Lang Pierre-Olivier, Meyer Nicolas, Heitz Damien, Dramé Moustapha, Jovenin Nicolas, Ankri Joël, Somme Dominique, Novella Jean-Luc, Gauvain Jean-Bernard, Couturier Pascal, Lanièce Isabelle, Voisin Thierry, de Wazières Benoit, Gonthier Régis, Jeandel Claude, Jolly Damien, Saint-Jean Olivier, Blanchard François
Department of Rehabilitation and Geriatrics, Hospital of Trois-Chêne, University Hospitals of Geneva, Chemin du Pont-Bochet 3, Thônex-Genève, 1226 Geneva, Switzerland.
Eur J Epidemiol. 2007;22(9):621-30. doi: 10.1007/s10654-007-9150-1. Epub 2007 Jul 25.
The preservation of autonomy and the ability of elderly to carry out the basic activities of daily living, beyond the therapeutic care of any pathologies, appears as one of the main objectives of care during hospitalization.
To identify early clinical markers associated with the loss of independence in elderly people in short stay hospitals.
Among the 1,306 subjects making up the prospective and multicenter SAFEs cohort study (Sujet Agé Fragile: Evolution et suivi-Frail elderly subjects, evaluation and follow-up), 619 medical inpatients, not disabled at baseline and hospitalized through an emergency department were considered. Data used in a multinomial logistic regression were obtained through a comprehensive geriatric assessment (CGA) conducted in the first week of hospitalization. Dependency levels were assessed at baseline, at inclusion and at 30 days using Katz's ADL index. Baseline was defined as the dependence level before occurrence of the event motivating hospitalization. To limit the influence of rehabilitation on the level of dependence, only stays shorter than 30 days were considered.
About 514 patients were eligible, 15 died and 90 were still hospitalized at end point (n = 619). Two-thirds of subjects were women, with a mean age of 83. At day 30 162 patients (31%) were not disabled; 61 (12%) were moderately disabled and 291 severely disabled (57%). No socio-demographic variables seemed to influence the day 30 dependence level. Lack of autonomy (odds ratio (OR) = 1.9, 95% confidence interval (CI) = 1.2-3.6), walking difficulties (OR = 2.7, 95% CI = 1.3-5.6), fall risk (OR = 2.1, 95% CI = 1.3-6.8) and malnutrition risk (OR = 2.2, 95% CI = 1.5-7.6) were found in multifactorial analysis to be clinical markers for loss of independence.
Beyond considerations on the designing of preventive policies targeting the populations at risk that have been identified here, the identification of functional factors (lack of autonomy, walking difficulties, risk of falling) suggests above all that consideration needs to be given to the organization per se of the French geriatric hospital care system, and in particular to the relevance of maintaining sector-type segregation between wards for care of acute care and those involved in rehabilitation.
除了对任何疾病的治疗护理外，保护老年人的自主性以及其进行日常生活基本活动的能力，似乎是住院期间护理的主要目标之一。
确定短期住院医院中与老年人独立性丧失相关的早期临床标志物。
在构成前瞻性多中心SAFEs队列研究（脆弱老年受试者：演变与随访）的1306名受试者中，考虑了619名医学住院患者，这些患者在基线时未残疾且通过急诊科入院。用于多项逻辑回归的数据通过住院第一周进行的全面老年评估（CGA）获得。使用Katz日常生活活动指数在基线、纳入时和30天时评估依赖程度。基线定义为导致住院事件发生前的依赖程度。为了限制康复对依赖程度的影响，仅考虑住院时间短于30天的情况。
约514名患者符合条件，15人死亡，90人在终点时仍住院（n = 619）。三分之二的受试者为女性，平均年龄83岁。在第30天时，162名患者（31%）未残疾；61名（12%）为中度残疾，291名（57%）为重度残疾。没有社会人口统计学变量似乎影响第30天的依赖程度。多因素分析发现自主性缺乏（比值比（OR）= 1.9，95%置信区间（CI）= 1.2 - 3.6）、行走困难（OR = 2.7，95% CI = 1.3 - 5.6）、跌倒风险（OR = 2.1，95% CI = 1.3 - 6.8）和营养不良风险（OR = 2.2，95% CI = 1.5 - 7.6）是独立性丧失的临床标志物。
除了对针对此处已确定的高危人群制定预防政策的设计进行考虑外，功能因素（自主性缺乏、行走困难、跌倒风险）的识别首先表明需要考虑法国老年医院护理系统本身的组织，特别是急性护理病房与康复病房之间保持科室类型隔离的相关性。
