社区居住老年人因门诊可治疗情况住院后功能障碍、恢复和入住养老院的纵向分析。
A Longitudinal Analysis of Functional Disability, Recovery, and Nursing Home Utilization After Hospitalization for Ambulatory Care Sensitive Conditions Among Community-Living Older Persons.
机构信息
Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut.
National Clinician Scholars Program, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.
出版信息
J Hosp Med. 2021 Aug;16(8):469-475. doi: 10.12788/jhm.3669.
BACKGROUND/OBJECTIVE: Hospitalizations for ambulatory care sensitive conditions (ACSCs) are considered potentially preventable. With little known about the functional outcomes of older persons after ACSC-related hospitalizations, our objectives were to describe: (1) the 6-month course of postdischarge functional disability, (2) the cumulative monthly probability of functional recovery, and (3) the cumulative monthly probability of incident nursing home (NH) admission.
METHODS
The analytic sample included 251 ACSC-related hospitalizations from a cohort of 754 nondisabled, community-living persons aged 70 years and older who were interviewed monthly for up to 19 years. Patient-reported disability scores in basic, instrumental, and mobility activities ranged from 0 to 13. Functional recovery was defined as returning within 6 months of discharge to a total disability score less than or equal to that immediately preceding hospitalization.
RESULTS
The mean age was 85.1 years, and the mean disability score was 5.4 in the month prior to the ACSC-related hospitalization. After the ACSC-related hospitalization, total disability scores peaked at month 1 and improved modestly over the next 5 months, but remained greater than the pre-hospitalization score. Functional recovery was achieved by 70% of patients, and incident NH admission was experienced by 50% within 6 months after the 251 ACSC-related hospitalizations.
CONCLUSIONS
During the 6 months after an ACSC-related hospitalization, older persons exhibited total disability scores that were higher than those immediately preceding hospitalization, with 3 of 10 not achieving functional recovery and half experiencing incident NH admission. These findings provide evidence that older persons experience clinically meaningful adverse patient-reported outcomes after ACSC-related hospitalizations.
背景/目的：门诊保健敏感条件（ACSC）相关住院治疗被认为是可以预防的。由于人们对 ACSC 相关住院治疗后老年人的功能结局知之甚少，我们的目标是描述：（1）出院后 6 个月的功能障碍进程，（2）功能恢复的累积月概率，以及（3）发生入住护理院（NH）的累积月概率。
方法
分析样本包括来自一个 754 名无残疾、居住在社区的 70 岁及以上人群队列的 251 例 ACSC 相关住院治疗，这些患者每月接受一次访谈，最长可达 19 年。患者报告的基本、工具和移动活动的残疾评分范围为 0 至 13。功能恢复定义为在出院后 6 个月内，总残疾评分恢复到低于或等于住院前的水平。
结果
平均年龄为 85.1 岁，在 ACSC 相关住院治疗前的一个月，平均残疾评分为 5.4。在 ACSC 相关住院治疗后，总残疾评分在第 1 个月达到峰值，并在接下来的 5 个月内略有改善，但仍高于住院前的评分。70%的患者实现了功能恢复，50%的患者在 251 例 ACSC 相关住院治疗后的 6 个月内发生了 NH 入住事件。
结论
在 ACSC 相关住院治疗后的 6 个月内，老年人的总残疾评分高于住院前的评分，有 3/10 的患者未实现功能恢复，有一半患者发生 NH 入住事件。这些发现提供了证据，表明 ACSC 相关住院治疗后，老年人经历了具有临床意义的不良患者报告结局。
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