頁籤選單縮合
題 名 | 地區轉型醫院老人住院型態與預後追蹤之分析=Admission Patterns and Outcome Follow-up of Community Older Adults in Reformed Geriatric Hospitals |
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作 者 | 吳風鈴; 陳晶瑩; 劉文俊; 陳慶餘; | 書刊名 | 臺灣老年醫學暨老年學雜誌 |
卷 期 | 6:3 2011.08[民100.08] |
頁 次 | 頁176-189 |
分類號 | 419.76 |
關鍵詞 | 老年病症候群; 老年周全性評估; 急性住院; 亞急性照護; Geriatric syndrome; Comprehensive geriatric assessment; Acute care; Subacute care; |
語 文 | 中文(Chinese) |
中文摘要 | 目的︰本文以地區醫院轉型為老人照護醫院計畫為基礎,前瞻性探討社區醫院中不 同住院型態之適應症(因急性疾病之住院、需亞急性照護之住院、合乎周全性老年評估 適應症之住院評估)的老年病患,其功能評估及預後之差異。 方法︰本研究個案來自12家地區醫院於2006年1月至2007年6月收案的老年住院病 患,所收集的資料包括:住院時的基本資料,涵蓋簡易心智功能檢查、憂鬱評估、日常 生活功能、工具性生活功能、營養評估等的周全性老年評估,及出院18個月後功能狀況 及預後的電話追蹤訪查。 結果:研究期間符合收案條件者共有726人,其中因急性住院者452人(62.3%)、符 合亞急性照護者45人(6.2%)、入院接受周全性評估者佔229人(31.5%)。18個月後追 蹤有149人死亡,佔20.5%。比較存活及死亡兩組的功能,在老年病症候群的功能回顧上, 死亡組比存活組有較多的認知障礙、聽力障礙、行動障礙、尿失禁、營養問題(以上 p<0.001)、溝通障礙、平衡障礙及排便障礙(以上p<0.05)。所施測的各項功能評估分 數,死亡組均較差(p<0.001)。比較三組不同住院適應症各種老年病症候群的比率,入 院接受周全性評估組有較多的尿失禁(p<0.05)、急性照護組有較多的疼痛(p<0.05); 而在功能評估分數上,入院接受周全性評估組有較低的營養評估(p<0.05)、工具性生 活功能分數(p<0.001),亞急性照護組有較低的日常生活功能分數(p<0.01)。住院時 及出院18個月後的日常生活功能及工具式日常生活功能,入院接受周全性評估組均明顯 低於另外兩組,但惡化程度並沒有顯著差異;在死亡率的部份,三組間則沒有顯著差異。 結論:住院追蹤18個月內的死亡者有較多的老年病症候群及較差的日常生活功能, 且不同住院適應症組別的存活率與功能指標的降低沒有顯著差異,顯示周全性老年評估 組的重要性。針對老化社會到來,地區醫院在老人照護的角色,及健保給付未納入亞急 性照護及周全性老年評估部分,需重新檢討。 |
英文摘要 | Background: In Taiwan, an interdisciplinary geriatric care program was initiated in 2006 to promote the care quality in community hospitals. The study aimed to compare the ratios of various geriatric syndromes of patients admitted for acute care, subacute care or comprehensive geriatric assessment (CGA) in community hospitals and to examine the functional changes of these patients at time of admission and 18-month follow-up. Methods: A prospective study of patients aged 65 or older hospitalized in twelve community hospitals was performed from Jan 2006 to Jun 2007. Baseline admission data, including demographic characteristics, geriatric syndrome questionnaire, Mini Mental State Examination (MMSE), Short Form Geriatric Depression Scale (GDS-15), Minimal Nutritional Assessment (MNA), Activities of Daily Living (ADL), and Instrumental Activities of Daily living (IADL) were collected. The 18-month outcome function and mortality data were obtained through telephone interview and chart review. Results: A total of 726 patients were recruited with 425 (62.3%) patients for acute care, 45 (6.2%) patients for sub-acute care and 229 (31.5%) patients for CGA. 149(20.5%) patients died during the 18-month follow-up. Compared to the survivor group, the group of deceased patients reported more case of memory impairment, hearing impairment, mobility impairments, urinary incontinence (all with p<0.001), communication problems, imbalance and constipation (all with p<0.05). The scores of various functional assessments were lower in the group of deceased patients. Regarding the ratio of geriatric syndromes, the CGA group showed more cases of urinary incontinence (p<0.05), and the acute care group had more cases of pain (p<0.05). The CGA group reported lower MNA (p<0.05) and IADL scores (p<0.001), while the subacute care group registered a lower ADL score (p<0.01). The CGA group had lower baseline and 18-month follow-up ADL and IADL scores than the other two groups, but the functional deterioration and mortality rates demonstrated no significantly different. Conclusions: The deceased elderly patients in community hospitals had more geriatric syndromes and lower functional activity scores. The 18-month functional deterioration and mortality rate were not significantly different among the acute, subacute and CGA groups. The National Insurance Bureau should rethink the coverage of subacute care and CGA for the elderly. |
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