Dwyer Rosamond A, Gabbe Belinda J, Tran Thach, Smith Karen, Lowthian Judy A
School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Emergency Department, Peninsula Health, Melbourne, Victoria, Australia.
Emerg Med Australas. 2021 Jun;33(3):447-456. doi: 10.1111/1742-6723.13650. Epub 2020 Oct 10.
To describe the clinical characteristics, medical interventions and patterns of ambulance service use related to the emergency, prehospital care of older people living in residential aged care (RAC) homes.
Retrospective cohort study using secondary analyses of routinely collected clinical and administrative data from Ambulance Victoria and population data from the Australian Bureau of Statistics for the state of Victoria, Australia. Participants included people aged 65 years and over, attended by emergency ambulances from 2008 to 2013, with data captured in the Ambulance Victoria electronic record.
The mean (standard deviation) age of RAC residents attended by emergency ambulance was 85 (7.3) years and 63% were women. Common comorbidities included dementia (32.7%), ischaemic heart disease (27.7%) and osteoarthritis (24.6%). Polypharmacy was prevalent with 70% currently prescribed antibiotics, over 20% prescribed sedatives and a further 14.9% antipsychotics. Fifteen percent of attendances were for falls, which were more frequent among women than men. Other common reasons for ambulance call-out included uncontrolled pain, respiratory tract infection, non-specific febrile illness and altered conscious state. Almost 90% of people were transported to hospital from the RAC, with just over half of call-outs occurring out-of-hours.
This is the first study to describe emergency prehospital care, case-mix and intervention of frail, older people living in RAC. These results demonstrate a clinically complex group of people with high rates of comorbidity, cognitive impairment and polypharmacy. These valuable data will inform education and training of prehospital clinicians, assist in targeting preventative medicine and primary care programmes and further development of alternate, acute and emergency care pathways for this unique patient group.
描述与居住在老年护理机构中的老年人紧急院前护理相关的临床特征、医疗干预措施及救护车服务使用模式。
采用回顾性队列研究，对从维多利亚州救护车服务机构常规收集的临床和管理数据以及澳大利亚统计局提供的维多利亚州人口数据进行二次分析。研究对象包括2008年至2013年期间由紧急救护车接诊的65岁及以上老年人，数据记录于维多利亚州救护车服务机构的电子记录中。
由紧急救护车接诊的老年护理机构居民的平均（标准差）年龄为85（7.3）岁，女性占63%。常见的合并症包括痴呆（32.7%）、缺血性心脏病（27.7%）和骨关节炎（24.6%）。多重用药情况普遍，70%的患者目前正在使用抗生素，超过20%的患者使用镇静剂，另有14.9%的患者使用抗精神病药物。15%的出诊是因为跌倒，女性比男性更频繁。其他常见的救护车出诊原因包括疼痛控制不佳、呼吸道感染、非特异性发热性疾病和意识状态改变。近90%的患者从老年护理机构被送往医院，超过一半的出诊发生在非工作时间。
这是第一项描述居住在老年护理机构中的体弱老年人紧急院前护理、病例组合和干预措施的研究。这些结果表明，这是一组临床情况复杂的人群，合并症、认知障碍和多重用药发生率高。这些有价值的数据将为院前临床医生的教育和培训提供信息，有助于针对预防医学和初级保健项目，并为这一独特患者群体进一步开发替代的急性和紧急护理途径。
