老年康复住院单位收治的认知障碍、抑郁和/或谵妄老年患者功能改善的评估

A Esperanza, R Miralles, I Rius, B Fernandez, A Digón, P Arranz, P Gonzalez, Y Raja, P Serrano, M Zafra, O Vazquez, P Gili, A M Cervera
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引用次数: 30

摘要

认知障碍、抑郁和谵妄是老年患者高发的问题。老年康复病房(GCU)是一种提供跨学科老年干预方案的住院设施,可能更适合这些患者。本研究旨在分析GCU住院的老年认知障碍、抑郁和/或谵妄患者的功能改善(FI)。一组107名患者接受了特殊的护理,习惯性地在GCU进行,他们也包括在康复计划中。认知障碍、抑郁和谵妄根据标准化方案进行诊断。分析变量为:年龄、入院前(BBA)、入院时(BA)和出院时(BD)的功能状态(Barthel指数)、诊断类别、认知功能(MMSE)和出院后目的地。采用校正后的Heinemann指数(CHI)评价GCU-stay期间获得的FI, CHI = 100 × (BD-BA)/(BBA-BA);采用效率指数(El)分析FI与GCU停留时间的关系,El = (BD-BA)/(GCU停留天数)。根据CHI,患者分为三组。第一组:CHI = 0或阴性(住院期间丧失功能能力的患者、因急性恶化而死亡或转送医院的患者)。II组:CHI < 35%(高FI)。平均年龄77.6±9.1岁,诊断类别为骨折/骨科49例(45.7%),神经学27例(25.2%),肺/心脏学6例(5.6%),其他25例(23.3%)。平均MMSE和BA评分分别为16.9 +/- 9.4和29.6 +/- 18.9。出院后目的地为:63例(58.8%)患者返回家中,28例(26.1%)患者已确定住院,11例(10.2%)患者死亡,最后5例(4.6%)患者转至急症护理医院。I组35例(32.7%),平均El = 0.12 +/-1.1;II组13例(12.1%)和0.26 +/- 0.38;III组59例(55.1%)和0.94例(±0.97)。尽管存在认知障碍、抑郁和/或谵妄,但很大比例的患者(67.2%)的功能能力得到了显著改善。35%(中度FI)。第三组:CHI >/=
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Evaluation of functional improvement in older patients with cognitive impairment, depression and/or delirium admitted to a geriatric convalescence hospitalization unit.

Cognitive impairment, depression and delirium are problems of high prevalence in older patients. The geriatric convalescence unit (GCU) is a hospitalization facility offering an interdisciplinary geriatric intervention program that may be more appropriate for these patients. This study intended to analyze the functional improvement (FI) in older patients with cognitive impairment, depression and/or delirium admitted to a GCU. A group of 107 patients received specific nurse care, habitually performed in GCU and they also were included in a rehabilitation program. Cognitive impairment, depression and delirium were diagnosed according to standardized protocols. The analyzed variables were: age, functional status (Barthel index) before admission (BBA), at admission (BA) and at discharge(BD), diagnostic categories, cognitive function (mini mental state examination: MMSE) and post-discharge destination. The corrected Heinemann index (CHI) was used to evaluate FI obtained during GCU-stay, where CHI = 100 x (BD-BA)/(BBA-BA), and the efficiency index(El) was used to analyze the relationship between FI and the length of stay in the GCU,where El = (BD-BA)/(days in GCU). According to CHI, patients were divided in three groups. Group I: CHI = 0 or negative (patients who lost functional capacity during hospitalization,those who died or were transferred to hospital owing to acute deterioration. Group II: CHI < 35 % (high FI). Mean age was 77.6 +/- 9.1 years, the diagnostic categories were: fractures/orthopedics 49 (45.7 %), neurological 27(25.2 %), pulmonary/cardiologic 6 (5.6 %) and other cases 25 (23.3 %). Mean MMSE and BA scores were 16.9 +/- 9.4 and 29.6 +/- 18.9, respectively. Post-discharge destinations were:63 patients (58.8 %) returned home, 28 (26.1 %) were definitively institutionalized, 11 (10.2%) died and finally 5 (4.6 %) were transferred to acute care hospital. In-Group I, there were 35 patients (32.7 %) with a mean value of the El = 0.12 +/-1.1; in Group II, 13 (12.1 %) and 0.26 +/- 0.38; in Group III, 59 (55.1 %) and 0.94 +/- 0.97, respectively. In spite of the presence of cognitive impairment, depression and/or delirium, a high proportion of patients (67.2 %)obtained a significant improvement in their functional capacity.35 % (moderate FI). Group III: CHI >/=

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