后天性脑损伤的老年人：一项基于人群的研究。
Older adults with acquired brain injury: a population based study.
机构信息
Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, Ontario, M5G 2A2, Canada.
出版信息
BMC Geriatr. 2013 Sep 23;13:97. doi: 10.1186/1471-2318-13-97.
BACKGROUND
Acquired brain injury (ABI), which includes traumatic (TBI) and non-traumatic brain injury (nTBI), is a leading cause of death and disability worldwide. The objective of this study was to examine the trends, characteristics, cause of brain injury, and discharge destination of hospitalized older adults aged 65 years and older with an ABI diagnosis in a population with universal access to hospital care. The profile of characteristics of patients with TBI and nTBI causes of injury was also compared.
METHODS
A population based retrospective cohort study design with healthcare administrative databases was used. Data on acute care admissions were obtained from the Discharge Abstract Database and patients were identified using the International Classification of Diseases - Version 10 codes for Ontario, Canada from April 1, 2003 to March 31, 2010. Older adults were examined in three age groups - 65 to 74, 75 to 84, and 85+ years.
RESULTS
From 2003/04 to 2009/10, there were 14,518 episodes of acute care associated with a TBI code and 51, 233 episodes with a nTBI code. Overall, the rate of hospitalized TBI and nTBI episodes increased with older age groups. From 2007/08 to 2009/10, the percentage of patients that stayed in acute care for 12 days or more and the percentage of patients with delayed discharge from acute care increased with age. The most common cause of TBI was falls while the most common type of nTBI was brain tumours. The percentage of patients discharged to long term care and complex continuing care increased with age and the percentage discharged home decreased with age. In-hospital mortality also increased with age. Older adults with TBI and nTBI differed significantly in demographic and clinical characteristics and discharge destination from acute care.
CONCLUSIONS
This study showed an increased rate of acute care admissions for both TBI and nTBI with age. It also provided additional support for falls prevention strategies to prevent injury leading to cognitive disability with costly human and economic consequences. Implications for increased numbers of people with ABI are discussed.
背景
获得性脑损伤（ABI）包括创伤性脑损伤（TBI）和非创伤性脑损伤（nTBI），是全球范围内导致死亡和残疾的主要原因。本研究的目的是研究在全民享有医院医疗服务的情况下，年龄在 65 岁及以上的因 ABI 住院的老年人的趋势、特征、脑损伤原因和出院去向。还比较了 TBI 和 nTBI 患者的受伤原因的特征概况。
方法
使用基于人群的回顾性队列研究设计和医疗保健管理数据库。从 Discharge Abstract Database 获取急性护理入院数据，并使用加拿大安大略省的国际疾病分类第 10 版代码从 2003 年 4 月 1 日至 2010 年 3 月 31 日识别患者。将老年人分为三组：65 至 74 岁、75 至 84 岁和 85 岁及以上。
结果
从 2003/04 年至 2009/10 年，有 14518 例与 TBI 代码相关的急性护理发作和 51233 例与 nTBI 代码相关的急性护理发作。总体而言，随着年龄组的增加，TBI 和 nTBI 发作的住院率增加。从 2007/08 年至 2009/10 年，在急性护理中停留 12 天或以上的患者百分比和延迟出院的患者百分比均随年龄增长而增加。TBI 的最常见原因是跌倒，而 nTBI 最常见的类型是脑肿瘤。出院至长期护理和复杂持续护理的患者百分比随年龄增长而增加，出院至家庭的患者百分比随年龄增长而减少。住院死亡率也随年龄增长而增加。TBI 和 nTBI 的老年患者在人口统计学和临床特征以及从急性护理出院的目的地方面存在显著差异。
结论
本研究表明，随着年龄的增长，TBI 和 nTBI 的急性护理入院率均有所增加。它还为预防跌倒策略提供了额外的支持，以防止导致认知障碍的伤害，从而带来人力和经济成本。讨论了与 ABI 人数增加相关的问题。
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