Johansson Yvonne A, Gillsjö Catharina, Kenne Sarenmalm Elisabeth
Skaraborg Hospital, Skövde, Sweden.
Jönköping University, The Research School of Health and Welfare, Aging Research Network-Jönköping (ARN-J), Jönköping, Sweden.
Dement Geriatr Cogn Dis Extra. 2021 May 5;11(2):71-77. doi: 10.1159/000515822. eCollection 2021 May-Aug.
Given the aging population and the high prevalence of cognitive impairment in older hospitalized patients, it is essential to provide good fundamental care to these vulnerable patients, who easily might be affected by poor outcomes as delirium. Risk factors for delirium are, for example, cognitive impairment, old age, pain, and sleep deprivation. Different symptoms are often unidentified in hospitals, and associated with poor well-being, but this is rarely studied in older patients with cognitive impairment. The study aim was to examine symptoms and sense of well-being in older hospitalized patients with cognitive impairment, as self-reported and reported in patient records.
Exploratory quantitative subgroup ( = 25) analysis of a point-prevalence study ( = 210). Inclusion criteria were age ≥65, and cognitive impairment. Data were collected through structured interviews, validated instruments, and patient records. Associations between well-being and symptoms, and concordance between the occurrence of self-reported symptoms and symptoms reported in patient records were analyzed.
The patients reported severe and distressing symptoms that were sparsely reported (14%) in their records. As well were cognitive impairment, and the patients' own descriptions of their well-being. Some symptoms and the total symptom burden were associated with poor well-being.
DISCUSSION/CONCLUSION: To our knowledge, this hypothesis-generating study is one of few studies that describe both symptoms and well-being as self-reported and reported in patient records, in vulnerable patients due to old age, cognitive impairment, and hospitalization. Despite the limited sample size, the results indicate that symptoms were more insufficient alleviated in these patients compared to patients with normal cognitive function in other studies. To our knowledge, this has not been shown previously. Additionally, patients' own experiences were sparsely reported in their records. A larger sample size and longitudinal design has the potential to determine if symptom alleviation differs between patients with and without cognitive impairment, and if a total symptom burden increases the risk of poor outcomes as delirium in vulnerable patients.
鉴于老年住院患者人口老龄化以及认知障碍的高患病率，为这些易受伤害的患者提供良好的基础护理至关重要，因为他们很容易受到诸如谵妄等不良后果的影响。谵妄的风险因素包括认知障碍、老年、疼痛和睡眠剥夺等。在医院中，不同症状往往未被识别，且与幸福感不佳相关，但在认知障碍老年患者中对此研究较少。本研究旨在通过患者自我报告及病历记录，调查认知障碍老年住院患者的症状及幸福感。
对一项现患率研究（n = 210）进行探索性定量亚组分析（n = 25）。纳入标准为年龄≥65岁且有认知障碍。通过结构化访谈、经过验证的工具及病历记录收集数据。分析幸福感与症状之间的关联，以及自我报告症状的发生情况与病历记录中报告症状的一致性。
患者报告了严重且令人痛苦的症状，但病历记录中对此报告较少（14%）。认知障碍以及患者对自身幸福感的描述也存在这种情况。一些症状及总症状负担与幸福感不佳相关。
讨论/结论：据我们所知，这项产生假设的研究是少数几项既描述了患者自我报告及病历记录中的症状，又描述了幸福感的研究之一，研究对象为因年老、认知障碍和住院而处于脆弱状态的患者。尽管样本量有限，但结果表明，与其他研究中认知功能正常的患者相比，这些患者的症状缓解情况更差。据我们所知，此前尚未有此发现。此外，患者自身经历在病历记录中的报告较少。更大的样本量和纵向设计有可能确定有认知障碍和无认知障碍患者的症状缓解情况是否存在差异，以及总症状负担是否会增加脆弱患者出现如谵妄等不良后果的风险。
