Department of Medicine Division of Geriatric Medicine and Gerontology, Center On Aging and Health, Johns Hopkins University, 2024 E. Monument Street, Suite 2-700, Baltimore, MD, 21205, USA.
Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, PA, Philadelphia, USA.
BMC Geriatr. 2022 Aug 31;22(1):718. doi: 10.1186/s12877-022-03397-6.
We aimed to study whether physical frailty and cognitive impairment (CI) increase the risk of recurrent hospitalizations in older adults, independent of comorbidity, and disability.
Two thousand five hundred forty-nine community-dwelling participants from the National Health and Aging Trends Study (NHATS) with 3 + years of continuous Medicare coverage from linked claims data were included. We used the marginal means/rates recurrent events model to investigate the association of baseline CI (mild CI or dementia) and physical frailty, separately and synergistically, with the number of all-source vs. Emergency Department (ED)-admission vs. direct admission hospitalizations over 2 years.
17.8% of participants had at least one ED-admission hospitalization; 12.7% had at least one direct admission hospitalization. Frailty and CI, modeled separately, were both significantly associated with risk of recurrent all-source (Rate Ratio (RR) = 1.24 for frailty, 1.21 for CI; p < .05) and ED-admission (RR = 1.49 for frailty, 1.41 for CI; p < .05) hospitalizations but not direct admission, adjusting for socio-demographics, obesity, comorbidity and disability. When CI and frailty were examined together, 64.3% had neither (Unimpaired); 28.1% CI only; 3.5% Frailty only; 4.1% CI + Frailty. Compared to those Unimpaired, CI alone and CI + Frailty were predictive of all-source (RR = 1.20, 1.48, p < .05) and ED-admission (RR = 1.36, 2.14, p < .05) hospitalizations, but not direct admission, in our adjusted model.
Older adults with both CI and frailty experienced the highest risk for recurrent ED-admission hospitalizations. Timely recognition of older adults with CI and frailty is needed, paying special attention to managing cognitive impairment to mitigate preventable causes of ED admissions and potentiate alternatives to hospitalization.
本研究旨在探讨身体虚弱和认知障碍（CI）是否会增加老年人再次住院的风险，而与共病和残疾无关。
共有 2549 名来自国家健康老龄化趋势研究（NHATS）的社区居民纳入本研究，他们在连续的医疗保险覆盖范围内有 3 年以上的记录，数据来自于相关索赔。我们使用边缘均值/复发事件模型来研究基线 CI（轻度 CI 或痴呆）和身体虚弱分别以及协同作用与 2 年内所有来源与急诊部（ED）入院和直接入院之间的住院次数的关系。
17.8%的参与者至少有一次 ED 入院；12.7%至少有一次直接入院。虚弱和 CI 分别建模，均与再次发生所有来源（RR=1.24 对于虚弱，1.21 对于 CI；p<0.05）和 ED 入院（RR=1.49 对于虚弱，1.41 对于 CI；p<0.05）的风险显著相关，但与直接入院无关，调整了社会人口统计学、肥胖、共病和残疾因素。当同时检查 CI 和虚弱时，64.3%的人既没有（未受损）；28.1%只有 CI；3.5%只有虚弱；4.1%CI+虚弱。与未受损者相比，单独 CI 和 CI+虚弱可预测所有来源（RR=1.20，1.48，p<0.05）和 ED 入院（RR=1.36，2.14，p<0.05），但调整后的模型中不包括直接入院。
患有 CI 和虚弱的老年人再次发生 ED 入院的风险最高。需要及时识别患有 CI 和虚弱的老年人，特别注意管理认知障碍，以减轻 ED 入院的可预防原因，并为住院替代方案提供契机。
