Kozyrskyi Anita L, Black Charlyn, Chateau Dan, Steinbach Carmen
Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, 727 McDermot Avenue, Suite 408, Winnipeg, MB, R3E 3P5, Canada.
Can J Aging. 2005 Spring;24 Suppl 1:107-19. doi: 10.1353/cja.2005.0048.
Hospitalization is a sentinel event that leads to loss of independence for many seniors. This study of long-stay hospitalizations (more than 30 days) in seniors was undertaken to identify risk factors for not going home, to characterize patients with risk factors who did go home and to describe 1-year outcomes following home discharge. Using Manitoba's health care databases, the likelihood of death in hospital, discharge to a nursing home, and transfer to another hospital was determined for a set of risk factors in seniors with long-stay hospitalizations in Winnipeg's acute hospitals. Of the 17,984 long-stay hospitalizations during 1993-2000, 45 per cent were discharged home, 20 per cent died, and 30 per cent were discharged to a nursing home or another hospital. Seniors who received home care prior to hospitalization were more likely to be discharged to a nursing home or die in hospital than to go home. Stroke and cognitive impairment increased the likelihood of discharge to a nursing home. Seniors with neoplasms, multiple co-morbidities, and length-of-stay more than 120 days were more likely to die in hospital. Long-stay patients with risk factors who did go home had few co-morbidities. Within 1 year of home discharge, 20 per cent of seniors died, 5-15 per cent were admitted to a nursing home or long-term care institution, and 26-35 per cent of persons were re-hospitalized from home. A full 37 per cent experienced none of these outcomes. Our findings point to opportunities to improve discharge outcomes and plan support services for seniors.
住院是一个标志性事件，会导致许多老年人失去独立生活能力。本研究针对老年人长期住院（超过30天）的情况展开，旨在确定无法回家的风险因素，描述存在风险因素但仍回家的患者特征，并阐述出院后1年的转归情况。利用曼尼托巴省的医疗保健数据库，针对温尼伯市急症医院中存在长期住院情况的老年人的一系列风险因素，确定了其在医院死亡、出院至养老院以及转至其他医院的可能性。在1993年至2000年期间的17984例长期住院病例中，45%出院回家，20%死亡，30%出院至养老院或其他医院。住院前接受过家庭护理的老年人出院至养老院或在医院死亡的可能性高于回家的可能性。中风和认知障碍会增加出院至养老院的可能性。患有肿瘤、多种合并症且住院时间超过120天的老年人在医院死亡的可能性更大。存在风险因素但回家的长期住院患者合并症较少。出院后1年内，20%的老年人死亡，5%至15%入住养老院或长期护理机构，26%至35%的人再次住院。整整37%的人未出现上述任何一种转归情况。我们的研究结果指出了改善出院转归以及为老年人规划支持服务的机会。
