School of Nursing, College of Medicine, Chang Gung University, 259 Wen-Hua 1st Road, Kwei-Shan, Taoyuan 33302, Taiwan.
J Gerontol A Biol Sci Med Sci. 2013 Feb;68(2):188-97. doi: 10.1093/gerona/gls164. Epub 2012 Sep 7.
Few studies have investigated the effects of care models that combine interdisciplinary care with nutrition consultation, depression management, and fall prevention in older persons with hip fracture. The purpose of this study was to compare the effects of a comprehensive care program with those of interdisciplinary care and usual care for elderly patients with hip fracture.
A randomized experimental trial was used to explore outcomes for 299 elderly patients with hip fracture receiving three treatment care models: interdisciplinary care (n = 101), comprehensive care (n = 99), and usual care (n = 99). Interdisciplinary care included geriatric consultation, continuous rehabilitation, and discharge planning with post-hospital services. Comprehensive care consisted of interdisciplinary care plus nutrition consultation, depression management, and fall prevention. Usual care included only in-hospital rehabilitation without geriatric consultation, in-home rehabilitation, and home environmental assessment.
Participants in the comprehensive care group had better self-care ability (odds ratio, OR = 3.19, p < .01) and less risk of depression (OR = 0.48, p < .01) than those who received usual care. The comprehensive care group had less risk of depression (OR = 0.51, p < .05) and of malnutrition (OR = 0.48, p < .05) than the interdisciplinary care group during the first year following discharge. Older persons with hip fracture benefitted more from the comprehensive care program than from interdisciplinary care and usual care.
Older persons with hip fracture benefitted more from comprehensive care including interdisciplinary care and nutrition consultation, depression management, and fall prevention than simply interdisciplinary care.
很少有研究调查过将跨学科护理与营养咨询、抑郁管理和预防老年人髋部骨折跌倒相结合的护理模式的效果。本研究旨在比较综合护理计划与跨学科护理和常规护理对老年髋部骨折患者的影响。
本研究采用随机对照试验来探索 299 名髋部骨折老年患者的治疗结果，他们接受了三种治疗护理模式：跨学科护理（n=101）、综合护理（n=99）和常规护理（n=99）。跨学科护理包括老年科咨询、持续康复和出院后服务的出院计划。综合护理包括跨学科护理加上营养咨询、抑郁管理和预防跌倒。常规护理仅包括住院康复，不包括老年科咨询、家庭康复和家庭环境评估。
与接受常规护理的患者相比，综合护理组的患者自我护理能力更好（优势比，OR=3.19，p<.01），抑郁风险更低（OR=0.48，p<.01）。与跨学科护理组相比，综合护理组在出院后的第一年，抑郁风险（OR=0.51，p<.05）和营养不良风险（OR=0.48，p<.05）均较低。髋部骨折的老年人从综合护理计划中获益多于从跨学科护理和常规护理中获益。
髋部骨折的老年人从包括跨学科护理和营养咨询、抑郁管理和预防跌倒的综合护理中获益多于单纯的跨学科护理。
