Lee Chiu-Hsiang, Chen Yu-An, Yang Chiu-Ming, Huang Kuang-Hua, Tsai Tung-Han, Chang Yuanmay, Shieh Shwn-Huey
School of Nursing, Chung Shan Medical University, Taichung 402, Taiwan.
Department of Nursing, Chung Shan Medical University Hospital, Taichung 402, Taiwan.
Healthcare (Basel). 2024 Oct 17;12(20):2069. doi: 10.3390/healthcare12202069.
Most residents of long-term care facilities (LTCFs) are patients with chronic diseases requiring long-term care. Unplanned hospitalization of older and frailer residents from LTCFs reduces their mobility and increases the number of infections, complications, and falls that might lead to severe disability or death. This study aimed to identify the critical risk factors associated with unplanned hospitalization among LTCF residents in Taiwan, providing insights that could inform better care practices in similar settings globally. A retrospective study was conducted using inpatient data from a medical center in central Taiwan, covering the period from 2011 to 2019. A total of 1220 LTCF residents were matched with general patients using propensity score matching. Multiple logistic regression analyses were performed to identify factors associated with unplanned hospitalization, controlling for relevant variables. LTCF residents had a significantly higher risk of unplanned hospitalization compared to general patients (OR = 1.44, 95% CI = 1.21-1.73). Key risk factors included advanced age (≥85 years, OR = 1.25, 95% CI = 1.02-1.54), the presence of comorbidities such as diabetes (OR = 1.17, 95% CI = 1.03-1.33) and renal failure (OR = 1.63, 95% CI = 1.42-1.86), high fall risk (OR = 2.67, 95% CI = 2.30-3.10), and being bedridden (OR = 6.55, 95% CI = 5.48-7.85). The presence of a tracheostomy tube also significantly increased hospitalization risk (OR = 1.73, 95% CI = 1.15-2.59). LTCF residents are at a higher risk of unplanned hospitalization, particularly those with specific comorbidities, physical limitations, and indwelling medical devices. These findings underscore the need for targeted interventions to manage these risks, potentially improving care outcomes for LTCF residents globally.
大多数长期护理机构（LTCFs）的居民都是需要长期护理的慢性病患者。LTCFs中年龄较大且身体较为虚弱的居民意外住院会降低他们的活动能力，并增加感染、并发症和跌倒的次数，而这些情况可能会导致严重残疾或死亡。本研究旨在确定台湾LTCF居民意外住院相关的关键风险因素，提供的见解可为全球类似环境下的更好护理实践提供参考。我们利用台湾中部一家医疗中心2011年至2019年期间的住院患者数据进行了一项回顾性研究。通过倾向得分匹配，共1220名LTCF居民与普通患者进行了匹配。进行了多项逻辑回归分析，以确定与意外住院相关的因素，并对相关变量进行了控制。与普通患者相比，LTCF居民意外住院的风险显著更高（比值比[OR]=1.44，95%置信区间[CI]=1.21-1.73）。关键风险因素包括高龄（≥85岁，OR=1.25，95%CI=1.02-1.54）、存在如糖尿病（OR=1.17，95%CI=1.03-1.33）和肾衰竭（OR=1.63，95%CI=1.42-1.86）等合并症、高跌倒风险（OR=2.67，95%CI=2.30-3.10）以及卧床不起（OR=6.55，95%CI=5.48-7.85）。气管造口管的存在也显著增加了住院风险（OR=1.73，95%CI=1.15-2.59）。LTCF居民意外住院的风险更高，尤其是那些患有特定合并症、身体有局限以及有留置医疗设备的居民。这些发现强调了针对这些风险进行有针对性干预的必要性，这可能会改善全球LTCF居民的护理结果。
