老年病患急診就醫的臨床特點和預後: 以醫院為基礎的回顧性研究

Clinical Characteristics and Prognosis of Medical Treatment in Emergency Room among Elderly Patients: A Hospital-Based Retrospective Study.

賴靚伃(CHING-YU LAI)

指導教授 ： 鐘淑英

中臺科技大學/護理學院/長期照顧碩士學位學程/碩士(2020年)

摘要

臺灣已邁入高齡社會，人口高齡化所帶來長期照護及醫療的問題已成為重要的議題。急診是提供老人全日就醫，及進入急性醫療照顧的重要管道。老人族群是高度使用急診醫療資源的族群，故了解老人使用急診醫療資源的特性為本研究重要之方向。目的：本研究探討長照機構及非長照機構老年病患急診就醫之臨床特點和預後動向。方法：本研究對象為到台灣中部某醫學中心急診就醫之長照機構及非長照機構老年病患，採病歷回溯研究法，收集自2014年1月1日至2018年12月31日五年期間之病歷資料，並利用邏輯斯迴歸探討急診就醫後死亡之預測因子。結果：急診就醫之長照機構老年病患之年齡高於非長照機構者，長照機構老年病患與女性、急診檢傷第1級、感染症、急診轉住院、急診就醫後死亡、住院後死亡、出院後14天再入院有顯著關係；非長照機構老年病患與男性、急診檢傷第3級、消化系統疾病、急診就醫後出院，及急診出院後三日內返診有顯著關係。兩者則在年齡、支持性管路數、腦血管疾病後遺症、褥瘡、慢性共病數、脈搏、體溫、急診留觀時數、白蛋白數值、血清尿素氮數值、白血球數及血糖值之間有差異。急診住院後死亡與長照機構老年病患、急診檢傷第1級、感染症有顯著關係。而支持性管路數、糖尿病、充血性心臟衰竭、腦血管疾病後遺症、褥瘡、慢性共病數、收縮壓、脈搏、呼吸、體溫、急診留觀時數、白蛋白值、血清尿素氮數值、白血球數、血糖值等變項，在急診住院後死亡及未死亡之間有顯著差異。利用邏輯斯迴歸預測急診就醫住院後動向之死亡因子，顯示與長照機構老年病患、急診檢傷分級、脈搏、血清尿素氮值及白血球數呈正相關。結論：長照機構老年病患急診就醫之疾病嚴重性和急診滯留時數，皆顯著高於非長照機構老年病患。老年病患於急診就醫住院後動向之相關死亡因子為年齡、檢傷分級、血清尿素氮值、及白血球數。

關鍵字

長期照護 ； 機構老年病患 ； 急診就醫

並列摘要

Taiwan has entered an “elderly society”. The problem of long-term care and medical treatment accompanying with the aging population has become an important issue. The emergency department is an important way to provide full-time medical treatment for the elderly and access to acute medical treatment. The elderly population highly uses emergency medical resources, thus, understanding the characteristics of the elderly using emergency medical resources is an important direction of this research. Purpose: This study investigated the clinical characteristics and prognostic trends of elderly patients in long-term care institutions (LTCI) and non-long-term care institutions (NLTCI) who visit the emergency department of a medical center in Central Taiwan. Method: The subjects were elderly patients coming from LTCI and NLTCI who visit the emergency department of a medical center in Central Taiwan. This research was used case history retrospective method. The medical records for the five-year period were collected from January 1, 2014 to December 31, 2018. Logistic regression was used to explore the predictors of death after emergency treatment. Results: In emergency department elderly patients in LTCI were older than those in NLTCI. There were significant relationships between elderly patients in LTCI and women, triage grade 1, infections, emergency transfer to hospitalization, death after emergency treatment, death after hospitalization, as well as re-admission 14 days after discharge. There were significant relationships between elderly patients in NLTCI and men, triage grade 3, digestive system diseases, discharge after emergency treatment, and return within three days after emergency discharge. Both had significant differences among the variables of age, the numbers of supportive tubings, sequelae of cerebrovascular disease, bedsores, the numbers of chronic comorbidities, pulse, body temperature, emergency observation hours, albumin value, serum urea nitrogen value, white blood cell counts, and blood sugar value. The dead events after emergency hospitalization had significant relationships with elderly patients in LTCI, triage grade 1, and infectious diseases. Therefore, there were significant differences between dead and undead events after emergency hospitalization among the variables of the numbers of supportive tubings, diabetes, congestive heart failure, sequelae of cerebrovascular disease, bedsores, the numbers of chronic comorbidities, systolic blood pressure, pulse, respiration, body temperature, emergency observation hours, albumin value, serum urea nitrogen value, as well as white blood cell counts. Logistic regression used to predict the death factors after emergency hospitalization showed that there were positive correlations between dead factors with elderly patients in LTCI, triage grade, pulse, serum urea nitrogen value and white blood cell counts. Conclusion: The severity of disease and the length of stay in emergency department in LTCI elderly patients are significantly higher than those in NLTCI. The related dead factors for elderly patients after emergency hospitalization are age, triage grade, serum urea nitrogen value, and white blood cell counts.

並列關鍵字

Long-term care ； Institutional elderly residents ； Emergency treatment

參考文獻

中華民國內政部戶政司全球資訊網（2018，4月9日）．民國107年3月戶口統計資料分析．取自https://www.ris.gov.tw/app/portal /2121?sn=590&p=22

中華民國內政部統計處（2019，9月11日）．108年第37週內政統計通報(107年國人平均壽命達80.7歲，再締新高）.取自https:// www.moi.gov.tw/stat/news_detail.aspx?sn=16744

王金香、何牧行、洪慧君、劉芳（2019）．探討曾有急診就醫經驗老年人之健康識能．榮總護理，36（1），14-26。doi：10.6142/VGHN.201903_36(1).0002

王靜怡、葉志嶸、許清芳（2010）．居住於社區、照顧住宅及護理之家老人的健康狀態及活動表現．中山醫學雜誌，21（2），145 -159。doi：10.30096/CSMJ.201006.0003

全國法規資料庫（2017）．長期照顧服務法第一章第 3 條．取自https://law.moj.gov.tw/News/NewsDetail.aspx?msgid=114581