Hospital-acquired functional decline in older patients cared for in acute medical wards and predictors: Findings from a multicentre longitudinal study

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• 作者：Alvisa Palese ; MNS ; BNS ; RN^a ; ^{alvisa.palese@uniud.it" class="auth_mail" title="E-mail the corresponding author} ; Silvia Gonella ; MNS ; BNS ; RN^b ; Renzo Moreale ; MNS ; BNS ; RN^a ; Annamaria Guarnier ; MNS ; BNS ; RN^c ; Paolo Barelli ; MNS ; BNS ; RN^c ; Paola Zambiasi ; MNS ; BNS ; RN^c ; Elisabetta Allegrini ; MNS ; BNS ; RN^d ; Letizia Bazoli ; MNS ; BNS ; RN^e ; Paola Casson ; MNS ; BNS ; RN^f ; Meri Marin ; MNS ; BNS ; RN^g ; Marisa Padovan ; MNS ; BNS ; RN^h ; Michele Picogna ; MNS ; BNS ; RNⁱ ; Patrizia Taddia ; MNS ; BNS ; RN^j ; Daniele Salmaso ; MNS ; BNS ; RN^k ; Paolo Chiari ; MNS ; BNS ; RN^l ; Tiziana Frison ; MNS ; BNS ; RN^m ; Oliva Marognolli ; MNS ; BNS ; RN^b ; Carla Benaglio ; MNS ; BNS ; RN^b ; Federica Canzan ; PhD^b ; Elisa Ambrosi ; PhD^b ; Luisa Saiani ; MNS ; BNS ; RN^b ; on behalf of ESAMED Group
• 关键词：Functional dependence ; Functional recovery ; Functional stability ; Nursing care ; Hospital ; Medical units ; Predictors ; Longitudinal study
• 刊名：Geriatric Nursing
• 出版年：2016
• 出版时间：May-June 2016
• 年：2016
• 卷：37
• 期：3
• 页码：192-199
• 全文大小：382 K

文摘

Describing the trajectories of hospital-associated functional decline in older patients admitted to acute medical units and identifying predictors at the individual, nursing, and hospital levels, were the aims of the study. A longitudinal survey among 12 acute medical units in which 1464 patients were consecutively enrolled and evaluated using the Barthel Index (BI), was performed. Functional decline was defined as a decrease in the BI of at least 5 points from admission to discharge. In all, 17.1% participants (n = 251) demonstrated functional decline. In accordance with multiple logistic regression analysis, 28.8% (R²) of the variance in the functional decline was explained by: confusion/disorientation (RR = 4.684; 95% CI = 3.144–6.978), admission from nursing homes (RR = 2.464; 95% CI = 1.642–3.697), daily care expressed in minutes offered by nursing aides (RR = 1.535; 95% CI = 1.275–1.849), higher workforce skill-mix (RR = 2.221; 95% CI = 1.763–2.797), bladder catheter insertion (RR = 1.599; 95% CI = 1.128–2.268), and higher BI score at admission (RR = 1.019; 95% CI = 1.014–1.024). Increasing the amount of care delivered by competent nurses—having a bachelors degree—providing and supervising direct-care activities, may reduce the occurrence of functional decline in older patients admitted to medical units.