Unit of Rehabilitation Medicine Postacute and Long Term Care Department I.N.R.C.A., Ancona, Italy -
Eur J Phys Rehabil Med. 2014 Dec;50(6):703-8. Epub 2014 May 23.
The study of the determinants of loss of autonomy during hospitalization may be valuable in the identification of the most effective interventions and to achieve better outcomes. The aim of this study was to describe changes in the level of autonomy of the elderly admitted to the hospital at the entrance and at discharge in relation to a rehabilitation program.
Prospective observational study conducted at the INRCA Geriatric Hospital of Ancona. The study included patients aged 65 years and over, daily admitted to INRCA Hospital of Ancona between September and December 2010. Criteria for inclusion were age ≥ 65 years, length of stay > 24 hours and signed informed consent. Patients admitted for less than 24 hours or in day hospital or day surgery were excluded from the beginning. A total of 1266 elderly patients were recruited in the period. From this sample, 74 people who died during hospitalization were excluded. At the time of hospitalization (within 24 hours) and at discharge, patients were evaluated with the Barthel Index (BI), the Rankin scale, and a short assessment of cognitive status derived from the Mini Mental State Examination (MMSE).
Referring to 1192 subjects who participated to the study, the mean age was 82.13 years ±7.39, age range between 65 and 100 years. The average BI was 56.6±36.16 (SD) (median value =60) at admission and 63.84±34.7 (SD) (median value=70) at discharge. The average Rankin score at admission was 2.63±1.5 (SD) (median value=3).
Patients presented better score of the BI at discharge and this figure was associated to the implementation of a rehabilitation treatment. Hospitalization of the elderly patient in a suitable environment, such as a geriatric hospital, contrary to some theories highlighting only the negative aspects of removal from the living environment, can be a measure of benefit for the reduction of disability and the recovery of compromised activities along and after the acute event. The collection of data on the level of autonomy of the subjects before and after hospitalization can be a useful element for clinical evaluation in a geriatric hospital.
研究住院期间自主性丧失的决定因素对于确定最有效的干预措施和实现更好的结果可能具有重要意义。本研究旨在描述入院时和出院时入住医院的老年人的自主性水平变化与康复计划的关系。
前瞻性观察研究在安科纳 INRCA 老年医院进行。该研究纳入了 2010 年 9 月至 12 月期间每天入住 INRCA 医院的年龄在 65 岁及以上的患者。纳入标准为年龄≥65 岁、住院时间>24 小时、签署知情同意书。入院时间少于 24 小时或日间住院或日间手术的患者从一开始就被排除在外。在该期间共招募了 1266 名老年人。从该样本中，排除了 74 名在住院期间死亡的患者。在住院期间（24 小时内）和出院时，患者使用巴氏量表（BI）、兰金量表和从简明精神状态检查（MMSE）中得出的认知状态简短评估进行评估。
在参与研究的 1192 名受试者中，平均年龄为 82.13 岁±7.39 岁，年龄范围在 65 岁至 100 岁之间。入院时平均 BI 为 56.6±36.16（SD）（中位数=60），出院时为 63.84±34.7（SD）（中位数=70）。入院时平均 Rankin 评分为 2.63±1.5（SD）（中位数=3）。
患者在出院时的 BI 评分更高，这一数字与实施康复治疗有关。将老年患者安置在一个合适的环境中，如老年医院，与一些仅强调从生活环境中去除的负面方面的理论相反，可能是减少残疾和在急性事件期间和之后恢复受损活动的一种有益措施。在住院前后收集受试者的自主性数据可以为老年医院的临床评估提供有用的元素。
