老年人在住院后接受康复治疗是否有益？瑞士三家疗养院的前瞻性队列研究。

Do older adults benefit from post-acute care following hospitalisation? A prospective cohort study at three Swiss nursing homes.

机构信息

Department of Geriatrics, University Hospital Zurich, Switzerland; Centre on Aging and Mobility, University of Zurich, Switzerland.

Zurich Geriatric Services and Nursing Homes, Zurich, Switzerland.

出版信息

Swiss Med Wkly. 2020 Feb 24;150:w20198. doi: 10.4414/smw.2020.20198.

DOI:10.4414/smw.2020.20198

PMID:32108929

Abstract

BACKGROUND

Post-acute care (PAC) programmes appear favourable for older adult inpatients too fragile to be discharged home without extensive support, but otherwise not qualifying for specific rehabilitation. Consequently, many Swiss nursing homes have opened PAC wards after a new federal law refined reimbursement in 2012. However, PAC outcomes in this setting have not been well studied.

OBJECTIVE

To investigate the functional outcomes of a nursing home-based PAC programme for older adult patients and to evaluate the influences of age, gender and frailty status on these outcomes.

METHODS

This was a prospective cohort study in 135 consecutive patients aged 60 and older admitted to PAC at three nursing homes in Zurich, Switzerland, over a two-month period. Geriatric assessment at admission included mobility, physical performance, cognition, nutrition, frailty, activities of daily living (ADL) and social support. The primary outcomes of the study, Short Physical Performance Battery (SPPB), handgrip strength (HGS) and Barthel Index (BI), were repeated before discharge from PAC. Multivariable linear models were used to analyse differences between these primary outcomes at admission and discharge, adjusting for baseline age, gender, BMI, length of stay (LOS), polypharmacy, cognition, and prior living status.

RESULTS

We identified statistically significant improvements between admission and discharge (mean [95% confidence interval]; % change) in BI (69.0 [65.0–72.9] vs 79.6 [75.6–83.6]; +15.4%), gait speed (0.55 [0.48–0.62] vs 0.65 [0.58–0.71] m/s; +18.2%) and SPPB scores (5.5 [5.0–6.1] vs 6.9 [6.3–7.4]; +24%), p-values for all comparisons <0.001.

CONCLUSIONS

In this real-word sample, PAC resulted in a significant and clinically relevant improvement in physical performance and ADL. However, our study should be replicated with a larger sample. Furthermore, long-term outcomes of PAC warrant additional investigation.

摘要

背景

急性后期护理（PAC）计划似乎对那些过于脆弱而无法在没有广泛支持的情况下出院回家但又不符合特定康复条件的老年住院患者有利，但瑞士许多疗养院在 2012 年新的联邦法律完善了报销规定后开设了 PAC 病房。然而，这种环境下的 PAC 结果并没有得到很好的研究。

目的

调查疗养院为老年患者提供的 PAC 计划的功能结果，并评估年龄、性别和脆弱状态对这些结果的影响。

方法

这是一项前瞻性队列研究，共纳入瑞士苏黎世的 3 家疗养院在两个月内收治的 135 例 60 岁及以上的连续患者。入院时进行老年评估，包括移动能力、身体表现、认知、营养、虚弱、日常生活活动（ADL）和社会支持。研究的主要结局包括短体物理表现电池（SPPB）、握力（HGS）和巴氏指数（BI），在 PAC 出院前重复。多变量线性模型用于分析入院和出院时这些主要结局之间的差异，调整基线年龄、性别、BMI、住院时间（LOS）、多药治疗、认知和之前的居住状态。

结果

我们发现 BI（69.0 [65.0–72.9] 与 79.6 [75.6–83.6]；+15.4%）、步速（0.55 [0.48–0.62] 与 0.65 [0.58–0.71] m/s；+18.2%）和 SPPB 评分（5.5 [5.0–6.1] 与 6.9 [6.3–7.4]；+24%）在入院和出院之间存在统计学上的显著改善，所有比较的 p 值均小于 0.001。