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130万人居住在疗养院中 通过AS的机构护理超过家庭护理的直接医疗费用 每年$ 11,000 $ 11,000。然而，导致的因素 痴呆症患者的制度化尚不清楚。”这 目前的研究将实现四个相关目标。首先是 确定人口中制度化的累积发生率 - 基于痴呆症患者及其匹配对照组的同类。第二个 是确定痴呆症患者制度化的风险 与a）人口统计学因素相关，b）合并疾病c）非 - 疗养院的健康护理利用和d）特有的因素 痴呆疾病。第三个目标是确定频率 家庭成员与健康发起了哪些制度化 护理专业人员。第四个目标是区分 存在恶化的功能状况和护理人员的能力 容忍这些障碍。这些目标都与公众相关 痴呆症患者的政策和护理创新。本研究将 利用梅奥诊所阿尔茨海默氏病患者登记册（ADPR） 并模仿ADPR的现有方案，并具有回顾性和 潜在组成部分。回顾性样本是基于人群的， 包括662例痴呆症患者 1975-1984和662年龄和性别匹配的对照。医疗记录 1975年至1979年和1980 - 1984年的案件和对照 抽象以确定疗养院安置的日期和地点。 由于梅奥诊所的病历连接系统 明尼苏达州所有Olmsted县的记录均已完成。护理率 将计算痴呆症样本中的家居位置。危险 与各种人口因素相关的放置模型和 将计算合并症的指数。前瞻性样本是 基于社区，目前包括536对痴呆症对 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 在后续行动中居住，以便居住地确定 直接观察。疾病特定的变量，包括认知状况， 功能状态和行为障碍将与共同融合 发病率和人口统计数据开发危害模型 前瞻性样本中的制度化。了解哪个 痴呆疾病过程的特征与 制度化是干预策略的必要先驱 试图延迟或防止需要制度化护理。