Indicateurs pr¡§|coces de?dur¡§|e de?s¡§|jour prolong¡§|e chez?les?sujets ag¡§|s: ¡§|tude pilote r¡§|alis¡§|e au CHRU de Strasbourg

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• 作者：Pierre-Olivier Lang¹ ; ² ; ^{Pierre.O.Lang@hcuge.ch} ; Damien Heitz³ ; Nicolas Meyer⁴ ; Moustapha Dramé ; ² ; ⁵ ; Nicolas Jovenin² ; ⁶ ; Joë ; l Ankri⁷ ; Dominique Somme² ; ⁸ ; Jean-Luc Novella² ; ⁵ ; Jean-Bernard Gauvain⁹ ; Alain Colvez¹⁰ ; Pascal Couturier¹¹ ; Isabelle Laniè ; ce¹¹ ; Thierry Voisin¹² ; Benoit de Waziè ; res¹³ ; Ré ; gis Gonthier¹⁴ ; Claude Jeandel¹⁵ ; Damien Jolly² ; ⁶ ; Olivier Saint-Jean⁸ ; Franç ; ois Blanchard² ; ⁵
• 刊名：La Presse M¡§|dicale
• 出版年：2007
• 出版时间：March 2007
• 年：2007
• 卷：36
• 期：3_part_P1
• 页码：389-398
• 全文大小：303 K

文摘

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Summary

Objectives

The aim of this study was to identify early indicators of prolonged hospital stays by elderly patients.

Methods

This prospective pilot study, conducted at Strasbourg University Hospital, included patients aged 75 years or older who were hospitalized via the emergency department (SAFES cohort: Sujet ?g¡§| Fragile: ¡§|valuation et suivi, that is, Frail Elderly Subjects: Evaluation and Follow-up). A gerontologic evaluation of these patients during the first week of their hospitalization furnished the data for an exact logistic regression. Two definitions were used for prolonged hospitalization: 30 days and a composite number adjusted for diagnosis-related group according to the French classification (f-DRG).

Results

The analysis examined 137 hospitalizations. More than two thirds of the patients were women (73 % ), with a mean age of 84 years. Twenty-four hospitalizations (17 % ) lasted more than 30 days, but only 6 (4 % ) lasted beyond the DRG-adjusted limit. No social or demographic variables appeared to affect the length of stay, regardless of the definition of prolonged stay. No indicator was associated with the 30-day limit, but clinical markers were linked to prolongation assessed by f-DRG adjustment. A ?¡ãrisk of malnutrition?¡À (OR = 14.07) and ?¡ãmood disorders?¡À (OR = 2,5) were both early markers for prolonged hospitalization. Although not statistically significant, ?¡ãwalking difficulties?¡À (OR = 2.72) and ?¡ãcognitive impairment?¡À (OR = 5.03) appeared to be associated with prolonged stays. No association was seen with either the variables measured by Katz's Activities of Daily Living Index or its course during hospitalization.

Conclusion

Our study shows that when generally recognized indicators of frailty are taken into account, a set of simple items enables a predictive approach to the prolongation of emergency hospitalizations of the elderly.