城市老年人口中社区养老和机构养老间的转换的外文翻译.docx

城市老年人口中社区养老和机构养老间的转换的外文翻译.docx

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城市老年人口中社区养老和机构养老间的转换的外文翻译

外文翻译

原文：

Transitionsbetweencommunityandnursinghomeresidenceinanurbanelderly

Abstract:

Overthecourseofathreeyearobservationandstudyperiod,some6%ofarepresentativecommunityresidingurbanelderlypopulationwereadmittedtonursinghomes.Nearlyhalfofthisgroupwerestilllivinginnursinghomesattheendofthisobservationperiod.Onethirdhaddiedafterenteringthenursinghome,andtheremainingpeoplehadreturnedtotheirownhomesinthecommunity.Thesethreegroupshadsignificantlydifferentmeanlengthsofstayinnursinghomes;nearlytwoyearsforthosewhosestaysweremorepermanent,50daysforthosewhosestayswereshortterm,and153daysonaverageforthosewhodiedfollowingadmission.

Atbaseline,thethreegroupsalsotendedtohavedifferentpatternsofhealth,functionalandsocialcharacteristics.Theshorttermstayersandthosewhodiedfollowingadmissiontoanursinghomedifferedfromrespondentswhodidnotenternursinghomes--primarilyintermsofpriorlivingarrangementsandlevelsofsocialsupport.Thepermanentstayersdifferedfromthetwoothernursinghomesub-groups,andfromcommunityresidents,inthattheytendedtobeolderandmorefunctionallyandmentallyimpaired.However,atbaselinetheyappearedatlessrisktoexpirethanthosepeoplewholaterdiedfollowingadmissiontonursinghomes.

Clinicalandresearchimplicationsbasedonthesefindingsarediscussed.

Background

Issuesconcerningtheplaceofnursinghomecareinacontinuumoflongtermcareservicescontinuetooccupytheattentionofhealthcareplanners,administrators,clinicians,andresearchers.'Thishasbeenthecaseforanumberofreasons.

First,morethan1,350,000elderlyAmericanscurrentlyresideinnursinghomes,andthenumberofnursinghomebedsnowexceedsthenumberofacutecarehospitalbeds.Whileatanyonemomentintimeonly5%ofthepopulation65yearsold,orolder,arenursinghomeresidents,thelife-timeriskofbeingadmittedtoanursinghomehasbeenvariouslyestimatedasupwardsof40%.

Second,costsfornursinghomecarearesubstantial.Theyaresecondonlytohospitalcareasaproportionofallexpendituresforhealthcare?

Nursinghomecostsencompassapproximately40%ofallMedicaidcostsandforcemanyotherwiseincomeindependentelderlyindividualsintopoverty.

Third,theavailabilityofandaccesstonursinghomebedsandtoqualitycareinnursinghomesispoorlyandunevenlydistributed.Finally,havingtorelinquishresidenceinthecommunityforinstitutionallivingisanabruptandradicaltransitionthatisseldomwelcomedbyelderlypersonsortheirfamilymembersexceptincasesofextremehardshiporsicknessamongcaregiversandisacceptedonlyasalastresortorwhenothercareoptionsareeithernotavailableorhavebeenexhausted.

Themagnitudeandurgencyoftheproblemofprovidingnursinghomecare--particularlyinaneraofbudgetarystringency--anditslikelygrowthovertimeduetothegrayingofthepopulationandincreaseintheproportionoftheoldestsegmentofthatpopulation,continuestogiverisetoalargebodyofresearch.Theseeffortsincludedinformationoncharacteristicsofnursinghomepopulations,determinantsofnursinghomeadmissionsandoutcomes,costs,policiesandplanning,andthetreatmentofmedicalconditions.Muchofthisliteratureisbeyondthescopeofthispaper.

Studiesofdiverseelderlypopulationsrangingfromthosefewthatincludebroadlyrepresentativegroupsaswellaspopulationsoffrailordisabledindividuals,thoselivinginspecialhousingenvironments,orparticipantsinspecialprograms,havecommonlyidentifiedadvancedageandfunctionaldeficitsashighriskfactorsfornursinghomeplacement.Studiesofelderlypopulationslivinginnursinghomesindicatethattheresidentpopulationshavebecomeolder,moredisabled,andhavehighratesofhospitalizationanddeath.Otherstudieshavedocumentedsignificantlocalandregionalvariationsinboththenumbersandcharacteristicsofreferralstonursinghomesandresidentpopulations,andhavedescribedvariationsinlengthofstayamongthoseadmittedtonursinghomes.

Despitetheseandotheradvancesinourknowledgeofthenursinghomeasasocialandhealthcareinstitution,anditsusebyelderlypopulations,significantgapsintheprecisionandrangeofthisknowledgeremaintobeclosed.Littleisknown,forexample,ofthedynamicsofthetransitionfromcommunitytonursinghomeresidenceand,forsome,returntolivinginthecommunity.Ourinabilitytopredictortoidentifymoreaccuratelypersonsathighriskofnursinghomeplacementhaslimitedourabilitytoprovidecommunity-basedservicesthatcouldsubstituteorpreventnursinghomeplacement.Becausewehaveinfrequentlystudiedrepresentativecommunitypopulationslongitudinally,dataonincidenceandprevalencearealsolimited.

Alongitudinalstudyofhealth,healthcareandaginginarepresentativeurbanpopulationofelderlypersonsresidinginthecommunityprovidedanopportunitytoexplorecertainofthetransitionaldynamics,characteristics,andoutcomesofstudyparticipantswhowereadmittedtonursinghomesduringthecourseofathreeyearperiodofobservation.Inthispaperwepresentfirstourfindingsfromanalysesoftheoccurrencesofnursinghomeadmissionsfollowedbytheresultsofanalysesofthehealthandsocialcharacteristicsofrespondentswhoexperiencedoneormorenursinghomeadmissions.

SociomedicalCharacteristicsoftheNursingHomeSubgroups

Theefforttodeterminewhetherthesenursinghomegroupscouldbedistinguishedfromoneanother,accordingtotheirsociomedicalcharacteristics,requiredseveralanalyticsteps.Wefirstcalculatedforeachgroupthemeanvaluesforbaselinesocial,demographic,economic,health,functional,socialsupport,andmedicalcarevariablesthattheliteraturesuggestedwererelatedeithertoadmissionortolengthofstayinnursinghomes.ThevariableswhichweresignificantlydifferentamongthegroupsareshowninTable4.

Othervariables,suggestedasimportantintheliterature,hadmeansthatwerenotsignificantlydifferentacrossthegroupsandthereforearenotshowninTable4.Thesevariablesincludedbaselinemeasuresofthenumberofreportedmedicalconditions,priorhospitalizations,nursinghomestaysandambulatorycarevisits,receiptofformalbutnotinformalsocialsupport,primarysourceofhealthcareotherthanahospital（grouppractice,privatephysician,otherornone）,ethnicandeducationalbackground,andlivingwithone'sspouse.

MultivariateAnalyses

WhiletherewereanumberofsignificantdistinctionsamongtheseoutcomegroupsasshowninTable4,theseunivariatedifferencesmaynotholdupwhenotherpossiblyconfoundingorcorrelatedvariablesaresystematicallycontrolledinamultivariateanalysis.Sinceouranalyticgoalsweremoredescriptivethanetiologicandthebackgroundliteraturesuggestedthatclustersofvariablesratherthanindividualvariablesweremorelikelytoberelevantindistinguishingbetweenthesegroups,wechosetousestepwisediscriminantfunctionanalysisasthemultivariateprocedure.

Wefirstformulatedaseriesofquestionsandthendevelopedsetsofanalyticcomparisonsbetweengroups.Thefirstquestionwaswhetherwecoulddistinguishallthoseadmittedtonursinghomes--whethertheyreturnedtocommunityornot,orevenwhethertheydiedornot--fromcommunityresidentswhowerenotadmittedtonursinghomesandsurvived,andfromcommunityresidentswhodied.Second,weaskedwhetherthereweredistinctionsbetweenthetwocommunityresidentgroups--thosewhoremainedaliveandthosewhodiedandthenursinghomesub-groups--theshorttermandthelongtermstayersandthosewhodiedfollowinganursinghomeadmission.Finally,wesoughttodeterminewhetherthereweredifferentsociomedicalcharacteristicsthatdistinguishedthethreenursinghomesubgroupsfromoneanother--apartfromwhateverdistinctionsemergedfromtheirearliercomparisonswiththecommunityresidentgroups.

SummaryandConclusions

Thefindingsofthisstudycanbesummarizedasfollows:

1.Overathreeyearperiod6%ofthecrosssectionofcommunityresidingolderpersonswereadmittedtonursinghomes.Athirdofthoseadmitteddied,nearlyhalfcontinuedtoresideinnursinghomes,andtheremainderreturnedtotheirhomes.Whilethenumberofnursinghomeentrantsmayseemsmall,itshouldbenotedthatthestudysamplewaslimitedtothoseelderlypersonsresidingintheirhomesandexcludedthoseinhospitalsorinnursinghomesatthetimethesamplewasselected.The6%figurecanbeviewedastherateofnursinghomeadmissionoverathreeyearperiodinanurbancommunitywithareasonablyadequatesupplyofmedicalcare,healthrelated,andlongtermcareservicesandfacilities.

2.Nursinghomesubgroupswereidentifiedthatdifferedfromeachothersociomedicallyandinlengthofstay.Thoseadmittedforshortstaysinnursinghomesresembledcommunityresidentsnotadmittedtonursinghomesmorethantheydidthepermanentnursinghomestayers.Similarly,thosewhodiedsubsequenttoanursinghomeadmissionresembledthosewhodiedinthecommunity.Inbothinstances,priorlevelsofsocialsupportandlivingarrangementsweretheprimarydistinctionbetweenthesetwonursinghomesubgroupsandtheircounterpartsinthecommunity.

3.Thepermanentnursinghomestayers,incontrasttothecommunityresidentsandtheothertwonursinghomesubgroupsweremorelikelytobeolder,moredisabled,andmentallyimpaired,sustainedstrokesmoreoften,andreceivedmoreinformalandformalsocialsupportpriortotheiradmission.T