Albert S M, Costa R, Merchant C, Small S, Jenders R A, Stern Y
Gertrude H. Sergievsky Center and Department of Medical Informatics, Columbia University, New York, NY 10032, USA.
J Gerontol A Biol Sci Med Sci. 1999 May;54(5):M267-71. doi: 10.1093/gerona/54.5.m267.
Prior studies offer conflicting findings on whether Alzheimer's disease (AD) is associated with an increased risk of hospitalization.
We investigated AD and hospitalization in the Washington Heights-Inwood Columbia Aging Project (WHICAP), a community-based study of 2,334 elders in New York City. In 1996, an electronic medical records system was established that allows an e-mail alert to be sent to the research team whenever WHICAP subjects are admitted to Columbia-Presbyterian Medical Center (CPMC), the site of hospital care for the majority of subjects.
Of the WHICAP cohort, 13.1% was admitted to CPMC in 21 months of follow-up; 17.5% of AD patients and 11.9% of unaffected subjects were admitted (p<.01). Multivariate logistic regression models showed that more advanced AD (Clinical Dementia Rating scale 3+) was a significant risk factor for hospitalization independently of age, gender, education, comorbid medical conditions, and death in the follow-up period (OR 2.3; 95% CI: 1.1, 4.6); subjects with mild or moderate AD did not show a significantly elevated risk. The prevalence of psychiatric symptoms did not differ between AD subjects who were hospitalized in the reporting period and AD subjects who were not hospitalized. Infectious disease was a more common discharge diagnosis for subjects with AD (p<.05).
In this community-based cohort, subjects with severe AD were more likely to be hospitalized than unaffected subjects. The increased use of hospital care by these AD patients appears to be specific to AD but is not a result of psychiatric morbidity or end-of-life care. Rather, a greater risk of medical complications that require hospital care, especially infections, appears to be characteristic of severe AD.
先前的研究对于阿尔茨海默病（AD）是否与住院风险增加相关存在相互矛盾的结果。
我们在华盛顿高地 - 因伍德哥伦比亚老龄化项目（WHICAP）中调查了AD与住院情况，该项目是一项针对纽约市2334名老年人的社区研究。1996年建立了一个电子病历系统，每当WHICAP受试者入住哥伦比亚长老会医学中心（CPMC）（大多数受试者的医院护理地点）时，该系统会向研究团队发送电子邮件警报。
在WHICAP队列中，13.1%的受试者在21个月的随访期间入住了CPMC；AD患者中有17.5%，未受影响的受试者中有11.9%入院（p<0.01）。多变量逻辑回归模型显示，更严重的AD（临床痴呆评定量表3+）是住院的一个重要危险因素，独立于年龄、性别、教育程度、合并的医疗状况以及随访期间的死亡情况（比值比2.3；95%置信区间：1.1，4.6）；轻度或中度AD的受试者未显示出显著升高的风险。在报告期内住院的AD受试者与未住院的AD受试者之间，精神症状的患病率没有差异。传染病是AD受试者更常见的出院诊断（p<0.05）。
在这个基于社区的队列中，重度AD受试者比未受影响的受试者更有可能住院。这些AD患者住院治疗的增加似乎是AD特有的，但不是精神疾病或临终护理的结果。相反，需要住院治疗的医疗并发症风险增加，尤其是感染，似乎是重度AD的特征。
