Department of rehabilitation and geriatrics, Medical school and University Hospitals of Geneva, Geneva, Switzerland.
J Nutr Health Aging. 2010 Feb;14(2):141-7. doi: 10.1007/s12603-009-0182-y.
Dementia is a serious, chronic, and costly public health problem. Prior studies have described dementia as increasing length of hospital stay, but so far no explanations have been proposed.
To identify early markers for prolonged hospital stay in demented elderly inpatients, 178 community-dwelling or institutionalized subjects aged 75+, hospitalized through an emergency department in 9 teaching hospitals in France, were analyzed. Prolonged hospital stays were defined according a limit adjusted for Diagnosis Related Group. All patients underwent a comprehensive geriatric assessment at admission. Logistic regression multifactorial mixed model was performed. Center effect was considered as a random effect.
Of the 178 stays, 52 were prolonged. Most concerned community-dwelling patients (86%). Multifactor analysis demonstrated that demographic variables had no influence on the length of stay, while diagnosis of delirium (OR 2.31; 95% CI 1.77 - 2.91), walking difficulties (OR 1.94; 95% CI 1.62 - 2.43) and report by the informal caregiver of moderate or severe burden (OR 1.52; 95% CI 1.19 - 1.86) or low social quality-of-life score (OR 1.25; 95% CI 1.03 - 1.40), according to the Zarit's Burden Inventory short scale (12 items) and the Duke's Health Profile respectively, were identified as early markers for prolonged hospital stays.
At the time of the rising incidence of cognitive disorders, these results suggest that preventive approaches might be possible. In a hospital setting as well as in a community-dwelling population, more specific, specialized and coordinated care, using the expertise of multiple disciplines appears as a probable effective measure to limit prolonged hospital stay. Such approaches require (i) clear patient-oriented goal definition, (ii) understanding and appreciation of roles among various health care and social disciplines and, (iii) cooperation between partners in patient's management. However, the cost- and health-effectiveness of such approaches should be evaluated.
痴呆是一个严重的、慢性的、代价高昂的公共卫生问题。先前的研究已经描述了痴呆症会导致住院时间延长，但迄今为止，尚未提出任何解释。
为了确定在法国 9 所教学医院通过急诊入院的 178 名居住在社区或机构中的 75 岁及以上的痴呆老年住院患者中，导致住院时间延长的早期标志物，对这些患者进行了分析。根据诊断相关组调整的限制，将延长的住院时间定义为延长的住院时间。所有患者在入院时均接受了全面的老年评估。采用多因素逻辑回归混合模型进行分析。中心效应被视为随机效应。
在 178 次住院中，有 52 次是延长的。大多数是居住在社区的患者（86%）。多因素分析表明，人口统计学变量对住院时间没有影响，而谵妄诊断（比值比 2.31；95%置信区间 1.77-2.91）、行走困难（比值比 1.94；95%置信区间 1.62-2.43）以及非正式护理者报告的中度或重度负担（比值比 1.52；95%置信区间 1.19-1.86）或低社会生活质量评分（比值比 1.25；95%置信区间 1.03-1.40），根据 Zarit 负担量表（12 项）和 Duke 健康状况量表，被确定为导致住院时间延长的早期标志物。
在认知障碍发病率上升的情况下，这些结果表明可能需要采取预防措施。在医院环境和社区居住人群中，使用多学科专业知识，提供更具体、专门和协调的护理，似乎是限制住院时间延长的有效措施。这种方法需要（i）明确以患者为中心的目标定义，（ii）理解和重视各种卫生保健和社会学科的角色，以及（iii）在患者管理方面合作伙伴之间的合作。然而，需要评估这种方法的成本效益和健康效果。
