Benoist Florence, Martin-Gaujard Géraldine, Bonnefoy Marc
Service de post-urgence gériatrique, Hôpital Edouard-Herriot, Lyon.
Service de gériatrie, Centre hospitalier Lyon-Sud, Pierre-Bénite.
Geriatr Psychol Neuropsychiatr Vieil. 2021 Mar 1;19(1):62-69. doi: 10.1684/pnv.2021.0913.
The increasing elderly population and their overlapping conditions require more specialised care. The difficulties accessing scheduled hospital admission lead to visits to Accident and Emergency Department (A&E), which have a harmful effect on these patients. The Regional Health Agency (ARS) has developed geriatric hotlines in all geriatric sectors. An analysis of the population concerned will allow changes to be made to this system in order to improve the care pathway for the elderly and to better meet the needs of the general practitioners. This was a descriptive, retrospective, monocentric epidemiological study conducted from February to July 2017. The applicant, reason for the call, the general practioner's request, the demographic and geriatric characteristics of the patients, the response provided were described. The calls were mainly made by the general practitioners, in 72.8% of the cases, for acute conditions. Access to hospital admission accounted for 69.6% of the requests, a home assessment, 16 %. Fifty-five per cent of the patients were admitted to hospital, 75 % of them directly in geriatrics. Twenty-one per cent of the requests for hospital admission received other treatment. The average age was 86 years, with a majority of patients being poly-medicated, having multiple pathologies and also more neurocognitive disorders than the general population. Guidance is provided in 30 % of the calls, improving the care pathway of these elderly patients. The time to response and to hospital admission is short, thus favouring direct access to hospital departments. The main independent risk factor for hospital admission was the presence of acute illness. This community-hospital link seems to answer the principal request of GPs, i.e. hospitalization in acute condition. It is beneficial for the management of these patient at risk of decompensation. Coordination and communication between the different community-hospital players must continue to develop to improve the care pathway of these complex geriatric patients.
老年人口的不断增加及其病情的重叠需要更专业的护理。由于难以获得预定的住院治疗，患者只能前往急诊部就诊，这对这些患者产生了有害影响。地区卫生机构（ARS）已在所有老年科设立了老年热线。对相关人群进行分析将有助于对该系统进行改进，以改善老年人的护理路径，并更好地满足全科医生的需求。这是一项描述性、回顾性、单中心的流行病学研究，于2017年2月至7月进行。描述了呼叫者、呼叫原因、全科医生的请求、患者的人口统计学和老年病学特征以及提供的回复。呼叫主要由全科医生发起，占病例的72.8%，原因是急性病症。住院请求占请求总数的69.6%，家庭评估占16%。55%的患者入院治疗，其中75%直接入住老年科。21%的住院请求接受了其他治疗。患者的平均年龄为86岁，大多数患者同时服用多种药物，患有多种疾病，且神经认知障碍比普通人群更多。30%的呼叫提供了指导，改善了这些老年患者的护理路径。响应和住院时间较短，因此有利于直接进入医院科室。住院的主要独立危险因素是存在急性疾病。这种社区与医院的联系似乎满足了全科医生的主要需求，即在急性病症下住院治疗。这有利于对这些有失代偿风险的患者进行管理。不同社区与医院参与者之间的协调和沟通必须继续发展，以改善这些复杂老年患者的护理路径。
