School of Pharmacy, University of Eastern Finland, Kuopio, Finland.
Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Finland.
J Gerontol A Biol Sci Med Sci. 2020 Oct 15;75(11):2184-2192. doi: 10.1093/gerona/glaa199.
Persons with Alzheimer's disease (AD) are at higher risk of hip fractures (HFs) than general older population and have worse prognosis after HF. Hospital stays after HF have shortened along time. We investigated the association between length of hospital stay after HF and mortality after discharge among persons with AD.
The MEDALZ cohort includes all Finnish community dwellers who received clinically verified AD diagnosis in 2005-2011 (N = 70 718). Patients who experienced first HF after AD diagnosis in 2005‒2015 (n = 6999) were selected. Length of hospital stay for HF was measured as a sum of the consecutive days spent in hospital after HF until discharge. Outcome was defined as death within 30 days after hospital discharge.
Mean of overall length of hospital stay after a HF decreased from 52.6 (SD 62.9) days in 2005 to 19.6 (SD 23.1) days in 2015. Shortest treatment decile (1‒4 days) had the highest risk of death within 30 days after discharge (adjusted hazard ratio [aHR] 2.76; 95% confidence interval [CI] 1.66-4.60) in addition to second (5‒6 days; aHR 2.52; 95% CI 1.50-4.23) and third (7‒10 days; aHR 2.22; 95% CI 1.34-3.69) deciles when compared to the sixth decile of length of stays (21‒26 days).
Among persons with AD, shorter length of hospital stay after HF was associated with an increased risk of death after discharge. After acute HF treatment, inpatient rehabilitation or proper care and services in home need to be organized to older persons with AD.
患有阿尔茨海默病（AD）的人比一般老年人髋部骨折（HFs）的风险更高，并且在 HF 后预后更差。HF 后的住院时间已经很长时间了。我们研究了 HF 后住院时间长短与 AD 患者出院后死亡率之间的关系。
MEDALZ 队列包括所有在 2005-2011 年接受临床确诊 AD 诊断的芬兰社区居民（N=70718）。选择在 2005-2015 年 AD 诊断后首次发生 HF 的患者（n=6999）。HF 后住院时间的测量方法为 HF 后直至出院连续住院的天数之和。结果定义为出院后 30 天内死亡。
HF 后整体住院时间的平均值从 2005 年的 52.6（SD 62.9）天减少到 2015 年的 19.6（SD 23.1）天。最短治疗十位数（1-4 天）在出院后 30 天内死亡的风险最高（调整后的危险比[aHR]2.76；95%置信区间[CI]1.66-4.60），其次是第二（5-6 天；aHR 2.52；95% CI 1.50-4.23）和第三（7-10 天；aHR 2.22；95% CI 1.34-3.69）十位数与第六个十位数（21-26 天）相比。
在 AD 患者中，HF 后住院时间较短与出院后死亡风险增加相关。急性 HF 治疗后，需要为 AD 老年人组织住院康复或适当的家庭护理和服务。
