Risk factors for early emergency hospital readmission in elderly medical patients
Risk factors for early emergency hospital readmission in elderly medical patients
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DOI：
10.1159/000022091
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发表时间：
1999-07-01
期刊：
影响因子：
3.5
通讯作者：
Pei, CKW
中科院分区：
文献类型：
--
作者：
Chu, LW;Pei, CKW
背景：早期急诊再入院是老年患者常见且重要的问题。需要识别早期紧急再入院的风险因素，以防止这种情况发生。目的：探讨老年内科急诊患者早期再入院的危险因素。方法：病例对照研究（性别和年龄匹配）进行了1996年3月至12月。从香港一所急性综合性大学医院招募了380名急诊再入院（28天内）的老年（年龄65岁或以上）内科患者和380名匹配的对照。研究潜在危险因素包括人口学、社会经济、主要内科疾病、共病、吞咽困难、身体功能状态和精神状态。实验结果：在早期急诊再入院的风险因素的双变量分析中，机构护理人员、既往访视护士服务、药物不良反应、慢性阻塞性肺疾病、终末期肾衰竭、活动受限于椅子或床、吞咽困难、使用鼻胃管喂养、尿失禁和肠失禁具有显著性。再入院病例与对照组相比，合并症的平均数较高，平均Barthel指数较低，日常生活活动（ADL）任务的平均障碍数较高，平均简明精神测试评分较低。在多因素Logistic回归模型中，ADL损害的数量（OR = 1.13，95%CI = 1.08-1.19），无收入（OR = 2.28，95%CI = 1.19-4.37），药物不良反应（OR = 4.19，95%CI = 1.56-11.2），晚期恶性肿瘤（OR = 2.45，95%CI = 1.37-4.37），充血性心力衰竭（OR = 1.63，95%CI = 1.05-2.53），慢性阻塞性气道疾病（OR = 2.1，95%CI = 1.47-3.02），终末期肾功能衰竭（OR = 5.48，95%CI = 1.69-17.75），吞咽困难（OR = 3.9，95% CI = 1.5-10.11）和合并症数量（OR = 1.3，95% CI = 1.13-1.49）是早期急诊再入院的重要危险因素。居住在私人养老院与再入院风险较低相关（OR = 0.53，95%CI = 0.36-0.93）。结论：明确的医疗，功能和社会经济因素被认为是老年内科患者早期急诊再入院的危险因素。在设计未来的预防战略时，应考虑采取多风险因素干预办法。
Background: Early emergency readmissions is a common and important problem in the elderly patient. Identification of the risk factors for early emergency readmissions is needed to prevent this occurring. Objective: The aim of this study was to study the risk factors for early emergency readmission in the elderly medical patient. Methods: A case-control study (sex- and age-matched) was conducted from March to December 1996. 380 elderly (age 65 years or over) medical patients with emergency hospital readmission (within 28 days) and 380 matched controls were recruited from an acute university general hospital in Hong Kong. Potential risk factors which included demographic, socio-economic, principal medical diseases, comorbid diseases, dysphagia, physical functional status and mental status were studied. results: In bivariate analyses for the risk factors of early emergency readmission, institutional carer, previous visiting nurse service, adverse drug reaction, chronic obstructive pulmonary disease, end-stage renal failure, mobility being chair- or bed-bound, dysphagia, use of a nasogastric tube feeding, urinary incontinence and bowel incontinence were significant. Readmission cases had higher mean number of comorbid diseases, lower mean Barthel Index, higher mean number of impairments in Activities of Daily Living (ADL) tasks and lower mean Abbreviated Mental Test score than controls. In multivariate logistic regression model, the number of ADL impairments (OR = 1.13, 95% CI = 1.08-1.19), no income (OR = 2.28, 95% CI = 1.19-4.37), adverse drug reaction (OR = 4.19, 95% CI = 1.56-11.2), advanced malignancy (OR = 2.45, 95% CI = 1.37-4.37), congestive heart failure (OR = 1.63, 95% CI = 1.05-2.53), chronic obstructive airways disease (OR = 2.1, 95% CI = 1.47-3.02), end-stage renal failure (OR = 5.48, 95% CI = 1.69-17.75), dysphagia (OR = 3.9, 95% CI = 1.5-10.11) and the number of comorbid diseases (OR = 1.3, 95% CI = 1.13-1.49) were significant risk factors for early emergency readmissions. Living in a private old aged home was associated with a lower risk of readmissions (OR = 0.53, 95% CI = 0.36-0.93). Conclusions: Definite medical, functional and socio-economic factors were found to be risk factors for early emergency readmissions in the elderly medical patient. A multiple risk factors intervention approach should be considered in designing future prevention strategies.