Josephine C. Jacobs PhD, Liberty Greene MS, MEd, Mayuree Rao MD, MS, Valerie A. Smith DrPH, Courtney H. Van Houtven PhD, Matthew L. Maciejewski PhD, Donna M. Zulman MD, MS
{"title":"老年退伍军人的社会风险与在家天数之间的关联。","authors":"Josephine C. Jacobs PhD, Liberty Greene MS, MEd, Mayuree Rao MD, MS, Valerie A. Smith DrPH, Courtney H. Van Houtven PhD, Matthew L. Maciejewski PhD, Donna M. Zulman MD, MS","doi":"10.1111/jgs.19064","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>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%).</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>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.</p>\n </section>\n </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 10","pages":"3035-3045"},"PeriodicalIF":4.3000,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"The association between social risks and days at home for older veterans\",\"authors\":\"Josephine C. Jacobs PhD, Liberty Greene MS, MEd, Mayuree Rao MD, MS, Valerie A. Smith DrPH, Courtney H. Van Houtven PhD, Matthew L. Maciejewski PhD, Donna M. Zulman MD, MS\",\"doi\":\"10.1111/jgs.19064\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Background</h3>\\n \\n <p>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.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>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.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>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%).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusions</h3>\\n \\n <p>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.</p>\\n </section>\\n </div>\",\"PeriodicalId\":17240,\"journal\":{\"name\":\"Journal of the American Geriatrics Society\",\"volume\":\"72 10\",\"pages\":\"3035-3045\"},\"PeriodicalIF\":4.3000,\"publicationDate\":\"2024-07-12\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of the American Geriatrics Society\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1111/jgs.19064\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"GERIATRICS & GERONTOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of the American Geriatrics Society","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/jgs.19064","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"GERIATRICS & GERONTOLOGY","Score":null,"Total":0}
The association between social risks and days at home for older veterans
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.
期刊介绍：
Journal of the American Geriatrics Society (JAGS) is the go-to journal for clinical aging research. We provide a diverse, interprofessional community of healthcare professionals with the latest insights on geriatrics education, clinical practice, and public policy—all supporting the high-quality, person-centered care essential to our well-being as we age. Since the publication of our first edition in 1953, JAGS has remained one of the oldest and most impactful journals dedicated exclusively to gerontology and geriatrics.
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