Onen F, Abidi H, Savoye L, Elchardus J M, Legrain S, Courpron P H
Department of Geriatrics, Centre Hospitalo-Universitaire Bichat-Claude Bernard, Paris, France.
Aging (Milano). 2001 Dec;13(6):421-9.
Emergency admissions of elderly patients constitute a major management issue due to the complexity of their problems. The aim of this retrospective observational study was to identify medical and social characteristics and crisis factors for emergency department (ED) hospitalization in elderly patients, and to evaluate the influence of these factors on the length of stay and outcome at discharge. During a 4-month period, 396 patients aged 70 years and older were referred to the ED of a University Hospital (Hĵpital Edouard Herriot) in Lyon, France. A questionnaire specifically designed for the study was completed for each patient using the information in the patients' files previously filled in by the "Rapid Geriatric Assessment Team" of the ED. We described civil and marital status, living conditions, reason for admission to ED and other associated pathologies according to the ICM-9, crisis factors, length of stay (LOS) and outcome at discharge. The mean age was 81.9 years (SD 6.5); two thirds (66.7%) of the study subjects were female, and 46.7% were widowed; the majority (68.7%) lived in their own homes. The main reasons for admission were cardiopulmonary diseases in 31.6% of cases, followed by neuropsychiatric disorders in 28.2%, and falls in 8.3%; a final category (31.8%) included subjects admitted for general, non-specific symptoms. Among the crisis factors observed, 49.4% presented an acute episode of a chronic illness, 33.6% lived alone, and 20.9% had been hospitalized during the 6-month period preceding the study. The average LOS was 3.15 days. The multivariate model showed that falls increase LOS by 74%, dementia by 65%, and depression by 21%. Upon discharge, 13% returned to their residence before hospitalization, 55% were transferred to a medical speciality ward, and 4% to other facilities, whereas only 19% were transferred to a geriatric ward, and 9% died during their stay in the ED. The multinomial model showed that outcome at discharge was influenced by functional dependency, dementia, depression, and acute episodes of a chronic illness. For many elderly, the ED remains a critical point of access to more complete managed care. This elderly population is comprised of polypathological, frail persons whose morbid state requires multidisciplinary management in geriatric units. The findings of this study suggest that interventions of multidisciplinary networks, such as home health care programs aimed at detecting crisis factors and establishing early prevention of crisis states, may improve unfavorable medical and social conditions and reduce hospitalization in geriatric patients.
由于老年患者问题的复杂性，其急诊入院构成了一个重大的管理问题。这项回顾性观察研究的目的是确定老年患者急诊科（ED）住院的医学和社会特征及危机因素，并评估这些因素对住院时间和出院结局的影响。在4个月的时间里，396名70岁及以上的患者被转诊至法国里昂一家大学医院（爱德华·埃里奥医院）的急诊科。利用急诊科“快速老年评估团队”之前填写的患者档案中的信息，为每位患者填写了一份专门为此研究设计的问卷。我们根据国际疾病分类第九版（ICM - 9）描述了患者的公民和婚姻状况、生活条件、急诊入院原因及其他相关病症、危机因素、住院时间（LOS）和出院结局。平均年龄为81.9岁（标准差6.5）；三分之二（66.7%）的研究对象为女性，46.7%为丧偶；大多数（68.7%）居住在自己家中。入院的主要原因是31.6%的病例患有心肺疾病，其次是28.2%患有神经精神障碍，8.3%因跌倒入院；最后一类（31.8%）包括因一般非特异性症状入院的患者。在观察到的危机因素中，49.4%出现慢性疾病急性发作，33.6%独自生活，20.9%在研究前6个月内曾住院。平均住院时间为3.15天。多变量模型显示，跌倒使住院时间增加74%，痴呆使住院时间增加65%，抑郁使住院时间增加21%。出院时，13%的患者回到住院前的住所，55%被转至专科病房，4%被转至其他机构，而只有19%被转至老年病房，9%在急诊科住院期间死亡。多项模型显示，出院结局受功能依赖、痴呆、抑郁和慢性疾病急性发作的影响。对许多老年人来说，急诊科仍然是获得更全面管理式医疗服务的关键点。这一老年人群由患有多种疾病的体弱患者组成，他们的病态需要在老年病房进行多学科管理。本研究结果表明，多学科网络的干预措施，如旨在检测危机因素并建立危机状态早期预防的家庭医疗保健项目，可能改善不利的医疗和社会状况，并减少老年患者的住院率。
