养老院居民转入医院的风险因素

　　既往研究显示，养老院中使用鼻饲喂养的居民比其他居民有更高的转入医院率（包括住院和急诊）。

　　美国阿拉巴马大学对3813位65岁以上的养老院居民进行调查，证实了鼻饲喂养是养老院居民转入医院的风险因素。此外，当存在营养不良表现，如体重下降和压疮时，养老院居民的转入医院风险都会增加。

JPEN J Parenter Enteral Nutr. 2016;40(4):141.

Characteristics Associated With Hospital Transfers Among Nursing Home Residents.

Joy W. Douglas; Linda L. Knol.

University of Alabama, Tuscaloosa, AL, USA.

Purpose: Increasing healthcare costs and the aging of the American population have led researchers to focus on the causes of hospitalizations among nursing home residents. Some research has suggested that nursing home residents with feeding tubes are more likely to be transferred to the hospital than other residents. In patients with advanced dementia, this move from the nursing home to the hospital is burdensome to the patients, their family members, and the healthcare system. The purpose of this study was to identify characteristics associated with hospital transfers among nursing home residents and to determine whether the presence of a feeding tube increases the risk for hospital transfers in this population.

Methods: The 2004 National Nursing Home Survey data set was utilized, with the analysis including 3813 non-Hispanic white and black residents aged 65 years and older. Residents receiving hospice or palliative care were excluded. The dependent variable, hospital transfer, was defined as a direct admission to the hospital or a visit to the emergency department. Logistic regression analysis was used to determine whether demographics, indicators of nutrition status, and other clinical factors were associated with transfer to the hospital among nursing home residents.

Results: Male sex and the presence of a feeding tube were associated with hospital transfers in this sample (OR: 1.42, 95% CI: 1.14-1.76; and OR: 1.73, 95% CI: 1.15-2.61, respectively), as were the presence of weight loss and pressure ulcers (OR: 1.82, 95% CI: 1.37-2.41; and OR: 1.45, 95% CI: 1.13-1.88, respectively). Increasing number of prescription medications was also associated with hospital transfers (OR: 1.06, 95% CI 1.03-1.09). Age, race, presence of advanced directives, and assignment to a specialty nursing unit were not significant predictors of being transferred from the nursing home to the hospital.

Conclusions: In this sample, feeding tubes did predict hospital transfers, which is consistent with other research. Additionally, weight loss and pressure ulcers, both indications of malnutrition, were also associated with hospital transfers in this sample. While more research is needed to fully understand these findings, this research suggests that impaired nutrition status among nursing home residents may lead to increased risk of being transferred from the nursing home to the hospital.

Financial support: None.