Section of Geriatrics, Department of Medical Sciences, AOU Città della Salute e della Scienza - Molinette, Turin, Italy.
Section of Geriatrics, Department of Medical Sciences, AOU Città della Salute e della Scienza - Molinette, Turin, Italy.
Eur J Intern Med. 2021 Aug;90:89-95. doi: 10.1016/j.ejim.2021.04.006. Epub 2021 May 1.
In a context of high demand for hospital services among older people, we aimed to assess the rate and determinants of inappropriate hospitalizations of older patients, and to what extent they were associated with inappropriate hospital stay. This prospective observational multicentre study evaluated a random sample of consecutive patients aged ≥ 70 years accessing the Emergency Department (ED) of two Italian tertiary hospitals. A standardized comprehensive geriatric assessment was carried out in each patient, including the Blaylock Risk Assessment Screen Scale (BRASS) for identification of patients at risk of difficult discharge. Inappropriate hospitalization was defined by the ED physician when patients did not necessitate hospital-provided procedures but was due to social reasons or lack of an alternative care-setting. Among 1877 patients (median age 80.7 years, 50.1% male), with a high prevalence of functional dependence and social isolation (around 30% and 25%, respectively), 767 (40.9%) were hospitalized. Incidence of inappropriate hospitalization was 14.6% (95% CI 12.1%-17.1%) and was associated with moderate-high risk of difficult discharge at BRASS (OR = 1.98, 95% CI 1.16-3.39, p = 0.013) and the presence of dementia with behavioural disorders (OR = 1.79, 95% CI 1.10-2.91, p = 0.020). Compared with patients appropriately admitted, inappropriate hospitalizations had shorter length of hospital stay but accounted for 1059/9154 days of stay (11.6%). Inappropriate hospitalizations occurred in less than 15% of cases, mainly accounted for by patients no longer manageable at home, but contributed to the greatest proportion of inappropriate hospital stay. These findings highlight the need of implementing appropriate home-care services and ensuring rapid access to suitable care-facilities for community-dwelling frail older patients.
在老年人对医院服务需求高的背景下，我们旨在评估老年患者不适当住院的发生率和决定因素，以及它们与不适当住院时间的关系。这项前瞻性观察性多中心研究评估了意大利两家三级医院急诊科连续就诊的≥70 岁患者的随机样本。对每位患者进行了标准化的全面老年评估，包括 Blaylock 风险评估筛查量表（BRASS），以识别有困难出院风险的患者。当患者不需要医院提供的治疗程序但由于社会原因或缺乏替代护理环境而住院时，即定义为不适当住院。在 1877 名患者（中位年龄 80.7 岁，50.1%为男性）中，功能依赖和社会孤立的患病率很高（分别为 30%和 25%左右），767 名（40.9%）患者住院。不适当住院的发生率为 14.6%（95%可信区间 12.1%-17.1%），与 BRASS 中度至高度困难出院风险（比值比[OR] = 1.98，95%可信区间 1.16-3.39，p = 0.013）和痴呆伴行为障碍（OR = 1.79，95%可信区间 1.10-2.91，p = 0.020）有关。与适当入院的患者相比，不适当的住院时间较短，但占 9154 天住院时间的 1059 天（11.6%）。不适当的住院发生在不到 15%的病例中，主要是由于患者在家中无法管理，但占不适当住院时间的比例最大。这些发现强调需要为社区居住的体弱老年人实施适当的家庭护理服务，并确保快速获得合适的护理设施。
