Morin Thomas, Lanièce Isabelle, Desbois Aurélie, Amiard Stéphanie, Gavazzi Gaëtan, Couturier Pascal
Clinique universitaire de médecine gériatrique, pôle pluridisciplinaire de médecine, Hôpital Albert Michallon, CHU de Grenoble, France.
Geriatr Psychol Neuropsychiatr Vieil. 2012 Sep;10(3):285-93. doi: 10.1684/pnv.2012.0359.
Frail elderly patients during their hospitalization can benefit of a comprehensive geriatric assessment (CGA) by an inpatient geriatric consultation team (IGCT). This assessment yields recommendations aiming to improve medical and social management during the patient's hospital stay and after discharge.
This study examines the socio-demographic profile of patients assessed by the IGCT and describes the type of recommendations, their adherence rate at 3 months and their impact in terms of mortality, rehospitalization, and institutionalization.
Retrospective, single center study including all patients assessed by the IGCT during the 4 first months of 2009. These 151 patients fulfilled criteria of either medical and/or social frailty or had been submitted to an inappropriate in-hospital trajectory. Hospital records and telephone follow-up (with informal and/or professional caregivers as well as primary care physicians) were used to monitor the implementation of recommendations up to three months after hospital discharge.
Mean age of the 151 patients was 85.6 years, 63% were women. 94% of patients lived at home, 70% had a non-supportive environment, 85% were frail and 11% had dementia. On admission, 64% of them had an acute functional loss. 93% of patients were admitted via the emergency room where 67% benefited from CGA. The median hospital duration stay was 14 days. At discharge, 76% of patients went back home, 12% were institutionalized and 12% had died. Three months after discharge, 18% of the 134 patients surviving hospitalization had been readmitted, 26% institutionalized and 12% had died. The CGA yielded an average of 7 recommendations (median value). The mean adherence rate was 78%. The majority of medical recommendations concerned ancillary care and standard medical management, showing high adherence rates (95%). Recommendations concerning the management of cognitive problems were less frequent and overall poorly adhered to (62%).
Mean adherence rate was maximal (97%) when the number of recommendations was limited to 4 and it dropped under 80% with more than 5 recommendations. The recommendations concerning management at home were generally followed (60-77%). Regarding to social outcomes, the main recommendation was to mobilize home assistance and its financial support. There was no significant difference between adherence rate in the hospital and in the community. The extent of adherence rate did not correlate with mortality or readmission at 3 months.
住院期间的体弱老年患者可受益于住院老年咨询团队（IGCT）进行的综合老年评估（CGA）。该评估产生旨在改善患者住院期间及出院后医疗和社会管理的建议。
本研究调查了由IGCT评估的患者的社会人口学特征，并描述了建议的类型、其3个月时的依从率及其在死亡率、再住院率和机构化方面的影响。
回顾性单中心研究，纳入2009年最初4个月期间由IGCT评估的所有患者。这151名患者符合医疗和/或社会虚弱标准，或经历了不适当的住院病程。医院记录和电话随访（与非正式和/或专业护理人员以及初级保健医生）用于监测出院后长达三个月的建议实施情况。
151名患者的平均年龄为85.6岁，63%为女性。94%的患者居家生活，70%的患者环境不支持，85%的患者体弱，11%的患者患有痴呆症。入院时，64%的患者有急性功能丧失。93%的患者通过急诊室入院，其中67%的患者受益于CGA。中位住院时间为14天。出院时，76%的患者回家，12%的患者被机构化，12%的患者死亡。出院三个月后，134名住院存活患者中有18%再次入院，26%被机构化，12%死亡。CGA平均产生7条建议（中位值）。平均依从率为78%。大多数医疗建议涉及辅助护理和标准医疗管理，依从率较高（95%）。关于认知问题管理的建议较少，总体依从性较差（62%）。
当建议数量限制在4条时，平均依从率最高（97%），当建议超过5条时，依从率降至80%以下。关于居家管理的建议通常得到遵循（60 - 77%）。关于社会结局，主要建议是动员居家援助及其财政支持。医院和社区的依从率之间没有显著差异。依从率的程度与3个月时的死亡率或再入院率无关。
