Cognitive impairment is the major risk factor for development of geriatric syndromes during hospitalization: Results from the GIFA study
Cognitive impairment is the major risk factor for development of geriatric syndromes during hospitalization: Results from the GIFA study
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DOI：
10.1159/000087440
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发表时间：
2005-01-01
影响因子：
2.4
通讯作者：
Fratiglioni, L
中科院分区：
文献类型：
--
作者：
Mecocci, P;von Strauss, E;Fratiglioni, L
目的：探讨老年患者住院期间发生特殊老年综合征(压疮、大便失禁、尿失禁、跌倒)的主要相关因素。设计：观察性前瞻性研究。单位：意大利各地的81家社区和大学医院。研究对象：13,729名年龄在65岁及以上的患者，在1991-1998年间的20个月内连续住进内科或老年急诊病房。测量：住院期间发生压疮、大便失禁、尿失禁和跌倒。结果：3%的住院患者已经出现压疮，7.3%的人出现大便失禁，而根据总人口的一个亚组(4268人)进行评估的尿失禁的患病率为22.3%。在住院期间(平均住院15天)，74名受试者出现新的压疮，55名患者大便失禁，279名受试者至少有一次跌倒。在多因素分析中，认知功能障碍、高龄(85岁以上)、住院时间(3周以上)和严重残疾是4种老年综合征发生的主要独立预测因素，认知功能障碍是所有4种预后的最显著危险因素(OR 4.9，95%CI 2.4~9.9；OR 6.3，95%CI 3.0~13.0；OR 5.3，95%CI 2.3~12.0；OR 1.6，95%CI 1.2~2.3)。结论：高龄患者在住院期间发生多种老年综合征的风险显著增加，特别是如果住院时间较长且认知功能受损。入院时标准化的综合老年评估有助于发现所有有风险的受试者，并防止医院获得性老年综合征的发展。版权所有(C)2005 S.Karger AG，巴塞尔。
Objective: To detect the main factors associated with the occurrence of specific geriatric syndromes (namely pressure sores, fecal incontinence, urinary incontinence and falls) in elderly patients during hospitalization. Design: Observational prospective study. Setting: Eighty-one community and university hospitals throughout Italy. Participants: 13,729 patients aged 65 years and more, consecutively admitted to medical or geriatric acute wards during 20 months in the period between 1991 and 1998. Measurements: Occurrence of pressure sores, fecal incontinence, urinary incontinence and falls during the stay in hospital. Results: Pressure sores were already present in 3% of hospitalized subjects, fecal incontinence in 7.3%, while urinary incontinence, evaluated on a subgroup of total population (4,268 subjects), had a prevalence of 22.3%. During hospitalization (mean stay of 15 days), 74 subjects developed new pressure sores, 55 became fecal and 35 urinary incontinent, and 279 subjects had at least one episode of fall. In multivariate analyses, cognitive impairment, advanced age (85+ years), length of stay (more than 3 weeks) and severe disability were the main independent predictors of development of the four geriatric syndromes, with cognitive impairment as the most significant risk factor for all the four outcomes (OR 4.9, 95% CI 2.4-9.9 for pressure sores; OR 6.3, 95% CI 3.0-13.0 for fecal incontinence; OR 5.3, 95% CI 2.3-12.0 for urinary incontinence; OR 1.6, 95% CI 1.2-2.3 for falls). Conclusion: Very old people have a significant increased risk of several geriatric syndromes during the stay in hospital, particularly if it is long and they are cognitively impaired. A standardized comprehensive geriatric evaluation at admission could be helpful in detecting all subjects at risk and preventing the development of hospital-acquired geriatric syndromes. Copyright (C) 2005 S. Karger AG, Basel.