Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, The Netherlands.
Division of Geriatrics, San Francisco VA Medical Center, California.
J Gerontol A Biol Sci Med Sci. 2020 Jun 18;75(7):1403-1410. doi: 10.1093/gerona/glaa039.
Acute hospitalization may lead to posthospital syndrome, but no studies have investigated how this syndrome manifests and geriatric syndromes are often used as synonym. However, studies on longitudinal associations between syndromes and adverse outcomes are scarce. We aimed to analyze longitudinal associations between geriatric syndromes and functional decline (FD), readmission, and mortality.
Prospective cohort study, including 401 acutely hospitalized patients (aged ≥ 70). We performed: (i) logistic regression analyses to assess associations between patterns of geriatric syndromes as they develop over time (between admission and 1 month postdischarge), and FD and readmission; (ii) generalized estimating equations to assess longitudinal associations between geriatric syndromes over five time points (admission, discharge, 1, 2, and 3 months postdischarge) and FD, mortality, and readmission at 3 months postdischarge.
After syndrome absent, syndrome present at both admission and 1 month postdischarge was most prevalent. Persistent patterns of apathy (odds ratio [OR] = 4.35, 95% confidence interval [CI] = 1.54-12.30), pain (OR = 3.26, 95% CI = 1.21-8.8), malnutrition (OR = 3.4, 95% CI = 1.35-8.56), mobility impairment (OR = 6.65, 95% CI = 1.98-22.38), and fear of falling (OR = 3.17, 95% CI = 1.25-8.02) were associated with FD. Developing cognitive impairment (OR = 6.40, 95% CI = 1.52-26.84), fatigue (OR = 4.71, 95% CI = 1.03-21.60), and fall risk (OR = 4.30, 95% CI = 1.21-16.57) postdischarge, was associated with readmission; however, only 4%-6% developed these syndromes. Over the course of five time points, mobility impairment, apathy, and incontinence were longitudinally associated with FD; apathy, malnutrition, fatigue, and fall risk with mortality; malnutrition with readmission.
Most geriatric syndromes are present at admission and patients are likely to retain them postdischarge. Several geriatric syndromes are longitudinally associated with mortality and, particularly, persistently present syndromes place persons are at risk of FD. Although few persons develop syndromes postdischarge, those developing cognitive impairment, fatigue, and fall risk were at increased readmission risk.
急性住院可能导致住院后综合征，但尚无研究调查该综合征的表现形式，且老年综合征常被用作同义词。然而，关于综合征与不良结局之间的纵向关联的研究很少。我们旨在分析老年综合征与功能下降（FD）、再入院和死亡之间的纵向关联。
前瞻性队列研究，纳入 401 名急性住院患者（年龄≥70 岁）。我们进行了：（i）逻辑回归分析，以评估随着时间的推移（入院和出院后 1 个月之间）老年综合征模式的发展与 FD 和再入院之间的关系；（ii）广义估计方程，以评估在五个时间点（入院、出院、1、2 和 3 个月出院）老年综合征与 FD、死亡率和 3 个月出院后再入院之间的纵向关联。
在无综合征、入院和出院后 1 个月均存在综合征之后，最常见的是同时存在多种综合征。持续性的冷漠（比值比 [OR] = 4.35，95%置信区间 [CI] = 1.54-12.30）、疼痛（OR = 3.26，95%CI = 1.21-8.8）、营养不良（OR = 3.4，95%CI = 1.35-8.56）、活动能力受损（OR = 6.65，95%CI = 1.98-22.38）和恐摔（OR = 3.17，95%CI = 1.25-8.02）与 FD 相关。出院后发生认知障碍（OR = 6.40，95%CI = 1.52-26.84）、疲劳（OR = 4.71，95%CI = 1.03-21.60）和跌倒风险（OR = 4.30，95%CI = 1.21-16.57）与再入院相关；然而，只有 4%-6%的人出现了这些综合征。在五个时间点的过程中，活动能力受损、冷漠和失禁与 FD 呈纵向相关；冷漠、营养不良、疲劳和跌倒风险与死亡率相关；营养不良与再入院相关。
大多数老年综合征在入院时就存在，并且患者在出院后很可能会保留这些综合征。一些老年综合征与死亡率呈纵向相关，特别是持续性存在的综合征使患者面临 FD 的风险。尽管出院后很少有人出现综合征，但出现认知障碍、疲劳和跌倒风险的人再入院的风险增加。
