Bo Mario, Fonte Gianfranco, Pivaro Federica, Bonetto Martina, Comi Chiara, Giorgis Veronica, Marchese Lorenzo, Isaia Gianluca, Maggiani Guido, Furno Elisabetta, Falcone Yolanda, Isaia Giovanni Carlo
Department of Medical and Surgical Disciplines, Section of Geriatrics, University of Turin, Turin, Italy.
Geriatr Gerontol Int. 2016 Mar;16(3):314-21. doi: 10.1111/ggi.12471. Epub 2015 Mar 9.
To characterize elderly medical patients and identify factors associated with prolonged length of stay.
The present prospective observational study evaluated consecutive patients aged ≥65 years admitted in acute geriatric and medical wards. A comprehensive assessment including demographic, clinical, functional and cognitive variables was carried out. Delayed discharge was defined when patients were discharged later than the date they were deemed medically ready for discharge by physicians. The analysis was initially carried out on the total sample and subsequently according to whether hospital admission had been from home, or from intermediate or long-term facilities.
Among 1568 patients (age 81.3 ± 7.3 years, 712 men), we observed a high prevalence of functional dependence, cognitive impairment, chronic immobilization and frailty (50%, 25%, 20% and 40%, respectively). Overall, delayed discharge occurred in 442 cases - resulting in 2637 days of prolonged hospital stay - and was independently associated with impairment in activities of daily living, frailty, high comorbidity and inappropriate admission. Among patients admitted from home (roughly 90% of the sample), delayed discharge occurred in 392 patients, and was independently associated with cognitive impairment, functional dependence, low severity of comorbidity and inappropriate admission (OR 3.39). Among patients admitted from intermediate or long-term facilities, lower cognitive impairment and greater severity of functional dependence were independently associated with prolonged stay.
Poor health conditions and high prevalence of geriatric syndromes are extremely common among older medical inpatients. Delayed discharge was mainly observed in patients admitted from home, and associated with cognitive impairment (OR 1.12) and functional dependence (OR 1.49).
对老年内科患者进行特征描述，并确定与住院时间延长相关的因素。
本前瞻性观察性研究评估了急性老年病科和内科病房收治的连续≥65岁患者。进行了包括人口统计学、临床、功能和认知变量在内的综合评估。当患者出院时间晚于医生认为其已具备出院医疗条件的日期时，定义为延迟出院。分析首先在总样本上进行，随后根据入院是来自家中还是来自中级或长期护理机构进行。
在1568例患者（年龄81.3±7.3岁，712例男性）中，我们观察到功能依赖、认知障碍、慢性活动受限和虚弱的患病率较高（分别为50%、25%、20%和40%）。总体而言，442例出现延迟出院，导致住院时间延长2637天，且与日常生活活动能力受损、虚弱、高合并症和不适当入院独立相关。在家中入院的患者（约占样本的90%）中，392例出现延迟出院，且与认知障碍、功能依赖、较低的合并症严重程度和不适当入院独立相关（比值比3.39）。在从中级或长期护理机构入院的患者中，较低的认知障碍和较高的功能依赖严重程度与住院时间延长独立相关。
健康状况不佳和老年综合征的高患病率在老年内科住院患者中极为常见。延迟出院主要见于在家中入院的患者，且与认知障碍（比值比1.12）和功能依赖（比值比1.49）相关。
