Grundy E, Glaser K
King's College, London.
J Epidemiol Community Health. 1997 Oct;51(5):531-40. doi: 10.1136/jech.51.5.531.
To compare transitions from private households to institutions between 1971-81 and 1981-91 among elderly people and see whether (1) differentials in the risk of institutionalisation changed and (2) whether the risk was higher in the second period.
Cross sequential analysis of data from the Office of National Statistics longitudinal study, a record linkage study which included individual level data from three national censuses, (1971, 1981, and 1991) and linked vital registration data.
Altogether 26,400 people aged 65 and over in 1971-81 and 32,500 persons aged 65 and over in 1981-91. These samples represent 1% of the population of England and Wales.
In both periods models including age, housing tenure, and marital status or household/family type terms fitted the data reasonably well. The effect of age was stronger in the second decade, while that of marital status was reduced. The risk of transition to an institution was nearly 33-52% higher in the second decade after controlling for these factors.
During the 1980s the availability of state financed institutional care increased substantially; a growth which the 1990 NHS and Community Care Act was designed to reverse. Increased access to institutional care undoubtedly is one factor underlying the higher transition rate to institutions observed in 1981-91 than for the previous decade. During 1981-91, transitions to live with relatives also declined substantially. It is not clear whether this simply represents the continuation of a previous trend or whether the increased availability of institutional care led to some substitution for family care. Either interpretation has worrying implications for policy makers keen to promote care in the community.
比较1971 - 1981年和1981 - 1991年老年人从私人家庭向机构转变的情况，并查看（1）机构收容风险的差异是否发生变化，以及（2）第二个时期的风险是否更高。
对国家统计局纵向研究的数据进行交叉序列分析，这是一项记录链接研究，包括来自三次全国人口普查（1971年、1981年和1991年）的个体层面数据以及链接的人口动态登记数据。
1971 - 1981年共有26400名65岁及以上的人，1981 - 1991年有32500名65岁及以上的人。这些样本代表了英格兰和威尔士人口的1%。
在两个时期，包含年龄、住房保有形式、婚姻状况或家庭/家庭类型等因素的模型都能较好地拟合数据。年龄的影响在第二个十年更强，而婚姻状况的影响则有所减弱。在控制这些因素后，第二个十年向机构转变的风险高出近33% - 52%。
在20世纪80年代，国家资助的机构护理的可及性大幅增加；1990年的《国民健康服务与社区护理法案》旨在扭转这一增长趋势。机构护理可及性的增加无疑是1981 - 1991年观察到的向机构转变率高于前一个十年的一个因素。在1981 - 1991年期间，向亲属家居住的转变也大幅下降。尚不清楚这仅仅是先前趋势的延续，还是机构护理可及性的增加导致了对家庭护理的某种替代。对于热衷于促进社区护理的政策制定者来说，这两种解释都有令人担忧的影响。
