Baztán J J, González M, Morales C, Vázquez E, Morón N, Forcano S, Ruipérez I
Servicio de Geriatría, Hospital Central de la Cruz Roja, Madrid.
Rev Clin Esp. 2004 Nov;204(11):574-82. doi: 10.1157/13067367.
To describe the evolution and results of the rehabilitation of elderly disabled cared in an average stay geriatric unit, and to define the factors associated with functional improvement and post-discharge institutionalization.
Observational longitudinal study in 459 patients with functional disability consecutively hospitalized between May 2000 and December 2001. Basal variables collected included the clinical, functional, mental, and sociodemographic manifestations previous to the admission. The favorable functional response (defined as a functional gain during the admission of > or = 20 points in the Barthel index) and the post-discharge institutionalization were regarded the main result variables.
The average age of patients was 80.56 (SD: +/- 7.45) years, 64.9% were women and 81% came from acute hospital units; the main cause of disability was stroke (48.5%) followed by orthopedic pathology (26.2%) and immobility for different causes (23.5%). 72.5% of patients get functional improvement and 16.4% were institutionalized after the discharge. The main independent risk factors for poor functional response found in the multivariate analysis were a scoring in Pfeiffer's cognitive test of 5-7 points (OR: 0.42; 95% CI: 0,22-0.78) and > or = 8 (OR: 0.29; 95% CI: 0.12-0.71), and a scoring in Barthel's index < 60 prior to the deterioration (OR: 0.36; 95% CI: 0.14-0.93). Independent risk factors for institutionalization after the discharge were age (OR: 1.06; 95% CI: 1.01-1.12), and a scoring in the Gijon's sociofamiliar scale > or = 9 (OR: 6.83; 95% CI: 1.91-24.47). A functional disability after the discharge in the Barthel's index < 40 also was independently associated to post-discharge institutionalization (OR: 3,07; 95% CI: 1.04-10.06).
Most of elderly with recent disability benefit functionally from care in specific hospital geriatric units. Moderate or severe cognitive deterioration after hospitalization is associated to lower recovery probability. Very advanced age, higher social precariousness and severe disability after discharge are associated with higher risk of institutionalization.
描述在普通住院老年病房接受护理的老年残疾患者的康复进程及结果，并确定与功能改善和出院后机构安置相关的因素。
对2000年5月至2001年12月期间连续住院的459例功能残疾患者进行观察性纵向研究。收集的基础变量包括入院前的临床、功能、心理和社会人口学表现。主要结果变量为良好的功能反应（定义为住院期间Barthel指数功能增益≥20分）和出院后机构安置情况。
患者平均年龄为80.56（标准差：±7.45）岁，64.9%为女性，81%来自急症医院科室；残疾的主要原因是中风（48.5%），其次是骨科疾病（26.2%）和因各种原因导致的行动不便（23.5%）。72.5%的患者功能得到改善，16.4%在出院后被安置到机构。多因素分析中发现的功能反应不佳的主要独立危险因素是Pfeiffer认知测试得分5 - 7分（比值比：0.42；95%置信区间：0.22 - 0.78）和≥8分（比值比：0.29；95%置信区间：0.12 - 0.71），以及病情恶化前Barthel指数得分<60分（比值比：0.36；95%置信区间：0.14 - 0.93）。出院后机构安置的独立危险因素是年龄（比值比：1.06；95%置信区间：1.01 - 1.12），以及吉洪社会家庭量表得分≥9分（比值比：6.83；置信区间：1.91 - 24.47）。出院后Barthel指数功能残疾<40分也与出院后机构安置独立相关（比值比：3.07；95%置信区间：1.04 - 10.06）。
大多数近期残疾的老年人在特定医院老年病房接受护理后功能上受益。住院后中度或重度认知功能衰退与较低的康复概率相关。高龄、较高的社会不稳定因素以及出院后严重残疾与机构安置的较高风险相关。
