Cognitively impaired older adults: From hospital to home
Cognitively impaired older adults: From hospital to home
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DOI：
10.1097/00000446-200502000-00028
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发表时间：
2005-02-01
影响因子：
2.7
通讯作者：
Bixby, MB
中科院分区：
文献类型：
--
作者：
Naylor, MD;Stephens, C;Bixby, MB
虽然众所周知，老年人的认知障碍会对住院期间和住院后的护理结果产生不利影响，但它往往未被认识或管理不善。很少有临床医生了解这些患者或其照顾者（配偶，伴侣，朋友或家庭成员）的需求。由于这些原因，我们进行了一项探索性研究，其主要目的如下：确定因急性内科或外科事件住院的老年人的认知障碍率确定这些老年人和照顾者在急性疾病发作期间的需求检查患者和照顾者在特定时间、住院期间和住院后立即的需求在费城的三家医院，对因常见内科或外科疾病住院的老年人进行了为期四个月的特定日期的认知障碍筛查。在完成筛查的145名患者中，65%（n = 94）无认知损害证据，35%（n = 51）有认知损害证据，后者中65%（n = 33）仅通过使用筛查工具识别出认知损害。患者及其护理人员一起接受访谈（4次，共20次患者-护理人员访谈）;每位护理人员也单独接受访谈（1次，共5次护理人员访谈）。访谈录都有记录。分析显示，病人和照顾者有未满足的需求，在以下几类：管理和谈判的照顾，管理疾病，心理社会应对。这项研究的结果强调了针对住院和出院后立即（2至6周）进行个性化干预的重要性。
Although it's known that cognitive impairment in older adults can adversely affect outcomes of care during and after hospitalization, it often goes unrecognized or is poorly managed. Few clinicians understand these patients' needs or those of their caregivers (a spouse, partner, friend, or family member). For these reasons, we conducted an exploratory study, the primary purposes of which were the following:to determine the rates of cognitive impairment among older adults hospitalized for acute medical or surgical eventsto identify the needs of these older adults and caregivers throughout an episode of acute illnessto examine patients' and caregivers' needs at specific times, during and immediately after hospitalizationOlder adults hospitalized for a common medical condition, or surgical condition were screened for the presence of cognitive impairment on specified days at three hospitals in Philadelphia for four months. Of 145 who completed the screening, 65% (n = 94) had no evidence of cognitive impairment and 35% (n = 51) had evidence of cognitive impairment; in 65 % (n = 3 3) of the latter group, cognitive impairment was identified only by using the screening instruments.Five cognitively impaired patients and their caregivers were identified as a convenience sub-sample; patients and their caregivers were interviewed together (four times, for a total of 20 patient-caregiver interviews); each caregiver was also interviewed alone (one time for a total of five caregiver interviews). The interviews were transcribed. Analysis of transcriptions revealed that patients and caregivers had unmet, needs in the following categories: managing and negotiating care, managing illness, and psychosocial coping. Findings from this study reinforce the critical importance of individualized interventions targeting the hospitalization and immediate-post-discharge period (two to six weeks).