背景:接受家庭护理的老年人比没有接受家庭护理的社区老年人有更高的去急诊科(ED)的风险。这可能是由于家庭护理接受者的合并症发生率较高和功能自主性降低所致。由于人们因其不同的合并症和自主性而接受不同类型的家庭护理,区分家庭护理的形式可能有助于识别具有不同ED就诊风险的亚人群,并有助于制定有针对性的干预措施.这项研究旨在比较接受不同形式的家庭护理的老年人和在一年内没有接受家庭护理的老年人访问ED的风险。
方法:使用2019年收集的65岁以上荷兰人口(N=3,314,440)的索赔数据进行了回顾性队列研究。参与者分类如下:没有声称的家庭护理(NO),家庭帮助(HH),个人护理(PC)HH+PC,和家庭护理(NHH)。主要结果是访问ED的人数。次要结果是家庭护理发生变化的人数,被制度化的人,或者谁死了。采用探索性逻辑回归。
结果:NO组中有2,758,093名成年人,HH组中的131,260,PC组中的154,462,HH+PC组中的96,526,和34,612在NHH基团中。家庭护理组比NO组观察到更多的ED就诊,对于PC组,这种风险增加到两倍以上。更密集的家庭护理形式发生了重大变化,制度化,或所有群体中的死亡。
结论:区分老年人接受的家庭护理形式可识别出与未接受家庭护理的社区居住老年人相比,ED就诊风险不同的亚人群。家庭护理过渡频繁,主要涉及更多的重症监护或死亡。尽管未接受家庭护理的老年人发生ED的风险较低,他们对ED访问的绝对量贡献最大。
BACKGROUND: Older adults receiving home care have a higher risk of visiting the emergency department (ED) than community-dwelling older adults not receiving home care. This may result from a higher incidence of comorbidities and reduced functional autonomy in home care recipients. Since people receive different types of home care because of their different comorbidities and autonomy profiles, it is possible that distinguishing between the form of home care can help identify subpopulations with different risks for ED visits and help develop targeted interventions. This study aimed to compare the risk of visiting the ED in older adults receiving different forms of home care with those living at home without receiving home care in a national cohort in one year.
METHODS: A retrospective cohort study using claims data collected in 2019 on the Dutch population aged ≥ 65 years (N = 3,314,440) was conducted. Participants were classified as follows: no claimed home care (NO), household help (HH), personal care (PC), HH + PC, and nursing home care at home (NHH). The primary outcome was the number of individuals that visited the ED. Secondary outcomes were the number of individuals whose home care changed, who were institutionalized, or who died. Exploratory logistic regression was applied.
RESULTS: There were 2,758,093 adults in the NO group, 131,260 in the HH group, 154,462 in the PC group, 96,526 in the HH + PC group, and 34,612 in the NHH group. More ED visits were observed in the home care groups than in the NO group, and this risk increased to more than two-fold for the PC groups. There was a significant change to a more intensive form of home care, institutionalization, or death in all groups.
CONCLUSIONS: Distinguishing between the form of home care older adults receive identifies subpopulations with different risks for ED visits compared with community-dwelling older adults not receiving home care on a population level. Home care transitions are frequent and mostly involve more intensive care or death. Although older adults not receiving home care have a lower risk of ED visits, they contribute most to the absolute volume of ED visits.