Timing and Risk Factors for Functional Changes Associated With Medical Hospitalization in Older Patients
Timing and Risk Factors for Functional Changes Associated With Medical Hospitalization in Older Patients
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DOI：
10.1093/gerona/glq069
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发表时间：
2010-08-01
影响因子：
5.1
通讯作者：
Denaro, Charles P.
中科院分区：
文献类型：
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作者：
Mudge, Alison M.;O'Rourke, Peter;Denaro, Charles P.
背景。老年患者在住院治疗过程中经常出现功能下降。这种下降有些是在入院时就已经确定的，而有些是在住院期间发生的。本研究的目的是分别描述澳大利亚老年患者院前和院内的功能变化，并确定与这些功能变化相关的危险因素。在澳大利亚某三级教学医院的普通医疗单位进行的前瞻性对照试验数据的二次分析。参与者是615名65岁或65岁以上的连续患者，在普通医疗单位住院超过2天，活着出院，并且在入院前基线没有完全依赖。入院前2周、入院时和出院时测量的日常生活活动用于计算院前和院内下降率以及院内恢复到入院前功能的比率。潜在的预测因素包括年龄、性别、诊断、疾病严重程度、入院前功能、入院前支持和记录的“老年综合征”（痴呆、跌倒、营养不良），使用多元logistic回归模型对每个功能改变结果进行了调查。64%的参与者院前功能下降；其中只有42%的患者在出院时恢复到入院前的功能。只有7%的患者住院率下降。不同的功能变化变量具有不同的预测因子模式。大多数下降发生在住院前，并与住院老年人预后不良的常见指标相关。住院下降并不常见，提示住院康复可能是一个更合适的干预目标。
Background. Older medical patients often experience a decline in function associated with hospitalization. Some of this decline is already established at hospital admission, whereas some occurs during hospitalization. Objectives of this study were to separately describe pre-hospital and in-hospital functional changes in older Australian medical patients and to identify risk factors associated with these functional changes.Methods. Secondary analysis of data from a prospective controlled trial conducted in general medical units of an Australian tertiary teaching hospital. Participants were 615 consecutive patients aged 65 years or older admitted under a general medical unit for more than 2 days, discharged alive, and not fully dependent at pre-admission baseline. Activities of daily living measured 2 weeks before admission, at admission, and at discharge were used to calculate rates of pre-hospital and in-hospital decline and of in-hospital recovery to pre-admission function. Potential predictors including age, sex, diagnosis, illness severity, pre-admission function, pre-admission supports, and documented "geriatric syndromes" (dementia, falls, malnutrition) were investigated for each functional change outcome using multiple logistic regression models.Results. Sixty-four percent of participants had pre-hospital functional decline; only 42% of these had recovered to pre-admission function by hospital discharge. Only 7% had in-hospital decline. The different functional change variables had distinct patterns of predictors.Conclusions. Most decline occurred prior to hospitalization and was associated with common indicators of poor outcomes in hospitalized elders. In-hospital decline was uncommon, suggesting that in-hospital recovery may be a more appropriate intervention target.