Geriatric Psychiatry, University Psychiatric Center, KU Leuven, Leuven, Belgium; Neuropsychiatry, Research Group Psychiatry, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium.
Department of Electrical Engineering (ESAT), KU Leuven, Leuven, Belgium; CSH (Circuits and Systems for Health) - Imec, Heverlee, Belgium.
J Am Med Dir Assoc. 2024 May;25(5):764-768. doi: 10.1016/j.jamda.2023.10.007. Epub 2023 Nov 13.
In psychogeriatric units for patients with dementia and behavioral problems, aggression is prevalent. Predictions and timely interventions of aggression are essential to create a safe environment and prevent adverse outcomes. Our study aimed to determine whether aggression severity early during admission to these units could be used as an indicator of adverse outcomes.
During one year, all aggressive incidents on a psychogeriatric unit were systematically recorded using the Revised Staff Observation of Aggression Scale (SOAS-R). The study investigated the link between the severity of incidents within the first 48 hours of admission and adverse outcomes.
All patients included in the study were admitted to a psychogeriatric unit for dementia and behavioral problems between November 2020 and October 2021.
The study population was categorized into groups according to the level of aggression severity during the first 48 hours of admission. The impact of aggression severity on the duration of admission, aggression frequency and severity during admission, medication usage at discharge, discharge destination, and mortality risk were examined.
During the initial 2 days of admission, 9 of 88 patients had 1 or more severe aggression incidents. An early manifestation of severe aggression was significantly associated with more incidents during hospitalization, a higher total SOAS-R score, and a sevenfold higher 1-year mortality risk compared with patients who did not or only mildly manifested aggression in the first 48 hours of admission.
An early manifestation of aggression not only poses a direct safety risk to all involved but is also an early indicator of patients at risk for more detrimental outcomes, specifically mortality risk. By identifying patients at higher risk for adverse outcomes early, health care providers can provide preventive or timelier interventions, mitigating the risk of adverse outcomes and optimizing care services.
在精神老年科病房，针对患有痴呆和行为问题的患者，攻击性较为普遍。对攻击性进行预测和及时干预对于创造安全环境和预防不良后果至关重要。我们的研究旨在确定在这些病房入院早期，攻击性严重程度是否可用作不良后果的预测指标。
在一年期间，使用修订后的医护人员观察攻击性量表（Revised Staff Observation of Aggression Scale，SOAS-R）系统地记录精神老年科病房的所有攻击性事件。本研究调查了入院后前 48 小时内事件严重程度与不良后果之间的联系。
所有入组研究的患者均在 2020 年 11 月至 2021 年 10 月期间因痴呆和行为问题被收入精神老年科病房。
根据入院前 48 小时内的攻击性严重程度，将研究人群分为不同的组。研究考察了攻击性严重程度对住院时间、住院期间的攻击性频率和严重程度、出院时的药物使用、出院去向和死亡风险的影响。
在入院的头 2 天，88 名患者中有 9 名或更多人发生了 1 次或多次严重攻击事件。入院前 48 小时内出现严重攻击性的早期表现与住院期间发生更多事件、SOAS-R 总分更高以及 1 年死亡率风险增加 7 倍显著相关，与入院前 48 小时内无攻击性或仅轻度表现的患者相比。
攻击性的早期表现不仅直接对所有相关人员构成安全风险，而且还是患者面临更多不良后果（特别是死亡风险）的早期指标。通过早期识别具有更高不良后果风险的患者，医疗保健提供者可以提供预防性或更及时的干预措施，从而降低不良后果的风险并优化护理服务。
