Dent Elsa, Hoogendijk Emiel O
Discipline of Public Health, School of Population Health, The University of Adelaide, 178 North Terrace-Terrace Towers, Adelaide, Australia.
BMC Geriatr. 2014 Sep 28;14:108. doi: 10.1186/1471-2318-14-108.
Frailty increases the risk of adverse outcomes in older people. The impact of psychosocial factors on frailty and adverse clinical outcomes associated with frailty has not yet been examined in the hospital setting. The aims of this study were to: i) investigate the association between psychosocial factors and frailty, and ii) to establish whether psychosocial factors impact on the association between frailty and adverse outcomes.
Data was collected from a Geriatric Evaluation and Management Unit (GEMU) in Australia. Frailty was identified using Fried's frailty criteria. Psychosocial factors included wellbeing, sense of control (mastery), social activities, home/neighbourhood satisfaction, social relationships, anxiety and depression. Outcome measures were: mortality at 12 months, long length of GEMU stay (LOS), 1-month emergency rehospitalisation, and a higher level of care needed on discharge. Covariates adjusted for were age, gender and comorbidity.
The mean (SD) age of participants (n = 172) at admission was 85.2 (6.4) years, with 129 (75%) female patients. 96 (56%) patients were classified as frail, with 64 (37%) pre-frail and 12 (7%) robust. Frail patients had an increased likelihood of 12-month mortality (HR, 95% CI = 3.16, 1.36-7.33), discharge to a higher level of care (OR, 95% CI = 2.40, 1.21-4.78), long LOS (OR, 95% CI = 2.04, 1.07-3.88) and 1-month emergency rehospitalisation (OR, 95% CI = 2.53, 1.10-5.82). Psychosocial factors associated with frailty included poor wellbeing, anxiety, depression, and a low sense of control. Several psychosocial factors increased the likelihood of adverse outcomes associated with frailty, including anxiety and low ratings for: wellbeing, sense of control, social activities and home/neighbourhood satisfaction.
Our results indicate that frail older adults with low psychosocial resources had an elevated risk of mortality, discharge to higher level care, long LOS and rehospitalisation. Consideration of psychosocial factors in comprehensive geriatric assessments will assist in patient care planning.
衰弱会增加老年人出现不良结局的风险。心理社会因素对衰弱以及与衰弱相关的不良临床结局的影响，在医院环境中尚未得到研究。本研究的目的是：i）调查心理社会因素与衰弱之间的关联，以及ii）确定心理社会因素是否会影响衰弱与不良结局之间的关联。
数据收集自澳大利亚的一个老年评估与管理单元（GEMU）。采用弗里德衰弱标准来识别衰弱。心理社会因素包括幸福感、掌控感、社交活动、家庭/邻里满意度、社会关系、焦虑和抑郁。结局指标为：12个月时的死亡率、GEMU住院时间长（LOS）、1个月内紧急再入院，以及出院时需要更高水平的护理。调整的协变量为年龄、性别和合并症。
参与者（n = 172）入院时的平均（标准差）年龄为85.2（6.4）岁，其中129名（75%）为女性患者。96名（56%）患者被归类为衰弱，64名（37%）为衰弱前期，12名（7%）为健康。衰弱患者12个月死亡率增加（HR，95%CI = 3.16，1.36 - 7.33）、出院时转至更高水平护理的可能性增加（OR，95%CI = 2.40，1.21 - 4.78）、住院时间长（OR，95%CI = 2.04，1.07 - 3.88）以及1个月内紧急再入院的可能性增加（OR，95%CI = 2.53，1.10 - 5.82）。与衰弱相关的心理社会因素包括幸福感差、焦虑、抑郁和掌控感低。一些心理社会因素增加了与衰弱相关的不良结局的可能性，包括焦虑以及幸福感、掌控感、社交活动和家庭/邻里满意度评分低。
我们的结果表明，心理社会资源低的衰弱老年人死亡、转至更高水平护理、住院时间长和再入院的风险升高。在综合老年评估中考虑心理社会因素将有助于患者护理计划。
