Nursing Home Residents Face Severe Functional Limitation or Death After Hospitalization for Pneumonia.
Nursing Home Residents Face Severe Functional Limitation or Death After Hospitalization for Pneumonia.
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DOI：
10.1016/j.jamda.2020.09.010
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发表时间：
2020-12
影响因子：
7.6
通讯作者：
Teno JM
中科院分区：
文献类型：
--
作者：
Griffith MF;Levy CR;Parikh TJ;Stevens-Lapsley JE;Eber LB;Palat ST;Gozalo PL;Teno JM
肺炎是疗养院居民住院的常见原因，在新冠肺炎大流行期间，肺炎作为住院原因的比例有所增加。住院的风险，包括显著的功能下降，是决定是否在疗养院治疗居民或转移到医院时的重要考虑因素。对于因肺炎住院的疗养院居民的出院后功能状态，相对于基线，人们知之甚少。我们试图确定疗养院居民因肺炎住院治疗后严重功能受限或死亡的风险。回顾性队列研究。参与者包括65岁的联邦医疗保险参保人，他们在2013年至2014年期间因肺炎在美国的一家疗养院住院。日常生活能力(ADL)、患者社会人口学和合并症从最小数据集(MDS)获得，MDS是为所有疗养院居民完成的评估工具。比较住院前和住院后的MDS评估以评估功能下降。出院后，对所有患者在完成出院后MDS前住院或死亡后的严重残疾(≥4 ADL4限制)的综合结果进行评估。2013年和2014年，共有241,804名疗养院居民因肺炎住院，其中89.9%(192,736人)经历了因肺炎住院后严重残疾或死亡的综合结果。尽管我们发现院前功能和认知状态与综合结果的形成有关，但53%的住院患者没有院前ADL限制，82%的患者没有认知限制。住院治疗肺炎与疗养院居民功能下降和死亡的显著风险有关，即使是那些住院前缺陷最小的人也是如此。养老院需要在提前护理计划和康复努力中为这些结果做好准备。
Pneumonia is a common cause of hospitalization for nursing home residents and has increased as a cause for hospitalization during the COVID-19 pandemic. Risks of hospitalization, including significant functional decline, are important considerations when deciding whether to treat a resident in the nursing home or transfer to a hospital. Little is known about postdischarge functional status, relative to baseline, of nursing home residents hospitalized for pneumonia. We sought to determine the risk of severe functional limitation or death for nursing home residents following hospitalization for treatment of pneumonia. Retrospective cohort study. Participants included Medicare enrollees aged ≥65 years, hospitalized from a nursing home in the United States between 2013 and 2014 for pneumonia. Activities of daily living (ADL), patient sociodemographics, and comorbidities were obtained from the Minimum Data Set (MDS), an assessment tool completed for all nursing home residents. MDS assessments from prior to and following hospitalization were compared to assess for functional decline. Following hospital discharge, all patients were evaluated for a composite outcome of severe disability (≥4 ADL limitations) following hospitalization or death prior to completion of a postdischarge MDS. In 2013 and 2014, a total of 241,804 nursing home residents were hospitalized for pneumonia, of whom 89.9% (192,736) experienced the composite outcome of severe disability or death following hospitalization for pneumonia. Although we found that prehospitalization functional and cognitive status were associated with developing the composite outcome, 53% of residents with no prehospitalization ADL limitation, and 82% with no cognitive limitation experienced the outcome. Hospitalization for treatment of pneumonia is associated with significant risk of functional decline and death among nursing home residents, even those with minimal deficits prior to hospitalization. Nursing homes need to prepare for these outcomes in both advance care planning and in rehabilitation efforts.
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DOI：
10.1016/j.jamda.2010.03.011
发表时间：
2011-09-01
影响因子：
7.6
作者：
Hutt, Evelyn;Ruscin, J. Mark;McNulty, Monica C.
通讯作者：
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影响因子：
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作者：
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影响因子：
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作者：
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通讯作者：
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影响因子：
4.7
作者：
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通讯作者：
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影响因子：
6.3
作者：
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通讯作者：
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