Section of Geriatrics, Department of Internal Medicine, School of Medicine, Yale University, New Haven 06511, CT, United States of America; Section of Geriatric Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam 110Z AZ, the Netherlands.
Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston 02215-5321, MA, United States of America.
Am J Emerg Med. 2020 Jan;38(1):127-131. doi: 10.1016/j.ajem.2019.07.023. Epub 2019 Jul 16.
There is an increasing focus in the emergency department (ED) on addressing the needs of persons with cognitive impairment, most of whom have multiple chronic conditions. We investigated which common comorbidities among multimorbid persons with cognitive impairment conferred increased risk for ED treat and release utilization.
We examined the association of 16 chronic conditions on use of ED treat and release visit utilization among 1006 adults with cognitive impairment and ≥ 2 comorbidities using the nationally-representative National Health and Aging Trends Study merged with Fee-For-Service Medicare claims data, 2011-2015.
At baseline, 28.5% had ≥6 conditions and 35.4% were ≥ 85 years old. After controlling for sex, age, race, education, urban-living, number of disabled activities of daily living, and sampling strata, we found significantly increased adjusted risk ratios (aRR) of ED treat and release visits for persons with depression (aRR 1.38 95% CI 1.15-1.65) representing 78/100 person-years, and osteoarthritis or rheumatoid arthritis (aRR 1.32 95% CI 1.12-1.57) representing 71/100 person-years. At baseline 93.9% had ≥1 informal caregiver and 69.7% had a caregiver that helped with medications or attended physician visits.
These results show that multimorbid cognitively impaired older adults with depression or osteoarthritis or rheumatoid arthritis are at higher risk of ED treat and release visits. Future ED research with multimorbid cognitively impaired persons may explore behavioral aspects of depression and/or pain and flairs associated with osteoarthritis or rheumatoid arthritis, as well as the role of informal caregivers in the care of these conditions.
急诊科越来越关注满足认知障碍患者的需求，这些患者大多数都有多种慢性疾病。我们研究了认知障碍且合并多种疾病的患者中哪些常见合并症会增加急诊就诊和离院的风险。
我们使用全国代表性的国家健康老龄化趋势研究（与按服务收费的医疗保险索赔数据合并），检查了 1006 名认知障碍且合并≥2 种合并症的成年人中 16 种慢性疾病与急诊就诊和离院就诊使用之间的关联，研究时间为 2011-2015 年。
在基线时，28.5%的患者有≥6 种疾病，35.4%的患者年龄≥85 岁。在控制了性别、年龄、种族、教育程度、城乡居住情况、日常生活活动受限的残疾人数以及抽样分层后，我们发现抑郁（调整后风险比[aRR] 1.38，95%置信区间[CI] 1.15-1.65）和骨关节炎或类风湿性关节炎（aRR 1.32，95%CI 1.12-1.57）的患者急诊就诊和离院的调整后风险比[aRR]显著增加，分别代表每 100 人年发生 78 例和 71 例就诊。基线时，93.9%的患者有≥1 名非专业护理人员，69.7%的患者有帮助服药或陪同就诊的护理人员。
这些结果表明，患有抑郁或骨关节炎或类风湿性关节炎且合并多种疾病的认知障碍老年患者急诊就诊和离院的风险更高。未来对合并多种疾病且认知障碍的患者进行急诊研究时，可能会探讨抑郁和/或与骨关节炎或类风湿性关节炎相关的疼痛发作的行为方面，以及非专业护理人员在这些疾病护理中的作用。
