并非全部丧失:急诊普通外科手术后老年人的功能恢复。

Matthew P Guttman, Bourke W Tillmann, Avery B Nathens, Susan E Bronskill, Refik Saskin, Anjie Huang, Barbara Haas
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引用次数: 1

摘要

背景:虽然功能下降和死亡是急诊普通手术(EGS)后老年人常见的长期结局,但我们假设患者出院后功能可能随着时间的推移而增强或减弱。功能波动期可能是干预以防止进一步衰退的机会。我们的目的是描述EGS入院后老年人的功能轨迹。方法:这是一项基于人群的回顾性队列研究,研究对象是安大略省所有独立的、社区居住的老年人(年龄≥65岁),他们在2006-2016年期间接受了EGS治疗。使用多状态模型检查出院后5年内患者的功能轨迹。患者在功能独立、使用长期家庭护理(在家协助个人护理、家政或医疗护理至少90天)、入住养老院和死亡之间来回转换。结果:我们确定了78,820例EGS入院的老年人(平均年龄77岁;53%的女性)。在入院后的5年中,32% (n = 24,928)需要新的慢性家庭护理,其中21% (n = 5,249)有两次或两次以上的慢性家庭护理发作,间隔时间为独立。长期家庭护理的平均时间为11个月,50% (n = 12,679)的长期家庭护理以恢复独立结束。对于任何时候需要长期家庭护理的患者,在随后的5年中,每年恢复独立生活的概率从36%到43%不等。结论:在EGS入院后经历功能衰退的老年人并非全部丧失。那些需要长期家庭护理的人中有一半会恢复独立,三分之一会有持久的恢复,在5年后保持独立。EGS后几年的功能波动可能是促进老年人康复和恢复的干预措施的独特机会。证据水平:预后和流行病学;第三层次。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Not all is lost: Functional recovery in older adults following emergency general surgery.

Background: Although functional decline and death are common long-term outcomes among older adults following emergency general surgery (EGS), we hypothesized that patients' postdischarge function may wax and wane over time. Periods of fluctuation in function may represent opportunities to intervene to prevent further decline. Our objective was to describe the functional trajectories of older adults following EGS admission.

Methods: This was a population-based retrospective cohort study of all independent, community-dwelling older adults (age ≥65 years) in Ontario with an EGS admission (2006-2016). A multistate model was used to examine patients' functional trajectories over the 5 years following discharge. Patients were followed as they transitioned back and forth between functional independence, use of chronic home care (in-home assistance for personal care, homemaking, or medical care for at least 90 days), nursing home admission, and death.

Results: We identified 78,820 older adults with an EGS admission (mean age, 77 years; 53% female). In the 5 years following admission, 32% (n = 24,928) required new chronic home care, 21% (n = 5,249) of whom had two or more episodes of chronic home care separated by periods of independence. The average time spent in chronic home care was 11 months, and 50% (n = 12,679) of chronic home care episodes ended with a return to independence. For patients requiring chronic home care at any time, the probability of returning to independent living during the subsequent 5 years ranged from 36% to 43% annually.

Conclusion: Not all is lost for older adults who experience functional decline following EGS admission. Half of those who require chronic home care will recover to independence, and one-third will have a durable recovery, remaining independent after 5 years. Fluctuations in function in the years following EGS may represent a unique opportunity for interventions to promote rehabilitation and recovery among older adults.

Level of evidence: Prognostic and Epidemiologic; Level III.

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