Long Term Outcomes of a Geriatric Liaison Intervention in Frail Elderly Cancer Patients.
Long Term Outcomes of a Geriatric Liaison Intervention in Frail Elderly Cancer Patients.
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DOI：
10.1371/journal.pone.0143364
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
van Leeuwen BL
中科院分区：
文献类型：
--
作者：
Hempenius L;Slaets JP;van Asselt D;de Bock TH;Wiggers T;van Leeuwen BL
本研究的目的是评估以医院为基础的老年联络干预的长期效果，以防止虚弱的老年癌症患者通过选择性手术治疗实体瘤后的术后谵妄。此外，研究了术后谵妄对长期预后的影响。本研究对体弱老年人联络干预研究的参与者进行了为期三个月的随访，这是一项多中心、前瞻性、随机对照试验。患者被随机分为标准治疗组和老年联络干预组。干预措施包括术前老年会诊、针对谵妄危险因素的个人治疗计划以及住院期间老年护士的日常访问。长期结果包括：死亡率、再住院、日常生活活动（ADL）功能、恢复独立的术前生活状态、使用支持性护理、认知功能和与健康相关的生活质量。分析260例患者资料，其中干预组127例，对照组133例。出院后3个月，干预组与常规护理组的各项指标均无差异。术后谵妄的存在与以下因素相关：ADL功能下降的风险增加（OR: 2.65, 95% CI: 1.02-6.88），支持辅助的使用增加（OR: 2.45, 95% CI: 1.02-5.87），以及恢复独立术前生活状态的机会减少（OR: 0.18, 95% CI: 0.07-0.49）。一项以医院为基础的老年联络干预预防体弱的老年癌症患者在接受选择性手术治疗实体瘤后的术后谵妄，在出院3个月后没有改善预后。证实了术后谵妄对晚期预后的负面影响。荷兰试验登记册，试验编号NTR 823。
The aim of this study was to evaluate the long term effects after discharge of a hospital-based geriatric liaison intervention to prevent postoperative delirium in frail elderly cancer patients treated with an elective surgical procedure for a solid tumour. In addition, the effect of a postoperative delirium on long term outcomes was examined. A three month follow-up was performed in participants of the Liaison Intervention in Frail Elderly study, a multicentre, prospective, randomized, controlled trial. Patients were randomized to standard treatment or a geriatric liaison intervention. The intervention consisted of a preoperative geriatric consultation, an individual treatment plan targeted at risk factors for delirium and daily visits by a geriatric nurse during the hospital stay. The long term outcomes included: mortality, rehospitalisation, Activities of Daily Living (ADL) functioning, return to the independent pre-operative living situation, use of supportive care, cognitive functioning and health related quality of life. Data of 260 patients (intervention n = 127, Control n = 133) were analysed. There were no differences between the intervention group and usual-care group for any of the outcomes three months after discharge. The presence of postoperative delirium was associated with: an increased risk of decline in ADL functioning (OR: 2.65, 95% CI: 1.02–6.88), an increased use of supportive assistance (OR: 2.45, 95% CI: 1.02–5.87) and a decreased chance to return to the independent preoperative living situation (OR: 0.18, 95% CI: 0.07–0.49). A hospital-based geriatric liaison intervention for the prevention of postoperative delirium in frail elderly cancer patients undergoing elective surgery for a solid tumour did not improve outcomes 3 months after discharge from hospital. The negative effect of a postoperative delirium on late outcome was confirmed. Nederlands Trial Register, Trial ID NTR 823.