死亡时住院，但生命最后一年之前存在的一些特征与非终末期住院以及生命最后一年的总住院天数有关。
