Harvey Lara, Mitchell Rebecca, Brodaty Henry, Draper Brian, Close Jacqueline
Falls and Injury Prevention Group, Neuroscience Research Australia, UNSW, Australia.
Falls and Injury Prevention Group, Neuroscience Research Australia, UNSW, Australia; Australian Institute of Health Innovation, Macquarie University, Australia.
Injury. 2016 Jan;47(1):226-34. doi: 10.1016/j.injury.2015.09.021. Epub 2015 Oct 9.
Injury is the most common reason for admission to hospital in people with dementia in Australia. However relatively little is known about the temporal trends and the hospital experience of people with dementia hospitalised for an injury. This population-based data linkage study compared the causes, temporal trends and health outcomes for injury-related hospitalisations in people with and without dementia.
Hospitalisation and death data for 235,612 individuals aged 65 years and over admitted to hospital for an injury over the ten year period (2003-2012) in New South Wales, Australia were probabilistically linked. Descriptive statistics including chi square tests, observed and age-standardised admission rates and rate ratios (RRs) were calculated. Trends over time were analysed using negative binomial regression.
There were 331,432 injury-related hospitalisations over the study period. Both the observed (RR 3.16; 95% CI 3.13-3.19) and age-standardised admission rate ratios (RR 1.78; 95% CI 1.77-1.79) were higher for people with dementia. Age-standardised rates increased by 3.5% (95% CI 3.1-3.9) per annum over the study period for people without dementia. In contrast, for people with dementia, rates increased by 2.4% (95% CI 1.8-3.1) per annum until 2007 and then decreased by 3.1% (95% CI -4.4 to -1.7) per annum from 2007 onwards. Compared to people without dementia, a higher proportion of people with dementia were hospitalised as a result of a fall (90.9% vs 75.2%, p<0.0001), sustained a fracture (57.2% vs 52.1%, p<0.0001), notably hip fracture (30.7% vs 14.7%, p<0.0001), had longer mean hospital lengths of stay (LOS) (16.5 vs 13.6 days), and higher 30-day mortality (8.7% vs 3.6% p<0.0001), although this pattern was not consistent across all injury types.
People with dementia are disproportionately represented in injury-related hospitalisations, experience longer hospital LOS and have poorer outcomes. Ninety percent of hospitalisations for people with dementia were as a result of a fall, highlighting the importance of developing and implementing effective fall-related preventive strategies in this high risk population.
在澳大利亚，受伤是痴呆症患者住院的最常见原因。然而，对于因伤住院的痴呆症患者的时间趋势和住院经历，我们所知相对较少。这项基于人群的数据关联研究比较了患有和未患有痴呆症的患者因伤住院的原因、时间趋势和健康结局。
对澳大利亚新南威尔士州235,612名65岁及以上在十年期间（2003 - 2012年）因伤住院的个体的住院和死亡数据进行概率关联分析。计算了包括卡方检验、观察到的和年龄标准化的住院率以及率比（RRs）在内的描述性统计量。使用负二项回归分析随时间的趋势。
在研究期间，共有331,432例与受伤相关的住院病例。痴呆症患者的观察到的住院率比（RR 3.16；95%可信区间3.13 - 3.19）和年龄标准化住院率比（RR 1.78；95%可信区间1.77 - 1.79）均更高。在研究期间，未患痴呆症的患者年龄标准化住院率每年增加3.5%（95%可信区间3.1 - 3.9）。相比之下，对于痴呆症患者，到2007年之前住院率每年增加2.4%（95%可信区间1.8 - 3.1），从2007年起每年下降3.1%（95%可信区间 - 4.4至 - 1.7）。与未患痴呆症的患者相比，痴呆症患者因跌倒住院的比例更高（90.9%对75.2%，p<0.0001），发生骨折的比例更高（57.2%对52.1%，p<0.0001），尤其是髋部骨折（30.7%对14.7%，p<0.0001），平均住院时间更长（16.5天对13.6天），30天死亡率更高（8.7%对3.6%，p<0.0001），尽管这种模式在所有损伤类型中并不一致。
在与受伤相关的住院病例中，痴呆症患者所占比例过高，住院时间更长，结局更差。痴呆症患者90%的住院是由跌倒导致的，这凸显了在这一高危人群中制定和实施有效的跌倒预防策略的重要性。
