Center for Athletic Health Management, Renai Branch, Taipei City Hospital, Taipei, Taiwan.
Center for General Education, Taipei University of Marine Technology, Taipei, Taiwan.
PLoS One. 2023 Jan 6;18(1):e0279654. doi: 10.1371/journal.pone.0279654. eCollection 2023.
To evaluate the effects of post-acute care (PAC) on frail older adults after acute hospitalization in Taiwan.
This was a multicenter interventional study. Frail patients aged ≥ 75 were recruited and divided into PAC or control group. The PAC group received comprehensive geriatric assessment (CGA) and multifactorial intervention including exercise, nutrition education, and medicinal adjustments for two to four weeks, while the control group received only CGA. Outcome measures included emergency room (ER) visits, readmissions, and mortality within 90 days after PAC.
Among 254 participants, 205 (87.6±6.0 years) were in the PAC and 49 (85.2±6.0 years) in the control group. PAC for more than two weeks significantly decreased 90-day ER visits (odds ratio [OR] 0.21, 95% confidence interval [CI] 0.10-0.43; p = 0.024), readmissions (OR 0.30, 95% CI 0.16-0.56; p < 0.001), and mortality (OR 0.20, 95% CI 0.04-0.87; p = 0.032). Having problems in self-care was an independent risk factor for 90-day ER visits (OR 2.11, 95% CI 1.17-3.78; p = 0.012), and having problems in usual activities was an independent risk factor for 90-day readmissions (OR 2.69, 95% CI 1.53-4.72; p = 0.001) and mortality (OR 3.16, 95% CI 1.16-8.63; p = 0.024).
PAC program for more than two weeks could have beneficial effects on decreasing ER visits, readmissions, and mortality after an acute illness in frail older patients. Those who perceived severe problems in self-care and usual activities had a higher risk of subsequent adverse outcomes.
ClinicalTrials.gov NCT Identifier: NCT05452395.
评估台湾急性住院后康复护理（PAC）对体弱老年人的影响。
这是一项多中心干预研究。招募年龄≥75 岁的体弱患者，并将其分为 PAC 组或对照组。PAC 组接受综合老年评估（CGA）和多因素干预，包括运动、营养教育和药物调整，为期 2 至 4 周，而对照组仅接受 CGA。在 PAC 后 90 天内，评估急诊室（ER）就诊、再入院和死亡率。
在 254 名参与者中，205 名（87.6±6.0 岁）在 PAC 组，49 名（85.2±6.0 岁）在对照组。PAC 持续时间超过两周显著降低了 90 天 ER 就诊率（优势比[OR]0.21，95%置信区间[CI]0.10-0.43；p=0.024）、再入院率（OR 0.30，95%CI 0.16-0.56；p<0.001）和死亡率（OR 0.20，95%CI 0.04-0.87；p=0.032）。自我护理存在问题是 90 天 ER 就诊的独立危险因素（OR 2.11，95%CI 1.17-3.78；p=0.012），日常活动存在问题是 90 天再入院和死亡率的独立危险因素（OR 2.69，95%CI 1.53-4.72；p=0.001）和（OR 3.16，95%CI 1.16-8.63；p=0.024）。
PAC 方案持续时间超过两周可能对体弱老年患者急性疾病后减少 ER 就诊、再入院和死亡率有有益效果。那些自我护理和日常活动存在严重问题的患者发生不良预后的风险更高。
ClinicalTrials.gov NCT 标识符：NCT05452395。
