Inouye S K, Wagner D R, Acampora D, Horwitz R I, Cooney L M, Tinetii M E
Yale University School of Medicine, Yale-New Haven Hospital, CT 06504.
J Am Geriatr Soc. 1993 Dec;41(12):1353-60. doi: 10.1111/j.1532-5415.1993.tb06487.x.
To test the effectiveness of a nursing-centered intervention to prevent functional decline among hospitalized elderly medical patients.
Prospective cohort study with stratified and matched cohort analyses.
General medicine wards of a university teaching hospital.
Two hundred sixteen patients aged > or = 70 years (85 intervention and 131 control patients).
The intervention included identification and surveillance of frail older patients, twice-weekly rounds of the Geriatric Care Team, and a nursing-centered educational program.
Functional decline, defined as a net decline in five activities of daily living (ADLs).
In stratified analyses, the intervention resulted in a beneficial effect with a relative risk of 0.82 (95% confidence interval [CI] 0.54 to 1.24) in patients (n = 106) with one of four geriatric target conditions at baseline (eg, delirium, functional impairment, incontinence, and pressure sores). The intervention had no effect in patients without target conditions at baseline (n = 110); thus, this subgroup was excluded from further analyses. When patients were matched on number of target conditions and risk for functional decline at baseline (n = 66), the intervention resulted in a significant beneficial effect, with a reduction in functional decline from 64% in controls to 41% in the intervention group, for a relative risk of 0.64 (95% CI, 0.43 to 0.96). The intervention group had significantly less decline in ADL score and in individual ADLs than control subjects. Specific interventions aimed at maximizing function, such as physical therapy, were received more often by intervention patients; however, the beneficial effects of the intervention were achieved without increasing per-day hospital costs.
The intervention appears effective to decrease functional decline in targeted elderly hospitalized medical patients.
检验以护理为中心的干预措施对预防老年内科住院患者功能衰退的有效性。
采用分层和匹配队列分析的前瞻性队列研究。
一所大学教学医院的普通内科病房。
216名年龄≥70岁的患者（85名干预组患者和131名对照组患者）。
干预措施包括识别和监测体弱老年患者、老年护理团队每周两次查房以及以护理为中心的教育项目。
功能衰退，定义为日常生活活动（ADL）五项指标的净下降。
在分层分析中，对于基线时患有四种老年目标疾病之一（如谵妄、功能障碍、失禁和压疮）的患者（n = 106），干预措施产生了有益效果，相对风险为0.82（95%置信区间[CI] 0.54至1.24）。干预措施对基线时无目标疾病的患者（n = 110）没有效果；因此，该亚组被排除在进一步分析之外。当根据基线时目标疾病的数量和功能衰退风险对患者进行匹配时（n = 66），干预措施产生了显著的有益效果，功能衰退从对照组的64%降至干预组的41%，相对风险为0.64（95% CI，0.43至0.96）。干预组的ADL评分和个体ADL的下降明显少于对照组。干预组患者接受旨在最大化功能的特定干预措施（如物理治疗）的频率更高；然而，在不增加每日住院费用的情况下实现了干预措施的有益效果。
该干预措施似乎能有效减少目标老年内科住院患者的功能衰退。
