長期照顧場所老人再住院相關因子探討

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Title:	長期照顧場所老人再住院相關因子探討
Other Titles:	Investigation of the Factors Associated with Hospital Readmission of Elderly Residing in Long-Term Care Facilities
Authors:	林詩淳 Lin, Shih-chum
Contributors:	自然醫學研究所辜美安 Mei-an Ku
Keywords:	老人;再住院;長期照顧場所 hospital readmission;elderly;Long-term care
Date:	2009
Issue Date:	2015-03-19 15:42:26 (UTC+8)
Abstract:	台灣與其他先進國家一樣面臨人口急速老化之問題。2008年底我國65歲以上人口佔全國人口的10.4%，老化指數為61.5%。有鑑於台灣人口急速老人化，居住長期照顧場所中老人也越來越多。　　　　本研究目的欲探討長期照顧場所老人再住院相關因子，針對流行病學中可改善的相關因子，找出改善之方案。本研究方法利用病歷資料做回溯性調查，從中南部某區域教學醫院2006年7月1日至2007年8月30日期間，以254位65歲以上老人為研究對象，排除重覆住院兩次以上者，總計193位為研究對象。統計分析以14天內再住院為依變項。研究發現住院時血糖大於200 mg/dl者的14天內再住院為正常者的4.72倍(p<0.001)。住院時尿素氮值異常者的14天內再住院為正常者的2.53倍(p=0.031)，出院時白血球數異常者的14天內再住院為正常者的3.17倍(p=0.019)。長期照顧場所的區域(勝算比為2.17；p=0.079)、簽屬拒絕心肺復甦(勝算比為2.01；p=0.099)及使用抗生素治療達到14天(勝算比為2.26；p=0.085)，在14天內再住院的相關因子中，有相關趨勢。　　　　建議未來運用再住院相關預測因子，提早並確實執行出院準備計畫、加強及衛教長期照護照顧場所的照顧者照護過程，預防再住院發生及合理控制醫療費用，提升醫療品質。　　Similar to most of the developed countries in the world, Taiwan is facing the problem of rapid aging of her population. At the end of 2008, Taiwan's elderly population was 10.4% of the nation's total population and the aging index was 61.5%. With such rapid aging, there has been an increase of institutionalization of the elderly. 　　　　The present study aimed to investigate the factors, especially the modifiable ones that may contribute to hospital readmissions of elderly residing in LTC facilities. A retrospective analysis of the medical records of LTC residents who were admitted to the geriatric ward of a regional teaching hospital in Southern Taiwan from July 1, 2006 to August 30, 2007 was conducted. A total of 254 cases were collected. After excluding those repeated readmissions 193 cases were analyzed, using multivariate logistic regression. The independent variable was the 14-day readmission. The results showed that 14-day hospital readmission was associated with blood glucose greater than 200 mg/dL at admission (odds ratio=4.72, p<0.001), abnormally high values of the admission blood urea nitrogen (BUN) (odds ratio=2.53, p=0.031), and high white blood cell count at discharge from the hospital (odds ratio =3.17, p=0.019). The following factors did not reach statistically significant level but showed some tendency to be associated with 14-day readmission: the location of the long-term care facility (odds ratio=2.17；p=0.079), presence of a Do-Not-Resuscitate (DNR) agreement (odds ratio=2.01；p=0.099), and therapy with antibiotics for over 14 days (odds ratio=2.26；p=0.085).　　　　These factors may be used in assisting hospital discharge planning, in educating the caregivers, and in turn, may help to improve the efficiency of resource utilization and health care quality for elderly residing in LTC facilities.
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