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与接受家庭医疗护理的低功能老年患者中出现意外入院和死亡相关的因素。

Factors associated with unexpected admissions and mortality among low-functioning older patients receiving home medical care.

机构信息

Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.

Sanei Clinic, Komaki, Aichi, Japan.

出版信息

Geriatr Gerontol Int. 2017 Oct;17(10):1623-1627. doi: 10.1111/ggi.12943. Epub 2017 Jan 6.

Abstract

AIM

The need for and availability of home medical care for elderly patients with limitations in terms of access to medical facilities has been increasing. We investigated the association between low function, malnutrition, dementia and multicomorbidity with patient prognosis, focusing on unexpected hospital admissions and mortality in elderly non-cancer patients receiving home care.

METHODS

The study included 124 Japanese patients receiving home medical care in the form of regular visits from doctors and nurses for physical and/or mental disability.

RESULTS

Of the patients studied, 36.2% experienced hospital admission. Student's t-test showed that admitted patients had significantly higher Charlson Comorbidity Index scores. Meanwhile, 19.6% of patients died during the course of the study. Student's t-test showed that older patients had a higher risk of mortality, and significantly lower activities of daily living and Mini-Nutritional Assessment Short-Form scores. Cox hazard analysis showed that multicomorbidity was a risk for unexpected hospital admission, and malnutrition was a risk for mortality in frail older adults receiving home medical care.

CONCLUSIONS

We found that multicomorbidity was a risk for unexpected hospital admission, and malnutrition was a risk for mortality in frail older adults receiving home medical care. Geriatr Gerontol Int 2017; 17: 1623-1627.

摘要

目的

由于行动不便而难以利用医疗设施的老年患者对上门医疗服务的需求和可及性不断增加。我们研究了功能低下、营养不良、痴呆和多种合并症与老年非癌症患者接受上门护理后的预后之间的关系,重点关注意外住院和死亡情况。

方法

该研究纳入了 124 名接受定期上门访视的医生和护士提供身体和/或精神残疾上门医疗服务的日本患者。

结果

在所研究的患者中,36.2%经历了住院。学生 t 检验显示,住院患者的 Charlson 合并症指数评分显著更高。同时,在研究过程中有 19.6%的患者死亡。学生 t 检验显示,年龄较大的患者死亡风险更高,日常生活活动和 Mini-Nutritional Assessment 短期评估评分显著更低。Cox 风险分析显示,多种合并症是意外住院的风险因素,而营养不良是体弱老年人接受上门医疗服务时死亡的风险因素。

结论

我们发现,多种合并症是体弱老年人接受上门医疗服务时意外住院的风险因素,而营养不良是死亡的风险因素。老年医学与老年病学杂志 2017; 17: 1623-1627。

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