与痴呆患者行为症状相关的医院实践和临床结局。

Hospital practices and clinical outcomes associated with behavioral symptoms in persons with dementia.

机构信息

Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, New York, USA.

Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, Pennsylvania, USA.

出版信息

J Hosp Med. 2022 Sep;17(9):702-709. doi: 10.1002/jhm.12921. Epub 2022 Aug 16.

DOI:10.1002/jhm.12921

PMID:35972233

Abstract

BACKGROUND

Hospitalized persons living with dementia (PLWD) often experience behavioral symptoms that challenge medical care.

OBJECTIVE

This study aimed to identify clinical practices and outcomes associated with behavioral symptoms in hospitalized PLWD.

DESIGN

A retrospective cross-sectional study.

SETTINGS AND PARTICIPANTS

The study included PLWD (65+) admitted to one of severe health system hospitals in 2019.

INTERVENTION

Behavioral symptoms were defined as the presence of (1) a psychoactive medication for behavioral symptoms; (2) an order for physical restraints or constant observation; and/or (3) physician documentation of delirium, encephalopathy, or behavioral symptoms.

MAIN OUTCOME AND MEASURES

Associations between behavioral symptoms and patient characteristics and hospital practices (e.g., bladder catheter) were examined. Multivariable logistic/linear regression was used to evaluate the association between behavioral symptoms and clinical outcomes (e.g., mortality).

RESULTS

Of hospitalized PLWD (N = 8637), the average age was 84.5 years (IQR = 79-90), 61.7% were female, 60.1% were white, and 9.4% (n = 833) were Hispanic. Behavioral symptoms were identified in 40.6% (N = 3606) of individuals. Behavioral symptoms were significantly associated with male gender (40.3% vs. 36.9%, p = .001), white race (62.7% vs. 58.3%, p < .001), and residence in a facility prior to admission (26.6% vs. 23.7%, p < .001). Regarding hospital practices, indwelling bladder catheters (11.2% vs. 6.0%, p < .001) and dietary restriction (41.9% vs. 33.8%, p < .001) were associated with behavioral symptoms. In multivariable models, behavioral symptoms were associated with increased hospital mortality (odds ratio [OR]: 1.90, CI95%: 1.57-2.29), length of stay (parameter estimate: 2.10, p < .001), 30-day readmissions (OR: 1.14, CI95%: 1.014-1.289), and decreased discharge home (OR: 0.59, CI95%: 0.53-0.65, p < .001).

CONCLUSIONS

Given the association between behavioral symptoms and poor clinical outcomes, there is an urgent need to improve the provision of care for hospitalized PLWD.

摘要

背景

住院痴呆患者（PLWD）经常出现挑战医疗的行为症状。

目的

本研究旨在确定与住院 PLWD 行为症状相关的临床实践和结果。

设计

回顾性横断面研究。

设置和参与者

该研究纳入了 2019 年入住一家严重医疗系统医院的 65 岁以上 PLWD。

干预

行为症状定义为存在以下情况之一：（1）治疗行为症状的精神活性药物；（2）使用身体约束或持续观察的医嘱；和/或（3）医生记录的谵妄、脑病或行为症状。

主要观察指标和措施

检查行为症状与患者特征和医院实践（如膀胱导管）之间的关联。多变量逻辑/线性回归用于评估行为症状与临床结果（如死亡率）之间的关联。

结果

在住院 PLWD（N=8637）中，平均年龄为 84.5 岁（IQR=79-90），61.7%为女性，60.1%为白人，9.4%（n=833）为西班牙裔。40.6%（N=3606）的人存在行为症状。行为症状与男性（40.3%比 36.9%，p=.001）、白种人（62.7%比 58.3%，p<.001）和入院前居住在机构（26.6%比 23.7%，p<.001）显著相关。在医院实践方面，留置导尿管（11.2%比 6.0%，p<.001）和饮食限制（41.9%比 33.8%，p<.001）与行为症状相关。在多变量模型中，行为症状与住院死亡率增加（优势比[OR]：1.90，95%CI：1.57-2.29）、住院时间延长（参数估计值：2.10，p<.001）、30 天再入院（OR：1.14，95%CI：1.014-1.289）和出院回家减少（OR：0.59，95%CI：0.53-0.65，p<.001）相关。