• 作者：Cesareo Fern&#225 ; ndez Alonso<sup>asup><sup> ; sup><sup>cesareofa@hotmail.comsup> ; Francisco Javier Martí ; n S&#225 ; nchez<sup>asup> ; Manuel Fuentes Ferrer<sup>csup> ; Juan Gonz&#225 ; lez del Castillo<sup>asup> ; Carlos Verdejo Bravo<sup>bsup> ; Pedro Gil Gregorio<sup>bsup> ; Jose Manuel Ribera Casado<sup>bsup> ; Pedro Villarroel Elipe<sup>asup> ; Juan Jorge Gonz&#225 ; lez Armengol<sup>asup>
• 关键词：Paciente mayor ; Dependencia previa ; Pé ; rdida funcional ; Estancia prolongada
• 刊名：Revista Espa帽ola de Geriatr铆a y Gerontolog铆a
• 出版年：2010
• 期刊代码：pca313_0211139X
• 类别：med
• 出版时间：March-April 2010
• 卷：45
• 期：2
• 页码：63-66
• 文件大小：167 K

ss="h4">Introduction

To determine the prognostic value of functional impairment on the final destination of elders admitted for acute medical illness to an emergency short-stay unit (ESSU).

ss="h4">Material and methods

We performed a prospective analysis of patients aged more than 65 years old admitted to the ESSU of Hospital Cl铆nico San Carlos in Madrid in April 2008. A protocol was designed that included epidemiologic variables (age and gender), clinical variables (reason for admission, comorbidity measured by the Charlson Index [CI]) and functional variables (previous, admission and functional decline [FD] measured with the Barthel [BI] and Lawton Indexes [LI]). The prognostic value of FD on the decision to admit patients was analyzed through ROC curves and the cut points that maximized sensitivity and specificity were determined.

ss="h4">Results

Sixty patients were included with a mean age of 80.7 (SD 8.2) years and 71.7%were women. The reasons for admission were acute infections in 31.7%, heart failure in 23.3%, syncope in 15.0%, intestinal obstruction in 11.7%, gastrointestinal bleeding in 10.0%, and arrhythmias in 8.3%. The mean CI was 2.27 (1.45). Functional assessment was as follows: mean previous BI score: 79.25 (SD 25) and at admission: 62.92 (SD 28.19). Mean previous LI score: 4.85 (SD 2.45) and at admission: 2.98 (SD 2.42).): BI-FD: 20%(1.25鈥?8.23), LI-FD 37.5%(16.7鈥?0.2%). FD was found in 100%of the patients. The mean length of stay was 1.70 (SD 0.62) days. Discharge destination was home discharge in 46.7%and hospitalization unit in 53.3%. Multivariate analysis according to discharge destination (home vs hospitalization) provided the following results : BI-FI 鈮?6%(OR=7.99 [1.1鈥?0.5], p=0.037), LI-FI 鈮?5%(OR=19.6 [0.04鈥?.52], p <0.0001).

ss="h4">Conclusions

Patients with significant FD in the emergency room should not be admitted to an ESSU since significant FD is a prognostic factor for transfer to a conventional ward.