{"title":"对全国187,547名残疾老年人开展家庭保健前后5年期间的医疗保健利用、药物治疗处方和临床结果进行了研究。","authors":"Shih-Tsung Huang, Fei-Yuan Hsiao, Wei-Ju Lee, Ming-Yueh Chou, Chih-Kuang Liang, Chu-Sheng Lin, Ching-Hui Loh, Liang-Kung Chen","doi":"10.1016/j.tjfa.2025.100063","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Longitudinal trajectories of healthcare utilization, medication prescription, and clinical outcomes among older adults with disabilities receiving home healthcare (HHC) holds significance but remains elusive.</p><p><strong>Methods: </strong>People aged≥65 years who newly received Taiwan's National Health Insurance funded HHC program from January 2005 to December 2013 were identified. Healthcare utilization, life-sustaining treatment, medication prescriptions (polypharmacy, psychotropics, anticholinergic burden and antibiotics), health status (Charlson's comorbidity index, CCI), and mortality were assessed over a 10-year period spanning 5 years before and after initiating HHC.</p><p><strong>Results: </strong>Overall, 187,547 patients (80.6 ± 7.7 years, 51.2 % females, CCI 3+: 51.2 %) with a high prevalence of dementia (34.0 %), stroke (38.7 %), and pneumonia (49.5 %), and usage of life-sustaining treatment (urinary catheters: 82.8 % and nasogastric feeding: 78.7 %) were obtained. A sudden peak of admission rate at 1 year (91.7 %) before HHC, followed by the 70 % and 60 % admission rate in the first and second year after receiving HHC were found. Quarterly changes of using life-sustaining treatment showed significant increases from as early as 1 year prior to HHC. Gradual increases of polypharmacy, use of psychotropics, and antibiotic (4.5-fold and 3-fold) after HHC further demonstrated the complex needs (both p < 0.01). The 5-year cumulative mortality rate was 81 % (40 % in the first year with an annual rate of 25 %).</p><p><strong>Interpretation: </strong>HHC recipients embody a confluence of complex care needs and high mortality risk, whereby various interventions aim to alleviate symptoms and sustain life. Engaging in proactive advanced care planning and end-of-life care should be prioritized when home healthcare is being contemplated.</p>","PeriodicalId":51629,"journal":{"name":"Journal of Frailty & Aging","volume":"14 4","pages":"100063"},"PeriodicalIF":3.3000,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Healthcare utilization, pharmacotherapy prescriptions, and clinical outcomes across a 5-year duration preceding and succeeding the initiation of home health care in a nationwide population-based cohort of 187,547 older adults with disabilities.\",\"authors\":\"Shih-Tsung Huang, Fei-Yuan Hsiao, Wei-Ju Lee, Ming-Yueh Chou, Chih-Kuang Liang, Chu-Sheng Lin, Ching-Hui Loh, Liang-Kung Chen\",\"doi\":\"10.1016/j.tjfa.2025.100063\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Longitudinal trajectories of healthcare utilization, medication prescription, and clinical outcomes among older adults with disabilities receiving home healthcare (HHC) holds significance but remains elusive.</p><p><strong>Methods: </strong>People aged≥65 years who newly received Taiwan's National Health Insurance funded HHC program from January 2005 to December 2013 were identified. Healthcare utilization, life-sustaining treatment, medication prescriptions (polypharmacy, psychotropics, anticholinergic burden and antibiotics), health status (Charlson's comorbidity index, CCI), and mortality were assessed over a 10-year period spanning 5 years before and after initiating HHC.</p><p><strong>Results: </strong>Overall, 187,547 patients (80.6 ± 7.7 years, 51.2 % females, CCI 3+: 51.2 %) with a high prevalence of dementia (34.0 %), stroke (38.7 %), and pneumonia (49.5 %), and usage of life-sustaining treatment (urinary catheters: 82.8 % and nasogastric feeding: 78.7 %) were obtained. A sudden peak of admission rate at 1 year (91.7 %) before HHC, followed by the 70 % and 60 % admission rate in the first and second year after receiving HHC were found. Quarterly changes of using life-sustaining treatment showed significant increases from as early as 1 year prior to HHC. Gradual increases of polypharmacy, use of psychotropics, and antibiotic (4.5-fold and 3-fold) after HHC further demonstrated the complex needs (both p < 0.01). The 5-year cumulative mortality rate was 81 % (40 % in the first year with an annual rate of 25 %).</p><p><strong>Interpretation: </strong>HHC recipients embody a confluence of complex care needs and high mortality risk, whereby various interventions aim to alleviate symptoms and sustain life. Engaging in proactive advanced care planning and end-of-life care should be prioritized when home healthcare is being contemplated.</p>\",\"PeriodicalId\":51629,\"journal\":{\"name\":\"Journal of Frailty & Aging\",\"volume\":\"14 4\",\"pages\":\"100063\"},\"PeriodicalIF\":3.3000,\"publicationDate\":\"2025-07-02\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Frailty & Aging\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1016/j.tjfa.2025.100063\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"GERIATRICS & GERONTOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Frailty & Aging","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1016/j.tjfa.2025.100063","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"GERIATRICS & GERONTOLOGY","Score":null,"Total":0}
Healthcare utilization, pharmacotherapy prescriptions, and clinical outcomes across a 5-year duration preceding and succeeding the initiation of home health care in a nationwide population-based cohort of 187,547 older adults with disabilities.
Background: Longitudinal trajectories of healthcare utilization, medication prescription, and clinical outcomes among older adults with disabilities receiving home healthcare (HHC) holds significance but remains elusive.
Methods: People aged≥65 years who newly received Taiwan's National Health Insurance funded HHC program from January 2005 to December 2013 were identified. Healthcare utilization, life-sustaining treatment, medication prescriptions (polypharmacy, psychotropics, anticholinergic burden and antibiotics), health status (Charlson's comorbidity index, CCI), and mortality were assessed over a 10-year period spanning 5 years before and after initiating HHC.
Results: Overall, 187,547 patients (80.6 ± 7.7 years, 51.2 % females, CCI 3+: 51.2 %) with a high prevalence of dementia (34.0 %), stroke (38.7 %), and pneumonia (49.5 %), and usage of life-sustaining treatment (urinary catheters: 82.8 % and nasogastric feeding: 78.7 %) were obtained. A sudden peak of admission rate at 1 year (91.7 %) before HHC, followed by the 70 % and 60 % admission rate in the first and second year after receiving HHC were found. Quarterly changes of using life-sustaining treatment showed significant increases from as early as 1 year prior to HHC. Gradual increases of polypharmacy, use of psychotropics, and antibiotic (4.5-fold and 3-fold) after HHC further demonstrated the complex needs (both p < 0.01). The 5-year cumulative mortality rate was 81 % (40 % in the first year with an annual rate of 25 %).
Interpretation: HHC recipients embody a confluence of complex care needs and high mortality risk, whereby various interventions aim to alleviate symptoms and sustain life. Engaging in proactive advanced care planning and end-of-life care should be prioritized when home healthcare is being contemplated.
期刊介绍：
The Journal of Frailty & Aging is a peer-reviewed international journal aimed at presenting articles that are related to research in the area of aging and age-related (sub)clinical conditions. In particular, the journal publishes high-quality papers describing and discussing social, biological, and clinical features underlying the onset and development of frailty in older persons. The Journal of Frailty & Aging is composed by five different sections: - Biology of frailty and aging In this section, the journal presents reports from preclinical studies and experiences focused at identifying, describing, and understanding the subclinical pathophysiological mechanisms at the basis of frailty and aging. - Physical frailty and age-related body composition modifications Studies exploring the physical and functional components of frailty are contained in this section. Moreover, since body composition plays a major role in determining physical frailty and, at the same time, represents the most evident feature of the aging process, special attention is given to studies focused on sarcopenia and obesity at older age. - Neurosciences of frailty and aging The section presents results from studies exploring the cognitive and neurological aspects of frailty and age-related conditions. In particular, papers on neurodegenerative conditions of advanced age are welcomed. - Frailty and aging in clinical practice and public health This journal’s section is devoted at presenting studies on clinical issues of frailty and age-related conditions. This multidisciplinary section particularly welcomes reports from clinicians coming from different backgrounds and specialties dealing with the heterogeneous clinical manifestations of advanced age. Moreover, this part of the journal also contains reports on frailty- and age-related social and public health issues. - Clinical trials and therapeutics This final section contains all the manuscripts presenting data on (pharmacological and non-pharmacological) interventions aimed at preventing, delaying, or treating frailty and age-related conditions.The Journal of Frailty & Aging is a quarterly publication of original papers, review articles, case reports, controversies, letters to the Editor, and book reviews. Manuscripts will be evaluated by the editorial staff and, if suitable, by expert reviewers assigned by the editors. The journal particularly welcomes papers by researchers from different backgrounds and specialities who may want to share their views and experiences on the common themes of frailty and aging.The abstracting and indexing of the Journal of Frailty & Aging is covered by MEDLINE (approval by the National Library of Medicine in February 2016).
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