Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
Research Foundation - Flanders (FWO), Brussels, Belgium.
J Am Geriatr Soc. 2021 May;69(5):1377-1387. doi: 10.1111/jgs.17093. Epub 2021 Mar 17.
BACKGROUND/OBJECTIVES: Older patients admitted to cardiac care units often suffer functional decline. We evaluated whether a nurse-led geriatric co-management program leads to better functional status at hospital discharge.
A quasi-experimental before-and-after study was performed between September 2016 and December 2018, with the main endpoint at hospital discharge and follow-up at 6 months.
Two cardiac care units of the University Hospitals Leuven.
One hundred and fifty-one intervention and 158 control patients aged 75 years or older admitted for acute cardiovascular disease or transcatheter aortic valve implantation.
A nurse from the geriatrics department performed a comprehensive geriatric assessment within 24 h of admission. The cardiac care team and geriatrics nurse drafted an interdisciplinary care plan, focusing on early rehabilitation, discharge planning, promoting physical activity, and preventing geriatric syndromes. The geriatrics nurse provided daily follow-up and coached the cardiac team. A geriatrician co-managed patients with complications.
The primary outcome was functional status measured using the Katz Index for independence in activities of daily living (ADL; one-point difference was considered clinically relevant). Secondary outcomes included the incidence of ADL decline and complications, length of stay, unplanned readmissions, survival, and quality of life.
The mean age of patients was 85 years. Intervention patients had better functional status at hospital discharge (8.9, 95% CI = 8.7-9.3 versus 9.5, 95% CI = 9.2-9.9; p = 0.019) and experienced 18% less functional decline during hospitalization (25% vs. 43%, p = 0.006). The intervention group experienced significantly fewer cases of delirium and obstipation during hospitalization, and significantly fewer nosocomial infections. At 6-month follow-up, patients had significantly better functional status and quality of life. There were no differences regarding length of stay, readmissions, or survival.
This first nurse-led geriatric co-management program for frail patients on cardiac care units was not effective in improving functional status, but significantly improved secondary outcomes.
背景/目的：入住心脏护理病房的老年患者常出现功能衰退。我们评估了护士主导的老年综合管理方案是否能改善出院时的功能状态。
这是一项 2016 年 9 月至 2018 年 12 月期间进行的准实验前后研究，主要终点为出院时和 6 个月时的随访。
鲁汶大学医院的两个心脏护理病房。
151 名干预组和 158 名对照组患者，年龄均在 75 岁或以上，因急性心血管疾病或经导管主动脉瓣植入术入院。
老年科护士在入院后 24 小时内进行全面的老年综合评估。心脏护理团队和老年科护士制定了跨学科护理计划，重点是早期康复、出院计划、促进身体活动和预防老年综合征。老年科护士提供日常随访并指导心脏团队。老年病医生共同管理有并发症的患者。
主要结局是使用 Katz 日常生活活动独立性指数（ADL）测量的功能状态（相差 1 分被认为具有临床意义）。次要结局包括 ADL 下降和并发症发生率、住院时间、非计划性再入院、存活率和生活质量。
患者的平均年龄为 85 岁。干预组患者出院时的功能状态更好（8.9，95%CI=8.7-9.3 与 9.5，95%CI=9.2-9.9；p=0.019），住院期间功能下降的比例低 18%（25%比 43%，p=0.006）。干预组在住院期间发生谵妄和便秘的情况明显较少，医院感染也明显较少。在 6 个月随访时，患者的功能状态和生活质量明显更好。住院时间、再入院率或存活率无差异。
这是首个针对心脏护理病房虚弱患者的护士主导的老年综合管理方案，并未有效改善功能状态，但显著改善了次要结局。
