老年人因可避免住院而导致的医院相关性残疾。
Hospital-associated disability due to avoidable hospitalizations among older adults.
机构信息
Departments of Emergency Medicine and Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
出版信息
J Am Geriatr Soc. 2023 May;71(5):1395-1405. doi: 10.1111/jgs.18238. Epub 2023 Jan 20.
BACKGROUND
Hospital-associated disability (HAD) is a common complication during the course of acute care hospitalizations in older adults. Many admissions are for ambulatory care sensitive conditions (ACSCs), considered potentially avoidable hospitalizations-conditions that might be treated in outpatient settings to prevent hospitalization and HAD. We compared the incidence of HAD between older adults hospitalized for ACSCs versus those hospitalized for other diagnoses.
METHODS
We conducted a retrospective cohort study in inpatient (non-ICU) medical and surgical units of a large southeastern regional academic medical center. Participants were 38,960 older adults 65 years of age admitted from January 1, 2015, to December 31, 2019. The primary outcome was HAD, defined as decline on the Katz Activities of Daily Living (ADL) scale from hospital admission to discharge. We used generalized linear mixed models to examine differences in HAD between hospitalizations with a primary diagnosis for an ACSC using standard definitions versus primary diagnosis for other conditions, adjusting for covariates and repeated observations for individuals with multiple hospitalizations.
RESULTS
We found that 10% of older adults were admitted for an ACSC, with rates of HAD in those admitted for ACSCs lower than those admitted for other conditions (16% vs. 20.7%, p < 0.001). Age, comorbidity, admission functional status, and admission cognitive impairment were significant predictors for development of HAD. ACSC admissions to medical and medical/surgical services had lower odds of HAD compared with admissions for other conditions, with no significant differences between ACSC and non-ACSC admissions to surgical services.
CONCLUSIONS
Rates of HAD among older adults hospitalized for ACSCs are substantial, though lower than rates of HAD with hospitalization for other conditions, reflecting that acute care hospitalization is not a benign event in this population. Treatment of ACSCs in the outpatient setting could be an important component of efforts to reduce HAD.
背景
医院相关残疾（HAD）是老年人在急性护理住院期间常见的并发症。许多住院是为了治疗可门诊治疗的敏感条件（ACSCs），这些条件被认为是可以避免的住院治疗 - 这些情况可能在门诊治疗以预防住院和 HAD。我们比较了因 ACSC 住院和因其他诊断住院的老年人 HAD 的发生率。
方法
我们在一家大型东南地区学术医疗中心的住院（非 ICU）内科和外科病房进行了回顾性队列研究。参与者是 38960 名年龄在 65 岁以上的老年人，他们于 2015 年 1 月 1 日至 2019 年 12 月 31 日入院。主要结局是 HAD，定义为从入院到出院时在 Katz 日常生活活动（ADL）量表上的下降。我们使用广义线性混合模型，使用标准定义，在因 ACSC 作为主要诊断的住院治疗与因其他疾病作为主要诊断的住院治疗之间，检查 HAD 差异，调整了协变量和个体多次住院的重复观察。
结果
我们发现，10%的老年人因 ACSC 住院，因 ACSC 住院的 HAD 发生率低于因其他疾病住院的 HAD 发生率（16%比 20.7%，p<0.001）。年龄、合并症、入院功能状态和入院认知障碍是 HAD 发展的重要预测因素。与因其他疾病住院相比，因内科和内科/外科服务而住院的 ACSC 患者发生 HAD 的可能性较低，而因外科服务而住院的 ACSC 患者与非 ACSC 患者之间无显著差异。
结论
因 ACSC 住院的老年人 HAD 发生率相当高，尽管低于因其他疾病住院的 HAD 发生率，但这反映了急性护理住院对这一人群来说并不是一个良性事件。在门诊环境中治疗 ACSC 可能是减少 HAD 的重要组成部分。
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