Preventable Iatrogenic Disability in Elderly Patients During Hospitalization
Preventable Iatrogenic Disability in Elderly Patients During Hospitalization
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DOI：
10.1016/j.jamda.2015.03.011
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发表时间：
2015-08-01
影响因子：
7.6
通讯作者：
Vellas, Bruno
中科院分区：
文献类型：
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作者：
Sourdet, Sandrine;Lafont, Christine;Vellas, Bruno
背景：在老年患者中，住院往往与新的或恶化的残疾有关。这种住院相关残疾的部分原因可能是由于衰老、虚弱、合并症和导致住院的疾病的累积效应，但也可能是由于医疗保健管理问题和医院环境。我们的目标是确定频率，原因，和可预防性的残疾引起的过程中的照顾或“医源性残疾。“方法：纳入了2011年10月至2012年3月期间在图卢兹大学医院的105个内科和外科住院的503例患者，年龄≥ 75岁，最短住院时间为2天。住院相关残疾定义为入院和出院之间Katz日常生活活动评分损失0.5分或更多。为了确定医源性的组成部分住院相关的残疾，在老年医学专家小组审查了每一个医疗图表使用标准化的记录审查，并确定沉淀医源性不良事件导致功能decline.Results：医源性残疾的发生率为11.9%（95%置信区间，9.2%-15.1%）。在60例医源性残疾病例中，49例（81.7%，95%置信区间，69.6%-90.5%）被判定为潜在可预防。在可预防的医源性残疾患者中，最常见的健康管理问题是活动度低[过度卧床休息（26.5%）和缺乏物理治疗师干预（55.1%）]、过度使用纸尿裤49.0%;经尿道导尿（30.6%）。目前的研究表明，很大比例的住院相关残疾可能是由医源性事件引起的，而且大多数都是可以预防的卫生保健专业人员需要接受教育，了解老年住院患者的特殊需求，并应考虑住院相关的残疾作为护理的结果。(C)2015年AMDA -急性后和长期护理医学协会。
Background: In older patients, hospitalization is often associated with new or worsening disability. This hospitalization-associated disability may be explained in part by the cumulative effect of aging, frailty, comorbidities, and illnesses that led to hospitalization but may also result from health care management issues and the hospital environment. Our objective was to determine the frequency, causes, and the preventability of disability induced by the processes of care or "iatrogenic disability."Methods: A total of 503 patients, aged 75 years and older, hospitalized in the 105 medical and surgical units of Toulouse University Hospital between October 2011 and March 2012, with a minimal length of stay of 2 days, were included. Hospitalization-associated disability was defined as a loss of 0.5 points or more in the Katz Activity of Daily Living Score between the time of hospital admission and discharge. To determine the iatrogenic component of hospitalization-associated disability, an expert panel in geriatric medicine reviewed each medical chart using a standardized record review and identified precipitating iatrogenic adverse events resulting in functional decline.Results: Incidence of iatrogenic disability was 11.9% (95% confidence interval, 9.2%-15.1%). Of the 60 cases of iatrogenic disability, 49 (81.7%, 95% confidence interval, 69.6%-90.5%) were judged to be potentially preventable. The most common health management issues identified in patients with preventable iatrogenic disability were low mobilization [by excessive bed rest (26.5%) and lack of physical therapist intervention (55.1%)], overuse of diapers (49.0%), and transurethral urinary catheterization (30.6%).Conclusions: The present study suggests that a significant proportion of hospitalization-associated disability may be induced by iatrogenic events, and that most of them are potentially preventable. Health care professionals need to be educated on the specific needs of elderly hospitalized patients and should consider hospitalization-associated disability as an outcome of care. (C) 2015 AMDA - The Society for Post-Acute and Long-Term Care Medicine.