老年患者及其护理人员在急诊科的关注点。
Concerns of older patients and their caregivers in the emergency department.
机构信息
Department of Internal Medicine and Gastroenterology, Zuyderland Medical Center, Heerlen, The Netherlands.
Division of General Internal Medicine, Department of Internal Medicine, Section Acute Medicine, Maastricht University Medical Center, Maastricht University, Maastricht, The Netherlands.
出版信息
PLoS One. 2020 Jul 9;15(7):e0235708. doi: 10.1371/journal.pone.0235708. eCollection 2020.
BACKGROUND
Older emergency department (ED) patients often have complex problems and severe illnesses with a high risk of adverse outcomes. It is likely that these older patients are troubled with concerns, which might reflect their preferences and needs concerning medical care. However, data regarding this topic are lacking.
METHODS
This study is a sub study of a prospective, multicenter, observational cohort study among older medical ED patients (≥65 years). Patients or their caregivers were asked about their illness-related concerns during the first stage of the ED visit using a questionnaire. All concerns were categorized into 10 categories, and differences between patients and caregivers, and between age groups were analyzed. Odds Ratios were calculated to determine the association of the concerns for different adverse outcomes.
RESULTS
Most of the 594 included patients (or their caregivers) were concerned (88%) about some aspects of their illness or their need for medical care. The most often reported concerns were about the severity of disease (43.6%), functional decline (9.4%) and dying (5.6%). Caregivers were more frequently concerned than patients (p<0.001) especially regarding the severity of disease (50.5 vs 39.6%, p = 0.016) and cognitive decline (10.8 vs. 0.3%, p <0.001). We found no difference between age groups. The concern about dying was associated with 30-day mortality (OR 2.89; 95%CI: 1.24-6.70) and the composite endpoint (intensive- or medium care admission, length of hospital stay >7 days, loss of independent living and unplanned readmission within 30 days) (OR 2.32; 95%CI: 1.12-4.82). In addition, unspecified concerns were associated with mortality (OR 1.88; 95%CI: 1.09-3.22).
CONCLUSION
The majority of older patients and especially their caregivers are concerned about their medical condition or need for medical care when they visit the ED. These concerns are associated with adverse outcomes and most likely reflect their needs regarding medical care. More attention should be paid to these concerns because they may offer opportunities to reduce anxiety and provide care that is adjusted to their needs.
TRIAL REGISTRATION
This study was registered on clinicalTriagls.gov (NCT02946398).
背景
老年急诊科（ED）患者常存在复杂问题和严重疾病，具有较高的不良结局风险。这些老年患者可能存在困扰，这些困扰可能反映了他们对医疗的偏好和需求。然而，目前缺乏这方面的数据。
方法
本研究是一项针对老年医学 ED 患者（≥65 岁）的前瞻性、多中心、观察性队列研究的子研究。在 ED 就诊的第一阶段，患者或其护理人员使用问卷询问他们与疾病相关的担忧。将所有关注点分为 10 类，并分析患者与护理人员之间以及不同年龄组之间的差异。计算比值比以确定不同不良结局相关的关注点。
结果
在纳入的 594 例患者（或其护理人员）中，大多数（88%）对其疾病的某些方面或对医疗的需求表示担忧。最常报告的关注点是疾病的严重程度（43.6%）、功能下降（9.4%）和死亡（5.6%）。护理人员比患者更频繁地表示担忧（p<0.001），特别是在疾病严重程度（50.5%比 39.6%，p=0.016）和认知能力下降（10.8%比 0.3%，p<0.001）方面。我们没有发现年龄组之间存在差异。对死亡的担忧与 30 天死亡率（OR 2.89；95%CI：1.24-6.70）和复合终点（重症或中等监护入院、住院时间>7 天、独立生活丧失和 30 天内计划性再入院）（OR 2.32；95%CI：1.12-4.82）相关。此外，未具体说明的关注点与死亡率（OR 1.88；95%CI：1.09-3.22）相关。
结论
大多数老年患者，尤其是他们的护理人员，在就诊 ED 时会对他们的医疗状况或医疗需求表示担忧。这些关注点与不良结局相关，很可能反映了他们对医疗的需求。应该更加关注这些关注点，因为它们可能提供减少焦虑和提供满足其需求的护理的机会。
试验注册
本研究在 clinicalTriagls.gov 上注册（NCT02946398）。
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