Acute care of severely frail elderly patients in a CGA-unit is associated with less functional decline than conventional acute care.
Acute care of severely frail elderly patients in a CGA-unit is associated with less functional decline than conventional acute care.
复制标题
在CGA单位中对严重虚弱的老年患者进行急性护理与传统急性护理相比，其功能下降较少。
DOI：
10.2147/cia.s139230
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发表时间：
2017
影响因子：
3.6
通讯作者：
Karlson BW
中科院分区：
文献类型：
--
作者：
Ekerstad N;Dahlin Ivanoff S;Landahl S;Östberg G;Johansson M;Andersson D;Husberg M;Alwin J;Karlson BW
在专门的急性护理病房接受治疗的人中，很大一部分是体弱多病的老年人。我们的目的是研究在综合老年评估（CGA）单位的急性护理这类患者是否是上级照顾在传统的急性医疗保健单位，当涉及到日常生活活动（ADL），虚弱，和使用市政帮助服务。在瑞典西部的一家大型县级医院进行了一项临床、前瞻性、对照试验，其中包括408名年龄≥ 75岁的体弱老年患者（平均年龄85.7岁; 56%为女性）。患者被分配到干预组（n=206）或对照组（n=202）。主要结局是出院后3个月ADL阶梯评估的功能活动ADL下降。次要结果是虚弱程度和市政帮助服务的使用。经回归分析校正后，CGA单元治疗与ADL下降风险降低独立相关[比值比（OR）0.093; 95%置信区间（CI）0.052-0.164; P<0.0001]，且虚弱程度增加不太普遍（OR 0.229; 95%CI 0.131-0.400; P<0.0001）。当ADL分为三个阶层（独立性，工具ADL依赖性，个人ADL依赖性），变化到更依赖相关的阶层在干预组中不太普遍（OR 0.194; 95%CI 0.085-0.444; P=0.0001）。两组在增加使用市政帮助服务方面无显著差异（OR 0.682; 95%CI 0.395-1.178; P=0.170）。在CGA单元中对虚弱的老年患者进行急性护理与3个月后较少的功能能力丧失和较少的虚弱增加独立相关。
A high percentage of individuals treated in specialized acute care wards are frail and elderly. Our aim was to study whether the acute care of such patients in a comprehensive geriatric assessment (CGA) unit is superior to care in a conventional acute medical care unit when it comes to activities of daily living (ADLs), frailty, and use of municipal help services. A clinical, prospective, controlled trial with two parallel groups was conducted in a large county hospital in West Sweden and included 408 frail elderly patients, age 75 or older (mean age 85.7 years; 56% female). Patients were assigned to the intervention group (n=206) or control group (n=202). Primary outcome was decline in functional activity ADLs assessed by the ADL Staircase 3 months after discharge from hospital. Secondary outcomes were degree of frailty and use of municipal help services. After adjustment by regression analyses, treatment in a CGA unit was independently associated with lower risk of decline in ADLs [odds ratio (OR) 0.093; 95% confidence interval (CI) 0.052–0.164; P<0.0001], and with a less prevalent increase in the degree of frailty (OR 0.229; 95% CI 0.131–0.400; P<0.0001). When ADLs were classified into three strata (independence, instrumental ADL-dependence, and personal ADL-dependence), changes to a more dependence-associated stratum were less prevalent in the intervention group (OR 0.194; 95% CI 0.085–0.444; P=0.0001). There was no significant difference between the groups in increased use of municipal help services (OR 0.682; 95% CI 0.395–1.178; P=0.170). Acute care of frail elderly patients in a CGA unit was independently associated with lesser loss of functional ability and lesser increase in frailty after 3 months.