Vincent Guion, Gerontopole, 20 rue du Pont Saint-Pierre, Cité de la Santé, CHU de Toulouse, 31059 Toulouse, France,
J Nutr Health Aging. 2021;25(3):318-324. doi: 10.1007/s12603-020-1476-3.
To describe the trajectories of pain, dyspnea, fever, confusion, agitation and fatigue of nursing home residents' (NHRs) after a transfer to the emergency department (ED).
Observational multicenter study.
17 EDs in France.
751 NHRs presenting to EDs over four non-consecutive weeks (one week per season) in 2016.
Trajectories of symptoms (binary variables) including pain, dyspnea, fever, agitation, confusion and fatigue at four times: before ED transfer, during the transfer, in the ED and after discharge.
Group-based multi-trajectory modelling was performed to identify groups of NHRs following similar trajectories of symptoms evolution after a transfer to ED. Five groups were identified. In group 1 (n=190), NHRs presented with confusion and a rising prevalence of fatigue. In group 2 (n=212), NHRs presented with a highly prevalent but declining pain. In group 3 (n=158), NHRs presented with similar peaking pain prevalence, rising confusion and fatigue, and a high but stable agitation prevalence. In group 4 (n=144), NHRs presented with a highly prevalent but declining dyspnea, rising then declining fever, rising confusion, and a high and fluctuating fatigue prevalence. In group 5 (n=47), NHRs presented with a highly prevalent but declining fever, rising then declining dyspnea, stable and high both fatigue and pain prevalence, stable and low prevalence of confusion.
Symptom alleviation in NHRs transferred to ED was better achieved in those with pain, fever or dyspnea rather than in those with confusion, agitation and fatigue. NHRs' resilience through the stress of an ED transfer could be predicted by comorbidity and functional abilities, challenged by acute conditions representing various levels of stress intensity, and evaluated on the course of non-specific symptoms. NHRs' resilience is key to estimate the appropriateness of an ED transfer and should facilitate advance care planning regarding NHRs' hospitalizations.
描述养老院居民（NHR）转至急诊部（ED）后疼痛、呼吸困难、发热、意识混乱、躁动和疲劳的轨迹。
观察性多中心研究。
法国 17 个 ED。
2016 年四个非连续周（每个季节一周）期间转至 ED 的 751 名 NHR。
在四个时间点测量症状轨迹（二项变量）：转至 ED 前、转至 ED 期间、ED 内和出院后：疼痛、呼吸困难、发热、躁动、意识混乱和疲劳。
采用基于群组的多轨迹建模来识别转至 ED 后具有相似症状演变轨迹的 NHR 群组。确定了 5 个群组。群组 1（n=190）的 NHR 表现出意识混乱和疲劳的患病率增加。群组 2（n=212）的 NHR 表现出疼痛的高患病率但呈下降趋势。群组 3（n=158）的 NHR 表现出相似的高峰疼痛患病率、躁动和疲劳增加，以及高但稳定的躁动患病率。群组 4（n=144）的 NHR 表现出高但呈下降趋势的呼吸困难，发热升高然后下降，意识混乱增加，疲劳患病率高且波动。群组 5（n=47）的 NHR 表现出高但呈下降趋势的发热，呼吸困难升高然后下降，疲劳和疼痛的患病率稳定且高，意识混乱的患病率稳定且低。
与意识混乱、躁动和疲劳相比，转至 ED 的 NHR 疼痛、发热或呼吸困难缓解更好。NHR 对 ED 转院压力的适应能力可以通过合并症和功能能力来预测，急性疾病代表了不同程度的压力强度，通过非特异性症状的过程来评估。NHR 的适应能力是评估 ED 转院是否合适的关键，应有助于制定 NHR 住院的预先护理计划。
