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標題: | 高齡急診病人之衰弱面向與其預後的關聯 Associations Between Frailty Dimensions and Outcomes in Older Emergency Department Patients |
作者: | 蔡于捷 YU-CHIEH TSAI |
指導教授: | 陳雅美 YA-MEI CHEN |
關鍵字: | 生理衰弱,心理衰弱,社會衰弱,再返急診,再住院,死亡, physical frailty,psychological frailty,social frailty,revisit,readmission,mortality, |
出版年 : | 2023 |
學位: | 碩士 |
摘要: | 研究背景和目的
老年族群是否衰弱之所以重要,是因為衰弱可做為健康預後的指標。目前全世界對於急診衰弱長者的相關研究其實相對缺乏,而對於老年族群的衰弱議題若不夠警覺,則可能讓因非典型症狀來急診的老年族群有較差的急診品質。 透過本研究,我們希望可以了解到使用急診醫療的老年族群中生理、心理、社會衰弱的比率,同時也能了解台灣老年族群急診就診前是否衰弱,對於預後的影響與關聯性。 研究方法 本研究為前瞻性之觀察性世代研究,針對2022/12/15~2023/03/02至新竹臺大分院生醫醫院竹北院區急診醫學部就診之病患進行收案,資料分析分為探討(1) 急診使用之老年族群是否生理、心理、社會衰弱(2)以及透過多變項羅吉斯迴歸,加入共變項探討生理、心理、社會衰弱,對一個月後追蹤是否再返急診、住院以及死亡有影響。共變項包括年齡、過去病史、一年內跌倒次數、性別、是否為機構住民、是否有多重用藥、當次就醫是否住院等。 研究結果 研究期間共收案207位民眾,其中有46.38%有生理衰弱,41.06%有心理衰弱, 48.79%有社會衰弱,可發現社會衰弱比率大於生理衰弱再大於心理衰弱。以羅吉斯迴歸分析生理衰弱、心理衰弱、社會衰弱對於一個月預後的影響,發現在調整共變項後,有生理衰弱的長者其一個月內再返急診的風險為沒有生理衰弱的長者的4.43倍(OR=4.43, p<0.01),有生理衰弱的長者其一個月內再住院的風險為沒有生理衰弱的長者的3.62倍(OR=3.62, p<0.05),有心理衰弱的長者其一個月內再返急診的風險為沒有心理衰弱的長者的2.23倍(OR=2.23, p<0.05)。另發現社會衰弱有較易一個月住院(OR=2.39, p=0.059)、一個月內死亡(OR=9.00, p=0.052)之傾向。 討論 本研究之生理衰弱、心理衰弱及社會衰弱比率是比過去研究社區取樣之比率來得高,推論為不同面向衰弱與急診醫療使用的需求有關。此外與過去社區研究不同的是社會衰弱比率高於生理心理衰弱比率,推測可能是因為社會衰弱長者因為社會網絡或支持較薄弱,較有急診醫療需求。以及未來若能針對社區之社會衰弱長者進行介入,或許有機會降低長者急診使用率。 本研究發現急診長者生理衰弱及心理衰弱與一個月再返急診之風險有關,前者也與一個月再住院風險有關,而社會衰弱的長者其一個月內再住院及一個月死亡的風險則有較高的傾向。若在急診就診時能篩檢出衰弱,則有機會針對此族群進行介入,像是轉介老年醫學科或是長期照顧管理中心等,可以提升照顧品質,也降低之後的醫療資源的使用。 結論 本研究是第一個在急診場域同時進行生理、心理、社會衰弱的三面向評估,也點出了急診場域與社區場域之衰弱比率差異,以及衰弱比率與急診一個月預後指標之關聯性,同時也推論社會衰弱與急診醫療使用的關聯性。 Introduction The significance of frailty in the elderly lies in its role as an indicator of health outcomes. Research on the prevalence of frail elderly individuals presenting to the emergency department is lacking worldwide. The aim of this study is to find out the prevalence of frailty among elderly individuals who utilize emergency medical services, and to investigate the relationship between physical, psychological, and social frailties and health outcomes for these elderly individuals in Taiwan. Method This was a prospective observational cohort study that aimed to enroll patients who sought medical attention at the Emergency Medicine Department of National Taiwan University BioMedical Park Hospital Zhubei Branch, from December 15, 2022, to March 2, 2023. The data analysis was divided into two parts: (1) The assessment of physical, psychological, and social frailty among the study participants, and (2) Multivariable logistic regression analysis was conducted to investigate the impact of physical, mental, and social frailty on revisits to the emergency department, readmissions, and mortality within one month of follow-up. Covariates included age, medical history, number of falls within one year, gender, institutional residency, polypharmacy, index admission. Result A total of 207 participants were enrolled. Among them, 46.38% were identified as physical frailty, 41.06% as psychological frailty, and 48.79% as social frailty. Elderly individuals with physical frailty had a 4.43 times higher risk (OR=4.43, p<0.01) of revisit to the emergency department within one month compared to those without physical frailty; and a 3.62 times higher risk (OR=3.62, p<0.05) of readmission within one month compared to the other groups. Elderly individuals with psychological frailty had a 2.23 times higher risk (OR=2.23, p<0.05) of revisit at the emergency department within one month compared to those without psychological frailty. Social frailty was associated with a higher likelihood of readmission (OR=2.39, p=0.059) and mortality (OR=9.00, p=0.052) within one month. Discussion The rates of physical frailty, psychological frailty, and social frailty in this study were higher compared to rates obtained from community samples. This suggests a relationship between different dimensions of frailty and the need for emergency medical care. Furthermore, the rate of social frailty was higher than that of physical frailty, which suggested that older adults experiencing social frailty may have a greater need for emergency medical care due to a lack of social network or support. This higher rate of social frailty compared to psychological frailty highlights the importance of addressing social frailty in interventions targeting social frailty in the community, as it may help reduce the rate of emergency department utilization among older adults in the future. This study found that the risk of revisiting the emergency department within one month among older adults was associated with physiological frailty and physical frailty. Moreover, the risk of readmission within one month was associated with physical frailty. Additionally, older adults experiencing social frailty have a higher tendency towards readmission within one month and higher risk of mortality within one month. Screening frailty during emergency department visits presents an opportunity for intervention and effective reduction of healthcare resources utilization in this population. Conclusion The findings of this study indicated that the prevalence of frailty among elderly individuals in the emergency department wa significantly higher than in the community. Additionally, the presence of physical frailty can assist in predicting the risk of revisit at the emergency department and readmission within one month for elderly patients seeking emergency care. Similarly, the presence of psychological frailty can help assess the risk of revisit at the emergency department within one month for elderly patients seeking emergency care. Most importantly, interventions aimed at reducing frailty in older adults after their discharge from the emergency room are crucial. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/90337 |
DOI: | 10.6342/NTU202302440 |
全文授權: | 未授權 |
顯示於系所單位: | 健康政策與管理研究所 |
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