衰弱干预对住院老年衰弱患者的效果。

The Effectiveness of Frailty Intervention for Older Patients with Frailty during Hospitalization.

机构信息

Dr. Ming-Yueh Chou, Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, 386, Ta-Chung 1st RD. Zuoying District 813, Kaohsiung, Taiwan, TEL: +886-7-3742121 ext 2091, FAX: +886-7-3468224; Email:

出版信息

J Nutr Health Aging. 2023;27(6):413-420. doi: 10.1007/s12603-023-1924-y.

DOI:10.1007/s12603-023-1924-y

PMID:37357324

Abstract

OBJECTIVES

This study aims to assess the effectiveness of a multidomain intervention program on the change in functional status of hospitalized older adults.

DESIGN

This single-arm, prospective, non-randomized interventional study investigates the efficacy of a multidomain interventional program including cognitive stimulation activity, simple exercises, frailty education, and nutrition counseling.

SETTING AND PARTICIPANTS

At a tertiary hospital in southern Taiwan, 352 eligible patients were sequentially enrolled. Included patients were aged ≥65 years (mean age, 79.6 ± 9.0 years; 62% male), scored 3-7 on the Clinical Frailty Scale (CFS), and were hospitalized in the geriatric acute ward.

INTERVENTION

Those receiving standard care (physical rehabilitation and nutrition counseling) during January-July 2019 composed the historical control group. Those receiving the multidomain intervention during August-December 2019 composed the intervention group.

MEASUREMENTS

The primary outcome was the change in activities of daily life (ADL) and frailty status, as assessed by Katz Index and Clinical Frailty Scale, with using the generalized estimating equation model. The length of hospital stay, medical costs, and re-admission rates were secondary outcomes.

RESULTS

Participants undergoing intervention (n = 101; 27.9%) showed greater improvements in the ADL and CFS during hospitalization (ADL adjusted estimate, 0.61; 95% CI, 0.11-1.11; p = 0.02; CFS adjusted estimate, -1.11; 95% CI, -1.42- -0.80; p < 0.01), shorter length of hospital stay (adjusted estimate, -5.00; 95% CI, -7.99- -2.47; p < 0.01), lower medical costs (adjusted estimate, 0.58; 95% CI, 0.49-0.69; p < 0.01), and lower 30- and 90-day readmission rates (30-day adjusted OR [aOR], 0.12; 95% CI, 0.27-0.50; p < 0.01; 60-day aOR, 0.04; 95% CI, 0.01-0.33; p < 0.01) than did controls.

CONCLUSIONS

Participation in the multidomain intervention program during hospitalization improved the functional status and decreased the hospital stay length, medical costs, and readmission rates of frail older people.

摘要

目的

本研究旨在评估多领域干预方案对住院老年患者功能状态变化的影响。

设计

这是一项单臂、前瞻性、非随机干预研究，调查了包括认知刺激活动、简单运动、虚弱教育和营养咨询在内的多领域干预方案的疗效。

地点和参与者

在台湾南部的一家三级医院，连续纳入了 352 名符合条件的患者。纳入的患者年龄≥65 岁（平均年龄 79.6±9.0 岁；62%为男性），临床虚弱量表（CFS）评分为 3-7 分，且在老年急性病房住院。

干预

2019 年 1 月至 7 月期间接受标准护理（物理康复和营养咨询）的患者构成历史对照组。2019 年 8 月至 12 月期间接受多领域干预的患者构成干预组。

测量

主要结局是日常生活活动（ADL）和虚弱状态的变化，采用 Katz 指数和临床虚弱量表进行评估，使用广义估计方程模型。住院时间、医疗费用和再入院率为次要结局。

结果

接受干预的患者（n=101；27.9%）在住院期间 ADL 和 CFS 改善更明显（ADL 调整估计值，0.61；95%CI，0.11-1.11；p=0.02；CFS 调整估计值，-1.11；95%CI，-1.42- -0.80；p<0.01），住院时间更短（调整估计值，-5.00；95%CI，-7.99- -2.47；p<0.01），医疗费用更低（调整估计值，0.58；95%CI，0.49-0.69；p<0.01），30 天和 90 天再入院率更低（30 天调整后的比值比[aOR]，0.12；95%CI，0.27-0.50；p<0.01；60 天 aOR，0.04；95%CI，0.01-0.33；p<0.01）。