PREDICTORS OF INSTITUTIONALIZATION IN DEMENTIA PATIENTS

痴呆症患者住院治疗的预测因素

• 批准号: 2052855
• 负责人: GLENN E. SMITH
• 金额: $ 10.86万
• 依托单位: MAYO CLINIC ROCHESTER
• 依托单位国家: 美国
• 财政年份: 1993
• 资助国家: 美国
• 起止时间: 1993-09-30 至 1998-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/2052855
• 关键词: age difference; behavior; caregivers; cognition; dementia; disease /disorder proneness /risk; female; gender difference; health care model; home health care; human morbidity; human old age (65+); human population study; human subject; institutional care facility; interpersonal relations; longitudinal human study; male; marriage /marital status; nursing homes; patient /disease registry; quality of life; training level

In 1985 1.3 million people were residing in nursing homes with costs of institutional care exceeding the direct medical costs of home care by as much as $11,000 per patient-year. Yet the factors contributing to institutionalization of dementia patients are not clearly understood.' The present study will undertake four related objectives. The first is to determine the cumulative incidence of institutionalization in population- based cohorts of dementia patients and their matched controls. The second is to determine risk for institutionalization of dementia patients associated with a) demographic factors, b) co-morbid illness c) non- nursing home health' care utilization and d) factors specific to the dementing illness. The third Objective is to determine the frequency with which institutionalization is initiated by family members versus health care professionals. The fourth objective is to distinguish between the presence of deteriorated functional status and caregivers' abilities to tolerate these impairments. Each of these aims has relevance for public policy and care innovations for dementia patients. The present study will capitalize on the Mayo Clinic Alzheimer's Disease Patient Registry (ADPR) and emulate the existing scheme of the ADPR in having retrospective and prospective components. The retrospective sample is population-based and includes 662 dementia patients with onset of dementia occurring between 1975-1984 and 662 age- and sex-matched controls. The medical records of cases and controls in 1975-1979 and 1980-1984 retrospective cohorts will be abstracted to determine the date and place of nursing home placement. Because of the medical records-linkage system at the Mayo Clinic these records are complete for all Olmsted County, MN patients. Rates of nursing home placement within the dementia sample will be calculated. Hazards models for placement associated with various demographic factors and an index of co-morbid illness will be calculated. The prospective sample is community-based and currently includes 536 matched pairs of dementia patients and controls. Data regarding residence will be collected during ADPR longitudinal follow-up procedures. Participants will be seen in their residence at follow-up so that place of residence will be determined by direct observation. Disease specific variables including cognitive status, functional status and behavioral disturbance will be integrated with co- morbidity and demographic data to develop hazards models for institutionalization in the prospective sample. Understanding which features of dementing disease processes are most directly related to institutionalization is a necessary precursor to intervention strategies seeking to delay or prevent the need for institutionalized care.

1985 年，有 130 万人住在疗养院，费用为 机构护理超过家庭护理的直接医疗费用 每个患者每年高达 11,000 美元。然而促成因素 痴呆症患者的收容尚不清楚。这 本研究将实现四个相关目标。第一个是 确定人口中收容机构的累积发生率 基于痴呆症患者及其匹配对照的队列。第二个 确定痴呆症患者入院的风险 与 a) 人口因素有关，b) 共存疾病 c) 非 疗养院医疗保健的利用率和 d) 特定于疗养院的因素 痴呆症。第三个目标是确定频率 哪种机构化是由家庭成员发起的还是由健康机构发起 护理专业人员。第四个目标是区分 功能状态和护理人员能力恶化的存在 容忍这些缺陷。这些目标中的每一个都与公众相关 痴呆症患者的政策和护理创新。本研究将 利用 Mayo Clinic 阿尔茨海默病患者登记处 (ADPR) 并效仿 ADPR 的现有方案进行追溯和 前瞻性组件。回顾性样本是基于人群的，并且 包括 662 名痴呆症患者，其痴呆症发作发生在 1975-1984 年和 662 个年龄和性别匹配的对照。的医疗记录 1975-1979 年和 1980-1984 年回顾性队列中的病例和对照 进行抽象以确定安置疗养院的日期和地点。 由于梅奥诊所的医疗记录链接系统，这些 明尼苏达州奥姆斯特德县所有患者的记录都是完整的。护理费率 将计算痴呆症样本中的家庭安置情况。危害 与各种人口因素相关的安置模型和 将计算合并症指数。预期样本是 以社区为基础，目前包括 536 对配对的痴呆症患者 患者和对照。有关居住的数据将在 ADPR 纵向随访程序。参与者将在他们的 后续居住地，居住地将由 直接观察。疾病特定变量，包括认知状态、 功能状态和行为障碍将与合作整合 发病率和人口统计数据来开发危害模型 预期样本中的制度化。了解哪些 痴呆疾病过程的特征与以下因素最直接相关： 制度化是干预战略的必要先决条件 寻求延迟或防止需要机构化护理。