超高齡居家照護病人因肺炎住院的危險因子

Risk Factors Associated with Hospitalization for Pneumonia in Oldest Old Home Care Recipients

目的：肺炎是造成老人住院或死亡常見的原因，但過往分析肺炎危險因子的文獻，少有研究是針對超高齡老人（≥ 85歲）或居家照護病人。因此，本研究目的為探討接受居家照護的超高齡老人發生肺炎住院的風險，與其相關的影響因子。 方法：本研究為回溯性病例分析，對象為臺灣北部某一醫學中心居家照護的超高齡老人，研究期間為2017年1月1日至2017年12月31日。我們根據病人的病歷去記錄各相關變項，並進行單變項及多變項邏輯迴歸分析，探討超高齡居家照護病人因肺炎住院的危險因子。 結果：本研究共收納212位居家照護的超高齡老人（男/女：60/152）。結果發現所有病人都有營養不良或潛在營養不良風險（迷你營養評估量表總分<24）。其中78位(36.8%)病人發生肺炎並住院，而且分析顯示：男性、失能、使用鼻胃管、過度多重用藥（每日使用≥ 10種藥物）、腦中風、失智症及慢性阻塞性肺病的病人，有較高的肺炎住院風險。此外，慢性阻塞性肺病(OR 3.44, 95% CI 1.61-7.33)、失智症(OR 2.46, 95% CI 1.24-4.85)以及男性(OR 2.39, 95% CI 1.15-4.98)病人，發生肺炎住院的機率有顯著增加。 結論：接受居家照護的超高齡老人，普遍都有營養不良的風險。有三分之一以上的病人會因肺炎住院，並且有很高的死亡率及再入院率。

 

Purpose: Pneumonia is a common cause of hospitalization and mortality in the elderly. However, research focusing on risk factors of pneumonia among the oldest old (≥ 85 years) and home care recipients has remained limited. Therefore, the study aimed to explore the risk factors associated with hospitalization for pneumonia in oldest old home care recipients. Methods: The retrospective study found its subjects in oldest old patients receiving the home care service of a medical center in north Taiwan. Related data from patients’ electronic medical records were extracted from January 1 to December 31, 2017. Multiple logistic regression analysis was performed to identify factors related to hospitalization for pneumonia. Results: A total of 212 oldest old home care recipients (men/women: 60/152) were recruited, and all of them were malnourished or at risk for malnourishment (mini nutritional assessment [MNA] scores< 24). 78 patients (36.8%) had been hospitalized for pneumonia. Analysis found subjects with these conditions at a greater risk of hospitalization for pneumonia: male sex, functional impairment, nasogastric tube use, excessive polypharmacy, stroke, dementia, and chronic obstructive pulmonary disease. Furthermore, chronic obstructive pulmonary disease (odds ratio [OR] 3.44, 95% confidence interval [CI] 1.61-7.33), dementia (OR 2.46, 95% CI 1.24-4.85), and male sex (OR 2.39, 95% CI 1.15-4.98) appeared to be significant contributing factors of hospitalization for pneumonia. Conclusion: As indicated by the study, malnutrition is a highly common problem in oldest old home care recipients. More than one-third of recipients developed pneumonia and required hospitalization, which lead to high mortality and increased readmission rates.