Importance of Geriatric Syndrome Screening within 48 Hours of Hospitalization for Identifying Readmission Risk: A Retrospective Study in an Acute-Care Hospital
Importance of Geriatric Syndrome Screening within 48 Hours of Hospitalization for Identifying Readmission Risk: A Retrospective Study in an Acute-Care Hospital
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DOI：
10.4235/agmr.20.0017
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发表时间：
2020-06-01
影响因子：
3.6
通讯作者：
Lee, Jongmin
中科院分区：
文献类型：
--
作者：
Shin, Jinyoung;Han, Seol-Heui;Lee, Jongmin
背景资料：鉴于老年综合征与再入院之间的关联，我们评估了老年综合征筛查护理（GSC）在识别再入院风险方面的适用性，并建议了GSC的适当时间。研究方法：在2016年11月至2017年10月期间，在2，663名65岁或以上的普通病房住院患者中，在入院后48小时内和出院前再次进行了考虑认知障碍，抑郁症，多种药物（五种或五种以上药物），功能移动性，吞咽困难，营养不良，疼痛和失禁的GSC。从每名患者，跌倒事件，压疮，潜在的不适当的药物使用，谵妄进行了评估，在入院。根据首次入院后1年内再入院的情况将患者分为两组。根据筛选期（入院时和出院前）和住院期间的下降情况，应用受试者工作特征曲线分析比较再入院组和未再入院组的临床问题患病率。我们还使用多元逻辑回归分析来评估根据老年综合征和临床结果的存在再入院的风险。结果：782例再入院患者（29.4%）的GSC不良率高于未再入院患者。入院时多种用药与再入院风险显著相关（受试者工作特征曲线下面积=0.602）。入院时跌倒事件（比值比[OR]=4.36; 95%可信区间[CI]，2.36-8.05）、尿失禁（OR=4.21; 95% CI，3.28-5.39）和抑郁情绪（OR=3.88; 95% CI，2.69-5.59）是再入院的危险因素。结论：入院时GSC评估的老年综合征与再入院风险增加相关。
Background: Given the association between geriatric syndrome and hospital readmission, we evaluated the suitability of geriatric syndrome screening for care (GSC) in identifying readmission risk and suggested the appropriate time for GSC. Methods: GSC considering cognitive impairment, depression, polypharmacy (five or more medications), functional mobility, dysphagia, malnutrition, pain, and incontinence was performed among 2,663 general ward inpatients aged 65 years or older within 48 hours after admission and again before discharge between November 2016 and October 2017. From each patient, fall events, pressure ulcers, potentially inappropriate medication use, and delirium were assessed at admission. Patients were divided into two groups on the basis of readmission within 1 year after the first admission. According to the screening period (at admission and before discharge) and in-hospital decline, we applied receiver operating characteristic curve analysis to compare the prevalence of clinical concerns between the readmission and no-readmission groups. We also used multiple logistic regression analysis to evaluate the risk of readmission according to the presence of geriatric syndrome and clinical outcomes. Results: The 782 readmitted patients (29.4%) showed a higher rate of poor GSC than those who were not readmitted. Polypharmacy at admission was significantly correlated with readmission risk (area under the receiver operating characteristic curve=0.602). Fall events (odds ratio [OR]=4.36; 95% confidence interval [Cl], 2.36-8.05), urinary incontinence (OR=4.21; 95% Cl, 3.28-5.39), and depressive mood (OR=3.88; 95/o Cl, 2.69-5.59) at admission were risk factors for readmission. Conclusion: Geriatric syndromes assessed by GSC at admission was associated with an increased risk of readmission.