Hospitalization-Associated Disability "She Was Probably Able to Ambulate, but I'm Not Sure"
Hospitalization-Associated Disability "She Was Probably Able to Ambulate, but I'm Not Sure"
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DOI：
10.1001/jama.2011.1556
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发表时间：
2011-10-26
影响因子：
120.7
通讯作者：
Johnston, C. Bree
中科院分区：
文献类型：
--
作者：
Covinsky, Kenneth E.;Pierluissi, Edgar;Johnston, C. Bree
在老年患者中，需要住院的急性内科疾病是一种哨兵事件，通常会导致残疾。这导致随后无法独立生活和完成基本的日常生活活动(ADL)。这种与住院相关的残疾大约发生在70岁以上的患者中，即使需要住院的疾病得到了成功的治疗，也可能引发这种残疾。在这篇文章中，我们描述了风险因素和风险分层工具，以确定老年人住院相关残疾的最高风险。我们描述了可能促进住院相关残疾的医院流程以及为预防这种残疾而开发的护理模式。由于对功能状态问题的认识是预防和管理残疾的必要前提，我们还描述了一种实用的方法来评估医院的功能状态，重点是评估ADLS、活动能力和认知能力。基于对急性老年病房的研究，我们描述了医院和临床医生可以考虑的预防患者住院相关残疾的干预措施。最后，我们描述了临床医生可以实施的方法，以改善患有住院相关残疾的老年人及其照顾者的生活质量。贾玛2011；306(16)：1782-1793
In older patients, acute medical illness that requires hospitalization is a sentinel event that often precipitates disability. This results in the subsequent inability to live independently and complete basic activities of daily living (ADLs). This hospitalization-associated disability occurs in approximately one-third of patients older than 70 years of age and may be triggered even when the illness that necessitated the hospitalization is successfully treated. In this article, we describe risk factors and risk stratification tools that identify older adults at highest risk of hospitalization-associated disability. We describe hospital processes that may promote hospitalization-associated disability and models of care that have been developed to prevent it. Since recognition of functional status problems is an essential prerequisite to preventing and managing disability, we also describe a pragmatic approach toward functional status assessment in the hospital focused on evaluation of ADLs, mobility, and cognition. Based on studies of acute geriatric units, we describe interventions hospitals and clinicians can consider to prevent hospitalization-associated disability in patients. Finally, we describe approaches clinicians can implement to improve the quality of life of older adults who develop hospitalization-associated disability and that of their caregivers. JAMA. 2011;306(16):1782-1793