老年综合评估联合综合治疗对高龄住院患者共病疗效及生活质量的影响

The effect of comprehensive geriatrics assement and comprehensive treatment for elderly inpatient's geriatric multimorbidity

目的探讨在老年住院患者中进行老年综合评估,并针对评估结果进行综合治疗对老年共病疗效及生活质量的影响。方法选取80岁以上老年科住院患者120例,分为干预组与对照组。应用智慧老年综合评估软件在入院3 d内对120例患者进行综合评估,然后针对评估结果对评估干预组患者进行综合治疗,包括对老年累积疾病、老年综合征、老年躯体功能、老年认知功能、老年心理情绪等方面的全面治疗干预。对照组进行老年综合评估后,仅对所患的各系统累积疾病进行治疗。干预6个月后进行第2次评估,评价进行综合评估干预后对老年住院患者的老年共病疗效及生活质量影响。结果评估干预组患者综合评估及综合治疗后,(1)累积疾病:干预组患者比对照组血压控制得更好[收缩压:(138. 0±6. 7) mm Hg比(145. 0±7. 2) mm Hg,P <0. 05],慢性阻塞性肺病急性发作(AECOPD)人次发生率占比更低(33. 3%比66. 7%),急性心力衰竭人次发生率占比更低(29. 4%比70. 6%)。(2)老年共病情况:匹茨堡睡眠质量指数量表(PSQI)、疼痛评分法(NRS)、国际尿失禁咨询委员会-尿失禁问卷简表(ICI-Q-SF)、简易智力状况检查(MMSE)、老年抑郁量表(GDS-15)、焦虑自评量表(SAS)、莫尔斯跌倒评估量表(Morse)评分均有改善,P <0. 05。简易营养状况评估(MNA-SF)提示营养不良率较对照组改善明显[31. 7%(19/60)比66. 7%(40/60)]。(3)日常生活质量:干预组日常生活能力量表(ADL)评分较干预前有明显改善[(65. 2±23. 4)分比(57. 3±28. 3)分,P <0. 05]。结论住院患者进行综合评估能及早发现各种老年共病,综合治疗能改善患者的疾病疗效及生活质量。

Objective To investigate the role of comprehensive geriatric assessment (CGA) and comprehensive management for the elderly inpatients with geriatric multimorbidity.Methods A comprehensive geriatric assessment was conducted among 120 elderly inpatients within three days of hospitalization.120 inpatients were divided into the control group and the study group.After the first assessment,we treated only accumulated systemic diseases in the control group,while in the study group,comprehensive treatment was conducted.We treated not only accumulated systemic diseases but also geriatric multimorbidity.After six months,comprehensive geriatric assessment was conducted among 120 elderly inpatients for the second time.The effect of CGA and comprehensive treatment were evaluated.Results After comprehensive evaluation and treatment of patients in the intervention group.(1)Accumulated systemic diseases:Compared with the control group,the control of blood pressure of patients in the intervention group was better [systolic pressure (138±6.7)mm Hg vs (145±7.2)mm Hg,P<0.05].The incidence percent of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) was lower(33.3 % vs 66.7 %) and the incidence percent of acute heart failure was lower(29.4 % vs 70.6 %).(2)Geriatric multimorbidity:Compared with the control group,the visual,hearing,and periodontal diseases affecting the quality of life decreased significantly in the intervention group after six months of intervention.The scales of PSQI、NRS、ICI-Q-SF、MMSE、SDS-15、SAS、MORSE in the intervention group was better than the control group(P<0.05).The simple nutrition assessment(MNA-SF) indicated a marked improvement in the rate of malnutrition compared to the control group[31.7 %(19/60) vs 66.7 %(40/60)].(3)Quality of daily life:We used the Activity of Daily Living Scale(ADL) to assess quality of life.The ADL score of the intervention group was significantly improved compared to the pre-intervention(65.2±23.4 vs 57.3±28.3,P<0.05).Conclusion Comprehensive geriatrics assement of the elderly inpatients can early detect geriatric multimorbidity,and comprehensive treatment can improve curative effect of diseases and patient’quality of life.