Daltrey Julie Frances, Boyd Michal Kathleen, Burholt Vanessa, McLeod Heather, Zhenqiang W U, Bloomfield Katherine, Robinson Jacqualine
Faculty of Medical and Health Sciences, School of Nursing, University of Auckland, Auckland, New Zealand.
Faculty of Commerce, Actuarial Science, University of Cape Town, South Africa.
J Eval Clin Pract. 2025 Apr;31(3):e70068. doi: 10.1111/jep.70068.
The timely identification of acute deterioration in people living in residential aged care is critical to reducing rates of resident morbidity and mortality. However, residents often present with atypical or nonspecific presentations that make this difficult. This study aimed to quantify the strength of the relationship between the indicators acute deterioration reported in the literature and morbidity and mortality.
A retrospective cohort study using routinely collected health data. A single dependant acute deterioration variable (emergency department presentation or hospital admission or death within 7 days of the last completed international resident assessment instrument long-term care facility (interRAI-LTCF) assessment) was correlated with indicators of acute deterioration reported in the literature and available in interRAI-LTCF. Univariate and multivariate logistic regression analysis evaluated this association.
Nine variables were independently associated with acute deterioration. These were being 'largely asleep or unresponsive' odds ratio (OR): 7.95, 95% CI: 4.72-13.39, p < 0.001, 'easily distracted' (OR: 1.78, 95% CI: 1.28-2.49, p < 0.001), eating 'one or fewer meals a day' (OR: 2.13, 95% CI: 1.67-2.73, p < 0.001), reduced activities of daily living (OR: 2.06, 95% CI: 1.11-3.82, p = 0.02) inability to complete toilet transfer (OR: 1.95, 95% CI: 1.24-3.03, p = 0.004), 'dyspnoea; at rest' (OR: 1.81, 95% CI: 1.32-2.49, p < 0.001), 'two or more falls in 30 days' (OR: 1.53, 95% CI: 1.15-2.03, p = 0.003), peripheral oedema (OR: 1.37, 95 CI: 1.07-1.77, p = 0.014) and daily pain (OR: 1.37, 95% CI: 1.05-1.77, p = 0.019).
Presenting with one of nine variables made residents between 1.4 and 8 times more likely to be experiencing acute deterioration than others living in the facility. The monitoring the resident for these variables by healthcare assistants could support the timely identification of acute deterioration.
Not applicable.
及时识别居住在老年护理机构中的老年人急性病情恶化情况对于降低居民发病率和死亡率至关重要。然而，居民通常表现出非典型或非特异性症状，这使得病情识别变得困难。本研究旨在量化文献中报道的急性病情恶化指标与发病率和死亡率之间关系的强度。
一项使用常规收集的健康数据进行的回顾性队列研究。将单个相关急性病情恶化变量（急诊科就诊、住院或在最后一次完成国际居民评估工具长期护理机构（interRAI-LTCF）评估后7天内死亡）与文献中报道且可在interRAI-LTCF中获取的急性病情恶化指标进行关联分析。单因素和多因素逻辑回归分析评估这种关联。
九个变量与急性病情恶化独立相关。这些变量分别是“大部分时间入睡或无反应”，比值比（OR）：7.95，95%置信区间（CI）：4.72 - 13.39，p < 0.001；“容易分心”（OR：1.78，95% CI：1.28 - 2.49，p < 0.001）；每天进食“一顿或更少餐食”（OR：2.13，95% CI：1.67 - 2.73，p < 0.001）；日常生活活动减少（OR：2.06，95% CI：1.11 - 3.82，p = 0.02）；无法完成从马桶转移（OR：1.95，95% CI：1.24 - 3.03，p = 0.004）；“静息时呼吸困难”（OR：1.81，95% CI：1.32 - 2.49，p < 0.001）；“30天内跌倒两次或更多次”（OR：1.53，95% CI：1.15 - 2.03，p = 0.003）；外周水肿（OR：1.37，95% CI：1.07 - 1.77，p = 0.014）和每日疼痛（OR：1.37，95% CI：1.05 - 1.77，p = 0.019）。
出现九个变量之一的居民发生急性病情恶化的可能性比居住在该机构的其他居民高1.4至8倍。医护助理对这些变量进行监测有助于及时识别急性病情恶化。
不适用。
