住院老年患者伴或不伴糖尿病的衰弱风险。
Frailty risk in hospitalised older adults with and without diabetes mellitus.
机构信息
School of Nursing, University of North Carolina at Greensboro, Greensboro, North Carolina.
出版信息
J Clin Nurs. 2018 Oct;27(19-20):3510-3521. doi: 10.1111/jocn.14529. Epub 2018 Jul 26.
BACKGROUND
Research indicates that diabetes mellitus (DM) may be a risk factor for frailty and individuals with DM are more likely to be frail than individuals without DM; however, there is limited research in hospitalised older adults.
OBJECTIVES
To determine the extent of frailty in hospitalised older adults with and without DM using a 16-item Frailty Risk Score (FRS) and assess the role of frailty in predicting 30-day rehospitalisation, discharge to an institution and in-hospital mortality.
METHODS
The study was a retrospective, cohort, correlational design and secondary analysis of a data set consisting of electronic health record data. The sample was older adults hospitalised on medicine units. Logistic regression was performed for 30-day rehospitalisation and discharge location. Cox proportional hazards regression was used to analyse time to in-hospital death and weighted using propensity scores.
RESULTS
Of 278 hospitalised older adults, 49% had DM, and the mean FRS was not significantly different by DM status (9.6 vs. 9.1, p = 0.07). For 30-day rehospitalisation, increased FRS was associated with significantly increased odds of rehospitalisation (AOR = 1.24, 95% CI [1.01, 1.51], p = 0.04). Although 81% were admitted from home, 57% were discharged home and 43% to an institution. An increased FRS was associated with increased odds of discharge to an institution (AOR = 1.48, 95% CI [1.26, 1.74], p < 0.001). The FRS was not significantly associated with increased risk of in-hospital death (p = 0.17), but DM was associated with a 484% increase in the instantaneous risk of death (AHR = 5.84, 95% CI [1.71, 19.9], p = 0.005).
CONCLUSION
Diabetes mellitus and frailty were highly prevalent; the mean FRS was not significantly different by DM status. Although increased frailty was significantly associated with rehospitalisation and discharge to an institution, only DM was significantly associated with in-hospital mortality.
RELEVANCE TO CLINICAL PRACTICE
Frailty assessment may augment clinical assessment and facilitate tailoring care and determining optimal outcomes in patients with and without DM.
背景
研究表明，糖尿病（DM）可能是衰弱的一个风险因素，患有 DM 的个体比没有 DM 的个体更容易衰弱；然而，在住院的老年人中，相关研究有限。
目的
使用 16 项衰弱风险评分（FRS）确定患有和不患有 DM 的住院老年患者衰弱的程度，并评估衰弱在预测 30 天再住院、出院至机构和院内死亡方面的作用。
方法
本研究为回顾性、队列、相关性设计，对电子病历数据组成的数据集进行二次分析。样本为住院内科病房的老年人。对 30 天再住院和出院地点进行 logistic 回归。使用 Cox 比例风险回归分析住院期间死亡的时间，并使用倾向评分加权。
结果
在 278 名住院老年人中，49%患有 DM，FRS 平均值在 DM 状态上无显著差异（9.6 与 9.1，p=0.07）。对于 30 天再住院，FRS 升高与再住院的几率显著增加相关（OR=1.24，95%CI [1.01，1.51]，p=0.04）。尽管 81%是从家中入院，但 57%出院回家，43%出院到机构。FRS 升高与出院到机构的几率增加相关（OR=1.48，95%CI [1.26，1.74]，p<0.001）。FRS 与院内死亡风险增加无显著相关性（p=0.17），但 DM 与即时死亡风险增加 484%相关（HR=5.84，95%CI [1.71，19.9]，p=0.005）。
结论
糖尿病和衰弱非常普遍；FRS 平均值在 DM 状态上无显著差异。尽管衰弱程度增加与再住院和出院到机构显著相关，但只有 DM 与院内死亡率显著相关。
临床意义
衰弱评估可以补充临床评估，有助于为有和没有 DM 的患者量身定制护理，并确定最佳结局。
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