Hospital-associated disability due to avoidable hospitalizations among older adults
Hospital-associated disability due to avoidable hospitalizations among older adults
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DOI：
10.1111/jgs.18238
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发表时间：
2023-01-20
影响因子：
6.3
通讯作者：
Kennedy, Richard E. E.
中科院分区：
文献类型：
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作者：
Skains, Rachel M. M.;Zhang, Yue;Kennedy, Richard E. E.
背景：医院相关残疾(HAD)是老年人急性护理住院过程中常见的并发症。许多住院是因为门诊护理敏感情况(ACSC)，被认为有可能避免住院-这种情况可能会在门诊环境中得到治疗，以防止住院和HAD。我们比较了因ACSCs住院的老年人和因其他疾病住院的老年人之间的HAD发生率。方法：我们在东南部一家大型区域性学术医学中心的住院(非ICU)内外科单元进行了一项回顾性队列研究。参与者是2015年1月1日至2019年12月31日入院的38,960名65岁的老年人。主要结果被定义为从入院到出院时Katz日常生活能力(ADL)量表的下降。我们使用广义线性混合模型来检验首次诊断为ACSC的住院患者与初次诊断为其他疾病的患者之间的HAD差异，调整协变量并对多次住院的个体进行重复观察。结果：我们发现10%的老年人因ACSC入院，而因ACSC入院的患者HAD发生率低于因其他疾病入院的患者(16%比20.7%，p<；0.001)。年龄、合并症、入院功能状态和入院认知障碍是HAD发生的重要预测因素。与其他情况相比，ACSC入院的内科和外科服务的HAD几率较低，ACSC和非ACSC入院的外科服务的HAD没有显著差异。结论：老年ACSCS住院的HAD发生率很高，但低于因其他条件住院的HAD，反映出急性护理住院在这一人群中并不是一件好事。在门诊环境中治疗ACSCs可能是减少HAD努力的一个重要组成部分。
Background: Hospital-associated disability (HAD) is a common complication during the course of acute care hospitalizations in older adults. Many admissions are for ambulatory care sensitive conditions (ACSCs), considered potentially avoidable hospitalizations-conditions that might be treated in outpatient settings to prevent hospitalization and HAD. We compared the incidence of HAD between older adults hospitalized for ACSCs versus those hospitalized for other diagnoses.Methods: We conducted a retrospective cohort study in inpatient (non-ICU) medical and surgical units of a large southeastern regional academic medical center. Participants were 38,960 older adults >= 65 years of age admitted from January 1, 2015, to December 31, 2019. The primary outcome was HAD, defined as decline on the Katz Activities of Daily Living (ADL) scale from hospital admission to discharge. We used generalized linear mixed models to examine differences in HAD between hospitalizations with a primary diagnosis for an ACSC using standard definitions versus primary diagnosis for other conditions, adjusting for covariates and repeated observations for individuals with multiple hospitalizations.Results: We found that 10% of older adults were admitted for an ACSC, with rates of HAD in those admitted for ACSCs lower than those admitted for other conditions (16% vs. 20.7%, p < 0.001). Age, comorbidity, admission functional status, and admission cognitive impairment were significant predictors for development of HAD. ACSC admissions to medical and medical/surgical services had lower odds of HAD compared with admissions for other conditions, with no significant differences between ACSC and non-ACSC admissions to surgical services.Conclusions: Rates of HAD among older adults hospitalized for ACSCs are substantial, though lower than rates of HAD with hospitalization for other conditions, reflecting that acute care hospitalization is not a benign event in this population. Treatment of ACSCs in the outpatient setting could be an important component of efforts to reduce HAD.