Rudberg M A, Sager M A, Zhang J
Department of Medicine, University of Chicago, USA.
J Gerontol A Biol Sci Med Sci. 1996 Sep;51(5):M189-94. doi: 10.1093/gerona/51a.5.m189.
Hospitalization, a sentinel event for many older persons, may mark a transition from independent living to either community-based or institutionalized long-term care. We determined the independent risk factors, including loss of function, of nursing home (NH) admission at hospital discharge and NH use at 3 months after hospital discharge among a diverse group of hospitalized older persons.
The subjects in this study were 1,265 noninstitutionalized persons from phase II of Hospital Outcomes Project for the Elderly. Using multiple logistic regression, we modeled NH admission with variables measured at the time of hospital admission as well as with length of stay (LOS) and decline in ADL independence from hospital admission to discharge. In addition, we modeled NH use at 3 months after hospital discharge with variables measured at the time of hospital discharge as well as with post-hospital measures of rehospitalization and decline in ADL independence following hospitalization.
The independence risk factors of NH placement at discharge are geographic site, increasing age, living alone, and low baseline ADL independence, LOS, and decline in ADL independence during hospitalization. The independent predictors for NH use at 3-month follow-up are increasing age, living alone, mental status, low discharge ADL independence, LOS, and decline in ADL independence during the 3 months after discharge.
Simple but different clinical variables predict NH use at hospital discharge and at 3 months. Furthermore, functional loss during and after hospitalization is an important independent risk factor of nursing home use and is a clinical outcome that may be modified to decrease the likelihood of NH admission.
住院对许多老年人来说是一个标志性事件，可能标志着从独立生活向社区养老或机构长期护理的转变。我们确定了在不同的住院老年人群体中，出院时入住养老院（NH）的独立危险因素，包括功能丧失，以及出院后3个月内养老院的使用情况。
本研究的受试者是来自老年医院结局项目第二阶段的1265名非机构化人员。我们使用多元逻辑回归模型，将入院时测量的变量以及住院时间（LOS）和从入院到出院日常生活活动（ADL）独立性的下降作为预测NH入院的变量。此外，我们将出院后3个月内养老院的使用情况建模，将出院时测量的变量以及出院后再入院和住院后ADL独立性下降的医院后测量值作为变量。
出院时入住NH的独立危险因素是地理位置、年龄增加、独居、基线ADL独立性低、LOS以及住院期间ADL独立性下降。3个月随访时NH使用的独立预测因素是年龄增加、独居、精神状态、出院时ADL独立性低、LOS以及出院后3个月内ADL独立性下降。
简单但不同的临床变量可预测出院时和3个月时NH的使用情况。此外，住院期间和出院后的功能丧失是使用养老院的重要独立危险因素，并且是一种可以改变以降低入住NH可能性的临床结局。
