Abstract：
BACKGROUND: Many health systems are trying to support the ability of older adults to remain in their homes for as long as possible. Little is known about the relationship between patient-reported social risks and length of time spent at home. We assessed how social risks were associated with days at home for a cohort of older Veterans at high risk for hospitalization and mortality.
METHODS: A prospective cross-sectional study using a 2018 survey of 3479 high-risk Veterans aged ≥65 linked to Veterans Health Administration data. Social risks included measures of social resources (i.e., no partner present, low social support), material resources (i.e., not employed, financial strain, medication insecurity, food insecurity, and transportation barriers), and personal resources (i.e., low medical literacy and less than high school education). We estimated how social risks were associated with days at home, defined as the number of days spent outside inpatient, long-term care, observation, or emergency department settings over a 12-month period, using a negative binomial regression model.
RESULTS: Not having a partner, not being employed, experiencing transportation barriers, and low medical literacy were respectively associated with 2.57, 3.18, 3.39, and 6.14 fewer days at home (i.e., 27% more facility days, 95% confidence interval [CI] 8%-50%; 42% more facility days, 95% CI 7%-89%; 34% more facility days, 95% CI 7%-68%; and 63% more facility days, 95% CI 27%-109%). Experiencing food insecurity was associated with 2.62 more days at home (i.e., 24% fewer facility days, 95% CI 3%-59%).
CONCLUSIONS: Findings suggest that screening older Veterans at high risk of community exit for social risks (i.e., social support, material resources, and medical literacy) may help identify patients likely to benefit from home- and community-based health and social services that facilitate remaining in home settings. Future research should focus on understanding the mechanisms by which these associations occur.
METHODS: A prospective cross-sectional study using a 2018 survey of 3479 high-risk Veterans aged ≥65 linked to Veterans Health Administration data. Social risks included measures of social resources (i.e., no partner present, low social support), material resources (i.e., not employed, financial strain, medication insecurity, food insecurity, and transportation barriers), and personal resources (i.e., low medical literacy and less than high school education). We estimated how social risks were associated with days at home, defined as the number of days spent outside inpatient, long-term care, observation, or emergency department settings over a 12-month period, using a negative binomial regression model.
RESULTS: Not having a partner, not being employed, experiencing transportation barriers, and low medical literacy were respectively associated with 2.57, 3.18, 3.39, and 6.14 fewer days at home (i.e., 27% more facility days, 95% confidence interval [CI] 8%-50%; 42% more facility days, 95% CI 7%-89%; 34% more facility days, 95% CI 7%-68%; and 63% more facility days, 95% CI 27%-109%). Experiencing food insecurity was associated with 2.62 more days at home (i.e., 24% fewer facility days, 95% CI 3%-59%).
CONCLUSIONS: Findings suggest that screening older Veterans at high risk of community exit for social risks (i.e., social support, material resources, and medical literacy) may help identify patients likely to benefit from home- and community-based health and social services that facilitate remaining in home settings. Future research should focus on understanding the mechanisms by which these associations occur.
摘要：
背景：许多卫生系统都在努力支持老年人尽可能长时间留在家中的能力。关于患者报告的社会风险与在家时间长短之间的关系知之甚少。我们评估了社会风险与在家生活天数之间的关系，研究了一组住院和死亡风险较高的老年退伍军人。
方法：一项前瞻性横断面研究，使用2018年对3479名年龄≥65岁的高危退伍军人进行的调查与退伍军人健康管理局的数据相关。社会风险包括社会资源的衡量标准(即，没有合伙人在场,低社会支持)，物质资源(即，没有雇佣,财务压力，药物不安全，粮食不安全，和运输障碍)，和个人资源(即，医学素养低，低于高中教育)。我们估计了社会风险与在家的日子有何关联，定义为住院以外的天数，长期护理,观察,或12个月内的急诊科设置，使用负二项回归模型。
结果：没有合作伙伴，没有被雇用,遇到交通障碍，和低医学素养分别与在家天数减少2.57、3.18、3.39和6.14相关(即，设施天数增加27%，95%置信区间[CI]8%-50%；设施天数增加42%，95%CI7%-89%；设施天数增加34%，95%CI7%-68%；设施天数增加63%，95%CI27%-109%）。经历粮食不安全与在家呆2.62天相关(即，设施天数减少24%，95%CI3%-59%）。
结论：研究结果表明，筛查社区退出高风险的老年退伍军人的社会风险（即，社会支持,物质资源,和医疗素养）可能有助于确定可能受益于家庭和社区健康和社会服务的患者，这些服务有助于留在家庭环境中。未来的研究应该集中在理解这些关联发生的机制上。
方法：一项前瞻性横断面研究，使用2018年对3479名年龄≥65岁的高危退伍军人进行的调查与退伍军人健康管理局的数据相关。社会风险包括社会资源的衡量标准(即，没有合伙人在场,低社会支持)，物质资源(即，没有雇佣,财务压力，药物不安全，粮食不安全，和运输障碍)，和个人资源(即，医学素养低，低于高中教育)。我们估计了社会风险与在家的日子有何关联，定义为住院以外的天数，长期护理,观察,或12个月内的急诊科设置，使用负二项回归模型。
结果：没有合作伙伴，没有被雇用,遇到交通障碍，和低医学素养分别与在家天数减少2.57、3.18、3.39和6.14相关(即，设施天数增加27%，95%置信区间[CI]8%-50%；设施天数增加42%，95%CI7%-89%；设施天数增加34%，95%CI7%-68%；设施天数增加63%，95%CI27%-109%）。经历粮食不安全与在家呆2.62天相关(即，设施天数减少24%，95%CI3%-59%）。
结论：研究结果表明，筛查社区退出高风险的老年退伍军人的社会风险（即，社会支持,物质资源,和医疗素养）可能有助于确定可能受益于家庭和社区健康和社会服务的患者，这些服务有助于留在家庭环境中。未来的研究应该集中在理解这些关联发生的机制上。
