Toh Hui Jin, Lim Zhen Yu, Yap Philip, Tang Terence
Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore.
Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Singapore Med J. 2017 Mar;58(3):134-138. doi: 10.11622/smedj.2016158. Epub 2016 Sep 9.
Prolonged stay in acute hospitals increases the risk of hospital-acquired infections in older patients, and disrupts patient flow and access to care due to bed shortages. We aimed to investigate the factors associated with prolonged length of stay (pLOS) among older patients (aged ≥ 78 years) in a tertiary hospital, to identify the potentially modifiable risk factors that could direct interventions to reduce length of stay (LOS).
During a three-month period from January 2013 to March 2013, we identified 72 patients with pLOS (LOS ≥ 21 days) and compared their demographic and clinical variables with that of 281 randomly selected control patients (LOS < 21 days) using univariate and multivariate logistic regression analyses.
The mean age of the patients was 85.30 ± 5.34 years; 54% of them were female and 72% were of Chinese ethnicity. Logistic regression revealed the following significant factors for increased LOS: discharge to intermediate and long-term care services (odds ratio [OR] 9.22, 95% confidence interval [CI] 3.56-23.89; p < 0.001); increased severity of illness (OR 2.41, 95% CI 1.12-5.21; p = 0.025); and presence of caregiver stress (OR 3.85, 95% CI 1.67-8.91; p = 0.002).
Presence of caregiver stress and nursing home placement are potential modifiable risk factors of pLOS among older patients. Early identification and management of caregiver stress, as well as expediting discharge planning, may help to reduce the length of stay for this cohort.
老年患者在急症医院长期住院会增加医院获得性感染的风险，并且由于床位短缺会扰乱患者流动及医疗服务的可及性。我们旨在调查一家三级医院中年龄≥78岁的老年患者长期住院（pLOS）相关因素，以确定可直接进行干预以缩短住院时间（LOS）的潜在可改变风险因素。
在2013年1月至2013年3月的三个月期间，我们确定了72例长期住院患者（住院时间≥21天），并使用单因素和多因素逻辑回归分析将其人口统计学和临床变量与281例随机选择的对照患者（住院时间<21天）进行比较。
患者的平均年龄为85.30±5.34岁；其中54%为女性，72%为华裔。逻辑回归显示以下增加住院时间的显著因素：转至中长期护理服务机构（比值比[OR]9.22，95%置信区间[CI]3.56 - 23.89；p<0.001）；疾病严重程度增加（OR 2.41，95%CI 1.12 - 5.21；p = 0.025）；以及存在照顾者压力（OR 3.85，95%CI 1.67 - 8.91；p = 0.002）。
照顾者压力的存在和安置在养老院是老年患者长期住院潜在的可改变风险因素。早期识别和处理照顾者压力以及加快出院计划制定，可能有助于缩短该队列患者的住院时间。
