对入住老年康复住院单元的认知障碍、抑郁和/或谵妄老年患者功能改善情况的评估。

Esperanza A, Miralles R, Rius I, Fernandez B, Digón A, Arranz P, Gonzalez P, Raja Y, Serrano P, Zafra M, Vazquez O, Gili P, Cervera A M

Universidad Autonoma de Barcelona, Servicio de Geriatría del IMAS, E-08024 Barcelona, Spain.

Arch Gerontol Geriatr Suppl. 2004(9):149-53. doi: 10.1016/j.archger.2004.04.021.

Cognitive impairment, depression and delirium are problems of high prevalence in older patients. The geriatric convalescence unit (GCU) is a hospitalization facility offering an interdisciplinary geriatric intervention program that may be more appropriate for these patients. This study intended to analyze the functional improvement (FI) in older patients with cognitive impairment, depression and/or delirium admitted to a GCU. A group of 107 patients received specific nurse care, habitually performed in GCU and they also were included in a rehabilitation program. Cognitive impairment, depression and delirium were diagnosed according to standardized protocols. The analyzed variables were: age, functional status (Barthel index) before admission (BBA), at admission (BA) and at discharge(BD), diagnostic categories, cognitive function (mini mental state examination: MMSE) and post-discharge destination. The corrected Heinemann index (CHI) was used to evaluate FI obtained during GCU-stay, where CHI = 100 x (BD-BA)/(BBA-BA), and the efficiency index(El) was used to analyze the relationship between FI and the length of stay in the GCU,where El = (BD-BA)/(days in GCU). According to CHI, patients were divided in three groups. Group I: CHI = 0 or negative (patients who lost functional capacity during hospitalization,those who died or were transferred to hospital owing to acute deterioration. Group II: CHI < 35 % (high FI). Mean age was 77.6 +/- 9.1 years, the diagnostic categories were: fractures/orthopedics 49 (45.7 %), neurological 27(25.2 %), pulmonary/cardiologic 6 (5.6 %) and other cases 25 (23.3 %). Mean MMSE and BA scores were 16.9 +/- 9.4 and 29.6 +/- 18.9, respectively. Post-discharge destinations were:63 patients (58.8 %) returned home, 28 (26.1 %) were definitively institutionalized, 11 (10.2%) died and finally 5 (4.6 %) were transferred to acute care hospital. In-Group I, there were 35 patients (32.7 %) with a mean value of the El = 0.12 +/-1.1; in Group II, 13 (12.1 %) and 0.26 +/- 0.38; in Group III, 59 (55.1 %) and 0.94 +/- 0.97, respectively. In spite of the presence of cognitive impairment, depression and/or delirium, a high proportion of patients (67.2 %)obtained a significant improvement in their functional capacity.35 % (moderate FI). Group III: CHI >/=

认知障碍、抑郁和谵妄在老年患者中是高发性问题。老年康复单元（GCU）是一个提供跨学科老年干预项目的住院设施，可能对这些患者更为合适。本研究旨在分析入住GCU的伴有认知障碍、抑郁和/或谵妄的老年患者的功能改善情况。一组107名患者接受了GCU惯常提供的特定护理，并且他们还被纳入了一个康复项目。认知障碍、抑郁和谵妄根据标准化方案进行诊断。分析的变量包括：年龄、入院前（BBA）、入院时（BA）和出院时（BD）的功能状态（Barthel指数）、诊断类别、认知功能（简易精神状态检查表：MMSE）以及出院后的去向。校正后的海涅曼指数（CHI）用于评估在GCU住院期间获得的功能改善，其中CHI = 100×(BD - BA)/(BBA - BA)，效率指数（El）用于分析功能改善与在GCU住院时间之间的关系，其中El = (BD - BA)/(在GCU的天数)。根据CHI，患者被分为三组。第一组：CHI = 0或为负数（住院期间失去功能能力的患者、死亡患者或因急性病情恶化转院的患者）。第二组：CHI < 35%（功能改善高）。平均年龄为77.6±9.1岁，诊断类别为：骨折/骨科49例（45.7%）、神经科27例（25.2%）、肺科/心脏科6例（5.6%）以及其他病例25例（23.3%）。MMSE和BA的平均得分分别为16.9±9.4和29.6±18.9。出院后的去向为：63名患者（58.8%）回家，28名（26.1%）最终入住机构，11名（10.2%）死亡，最后5名（4.6%）转至急症医院。在第一组中，有35名患者（32.7%），El的平均值为0.12±1.1；在第二组中，有13名（12.1%），El为0.26±0.38；在第三组中，有59名（55.1%），El为0.94±0.97。尽管存在认知障碍、抑郁和/或谵妄，但仍有很大比例的患者（67.2%）在功能能力方面获得了显著改善。35%（功能改善中等）。第三组：CHI≥