超高齡居家照護病人因肺炎住院的危險因子

Risk Factors Associated with Hospitalization for Pneumonia in Oldest Old Home Care Recipients

林倩如(Chien-Ju Lin) ； 張宇辰(Yu-Chen Chang) ； 鄒孟婷(Meng-Ting Tsou) ； 詹欣隆(Hsin-Lung Chan) ； 陳盈如(Ying-Ju Chen) ； 黃麗卿(Lee-Ching Hwang)

《台灣家庭醫學雜誌》 29卷1期 (2019/03) Pp. 34-42

https://doi.org/10.3966/168232812019032901004

摘要

目的：肺炎是造成老人住院或死亡常見的原因，但過往分析肺炎危險因子的文獻，少有研究是針對超高齡老人（≥85歲）或居家照護病人。因此，本研究目的為探討接受居家照護的超高齡老人發生肺炎住院的風險，與其相關的影響因子。方法：本研究為回溯性病例分析，對象為臺灣北部某一醫學中心居家照護的超高齡老人，研究期間為2017年1月1日至2017年12月31日。我們根據病人的病歷去記錄各相關變項，並進行單變項及多變項邏輯迴歸分析，探討超高齡居家照護病人因肺炎住院的危險因子。結果：本研究共收納212位居家照護的超高齡老人（男／女：60／152）。結果發現所有病人都有營養不良或潛在營養不良風險（迷你營養評估量表總分＜24）。其中78位（36.8％）病人發生肺炎並住院，而且分析顯示：男性、失能、使用鼻胃管、過度多重用藥（每日使用≥10種藥物）、腦中風、失智症及慢性阻塞性肺病的病人，有較高的肺炎住院風險。此外，慢性阻塞性肺病（OR3.44，95％CI1.61－7.33）、失智症（OR2.46，95％CI1.24－4.85）以及男性（OR2.39，95％CI1.15－4.98）病人，發生肺炎住院的機率有顯著增加。結論：接受居家照護的超高齡老人，普遍都有營養不良的風險。有三分之一以上的病人會因肺炎住院，並且有很高的死亡率及再入院率。

關鍵字

超高齡老人 ； 85歲 ； 居家照護 ； 肺炎 ； 營養不良

並列摘要

Purpose: Pneumonia is a common cause of hospitalization and mortality in the elderly. However, research focusing on risk factors of pneumonia among the oldest old (≥ 85 years) and home care recipients has remained limited. Therefore, the study aimed to explore the risk factors associated with hospitalization for pneumonia in oldest old home care recipients. Methods: The retrospective study found its subjects in oldest old patients receiving the home care service of a medical center in north Taiwan. Related data from patients' electronic medical records were extracted from January 1 to December 31, 2017. Multiple logistic regression analysis was performed to identify factors related to hospitalization for pneumonia. Results: A total of 212 oldest old home care recipients (men/women: 60/152) were recruited, and all of them were malnourished or at risk for malnourishment (mini nutritional assessment [MNA] scores＜ 24). 78 patients (36.8%) had been hospitalized for pneumonia. Analysis found subjects with these conditions at a greater risk of hospitalization for pneumonia: male sex, functional impairment, nasogastric tube use, excessive polypharmacy, stroke, dementia, and chronic obstructive pulmonary disease. Furthermore, chronic obstructive pulmonary disease (odds ratio [OR] 3.44, 95% confidence interval [CI] 1.61-7.33), dementia (OR 2.46, 95% CI 1.24-4.85), and male sex (OR 2.39, 95% CI 1.15-4.98) appeared to be significant contributing factors of hospitalization for pneumonia. Conclusion: As indicated by the study, malnutrition is a highly common problem in oldest old home care recipients. More than one-third of recipients developed pneumonia and required hospitalization, which lead to high mortality and increased readmission rates.

並列關鍵字

85 years old ； home health care ； malnutrition ； oldest old ； pneumonia

參考文獻

World Health Organization: Global health and aging. https://www.who.int/ageing/publications/global_health.pdf. Accessed January 3, 2019.

中華民國國家發展委員會：中華民國人口推估（2018至2065年）報告。2019年1月3日，取自https://pop-proj.ndc.gov.tw/

Janssens JP, Krause KH: Pneumonia in the very old. Lancet Infect Dis 2004; 4: 112-24.

Kaplan V, Clermont G, Griffin MF, et al: Pneumonia: still the old man’s friend? Arch Intern Med 2003; 163: 317-23.

中華民國衛生福利部統計處：106年死因統計結果分析。2019年1月3日，取自https://dep.mohw.gov.tw/DOS/cp-3960-41756-113.html