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

吳風鈴(Feng-Ling Wu) ； 陳晶瑩(Chin-Ying Chen) ； 劉文俊(Wen-Jing Liu) ； 陳慶餘(Ching-Yu Chen)

《台灣老年醫學暨老年學雜誌》 6卷3期 (2011/08) Pp. 176-189

https://doi.org/10.29461/TGG.201108.0003

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.

關鍵字

老年病症候群 ； 老年周全性評估 ； 急性住院 ； 亞急性照護

並列摘要

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.

並列關鍵字

geriatric syndrome ； comprehensive geriatric assessment ； acute care ； subacute care