Cataneo-Piña Daniela Josefina, Hernández-Favela Celia Gabriela, Mondragón-Posadas Lidia Aurora, Torres Nuñez Citlalic
Geriatrics Department Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas Mexico City Mexico.
Aging Med (Milton). 2023 Nov 12;6(4):353-360. doi: 10.1002/agm2.12271. eCollection 2023 Dec.
The primary aim of this study was to evaluate the influence of targeted interventions, administered through comprehensive geriatric assessments on the incidence of hospitalization-related complications among older adults diagnosed with pulmonary diseases.
A retrospective analysis of medical records encompassed individuals aged 75 years and older who were admitted to a lung center during the period spanning from March to June 2023. These admissions occurred in a context where standardized geriatric management protocols were systematically implemented. This study's scope extended to assessing the prevalence of hospital-related complications, encompassing delirium and pressure ulcers. A rigorous multivariate logistic regression analysis was conducted to discern and characterize associated factors.
The integration of comprehensive geriatric assessment yielded a substantial reduction in in-hospital complications among the cohort of 118 patients (mean age : 82.1 ± 5.6 years, 44.5% women). The incidence of delirium decreased from 53.3% to 21.8% [odds ratio (OR): 0.246, 95% confidence interval (CI): 0.134-0.450, < 0.001], whereas the presence of pressure ulcers decreased from 43.9% to 25% (OR: 0.395, 95% CI: 0.217-0.715, < 0.001). The multivariate analysis uncovered independent associations between delirium and variables including community-acquired pneumonia (OR: 4.417, 95% CI : 1.574-12.395, = 0.005), severe disability (OR: 2.981, 95% CI: 1.140-7.798, = 0.026), and hearing loss (OR: 3.219, 95% CI : 1.260-8.170, = 0.014). Prolonged hospital stays emerged as the sole factor significantly associated with pressure ulcers (OR: 1.071, 95% CI: 1.033-1.109). Furthermore, an intricate bidirectional relationship was evident between delirium and pressure ulcers (OR: 7.158, 95% CI: 2.962-17.300, < 0.01).
In conjunction with its consequent interventions, geriatric evaluation assumes a pivotal role in ameliorating adverse outcomes stemming from hospitalization among older adults afflicted with pulmonary ailments. This role gains particular salience among subpopulations characterized by heightened susceptibility, such as individuals coping with hearing loss and severe disability.
本研究的主要目的是评估通过综合老年评估实施的针对性干预措施对诊断为肺部疾病的老年人住院相关并发症发生率的影响。
对2023年3月至6月期间入住肺部中心的75岁及以上患者的病历进行回顾性分析。这些入院病例是在系统实施标准化老年管理方案的背景下发生的。本研究的范围扩展到评估包括谵妄和压疮在内的医院相关并发症的患病率。进行了严格的多变量逻辑回归分析以识别和表征相关因素。
综合老年评估的整合使118例患者（平均年龄：82.1±5.6岁，44.5%为女性）队列中的住院并发症大幅减少。谵妄的发生率从53.3%降至21.8%[比值比（OR）：0.246，95%置信区间（CI）：0.134 - 0.450，P < 0.001]，而压疮的发生率从43.9%降至25%（OR：0.395，95% CI：0.217 - 0.715，P < 0.001）。多变量分析发现谵妄与包括社区获得性肺炎（OR：4.417，95% CI：1.574 - 12.395，P = 0.005）、严重残疾（OR：2.981，95% CI：1.140 - 7.798，P = 0.026）和听力损失（OR：3.219，95% CI：1.260 - 8.170，P = 0.014）等变量之间存在独立关联。住院时间延长是与压疮显著相关的唯一因素（OR：1.071，95% CI：1.033 - 1.109）。此外，谵妄和压疮之间存在复杂的双向关系（OR：7.158，95% CI：2.962 - 17.300，P < 0.01）。
老年评估及其后续干预措施在改善患有肺部疾病的老年人因住院产生的不良后果方面发挥着关键作用。在听力损失和严重残疾等易感性较高的亚人群中，这一作用尤为突出。
