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

10.3966/168232812019032901004

林倩如(Chien-Ju Lin)；張宇辰(Yu-Chen Chang)；鄒孟婷(Meng-Ting Tsou)；詹欣隆(Hsin-Lung Chan)；陳盈如(Ying-Ju Chen)；黃麗卿(Lee-Ching Hwang)

超高齡老人 ； 85歲 ； 居家照護 ； 肺炎 ； 營養不良 ； 85 years old ； home health care ； malnutrition ； oldest old ； pneumonia

台灣家庭醫學雜誌

29卷1期（2019 / 03 / 01）

34 - 42

繁體中文

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（OR3.44，95％CI1.61－7.33）、失智症（OR2.46，95％CI1.24－4.85）以及男性（OR2.39，95％CI1.15－4.98）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.

1. 白淑芬,張國軒,林秀娜,蔡美菊,張宏哲(2017)。接受居家護理老人住院情形及其相關因素探討。長期照護雜誌，21，53-75。
   連結：
2. 李浩誠,李宗諭,楊逸菊,李侑珊(2018)。居家照護病人一年內住院或急診之危險因子探討。台灣家醫誌，28，208-218。
   連結：
3. Almirall, J,Bolibar, I,Serra-Prat, M(2008).New evidence of risk factors for community-acquired pneumonia: a population-based study.Eur Respir J,31,1274-1284.
4. Almirall, J,Serra-Prat, M,Bolibar, I,Balasso, V(2017).Risk factors for community-acquired pneumonia in adults: a systematic review of observational studies.Respiration,94,299-311.
5. American Geriatrics Society Ethics Committee,Clinical Practice and Models of Care Committee(2014).American Geriatrics Society feeding tubes in advanced dementia position statement.J Am Geriatr Soc,62,1590-1593.
6. Attridge, RT,Frei, CR(2011).Health care-associated pneumonia: an evidence-based review.Am J Med,124,689-697.
7. Cheng, HS,See, LC,Shieh, YH(2001).Estimating stature from knee height for adults in Taiwan.Chang Gung Med J,24,547-556.
8. Corrao, S,Argano, C,Natoli, G(2018).Disability, and not diabetes, is a strong predictor of mortality in oldest old patients hospitalized with pneumonia.Eur J Intern Med,54,53-59.
9. Demicheli, V,Jefferson, T,Di Pietrantonj, C(2018).Vaccines for preventing influenza in the elderly.Cochrane Database Syst Rev,2,CD004876.
10. DiBardino, DM,Wunderink, RG(2015).Aspiration pneumonia: a review of modern trends.J Crit Care,30,40-48.
11. Dwyer, LL,Harris-Kojetin, LD,Valverde, RH(2013).Infections in long-term care populations in the United States.J Am Geriatr Soc,61,342-349.
12. Gomes, GF,Pisani, JC,Macedo, ED,Campos, AC(2003).The nasogastric feeding tube as a risk factor for aspiration and aspiration pneumonia.Curr Opin Clin Nutr Metab Care,6,327-333.
13. Janssens, JP,Krause, KH(2004).Pneumonia in the very old.Lancet Infect Dis,4,112-124.
14. Juthani-Mehta, M,De, Rekeneire, N,Allore, H(2013).Modifiable risk factors for pneumonia requiring hospitalization of community-dwelling older adults: the Health, Aging, and Body Composition Study.J Am Geriatr Soc,61,1111-1118.
15. Kaplan, V,Clermont, G,Griffin, MF(2003).Pneumonia: still the old man’s friend?.Arch Intern Med,163,317-323.
16. Koivula, I,Sten, M,Makela, PH(1994).Risk factors for pneumonia in the elderly.Am J Med,96,313-320.
17. Masnoon, N,Shakib, S,Kalisch-Ellett, L,Caughey, GE(2017).What is polypharmacy? A systematic review of definitions.BMC Geriatr,17,230.
18. Mitchell, SL,Teno, JM,Kiely, DK(2009).The clinical course of advanced dementia.N Engl J Med,361,1529-1538.
19. Moberley, S,Holden, J,Tatham, DP,Andrews, RM(2013).Vaccines for preventing pneumococcal infection in adults.Cochrane Database Syst Rev,1,CD000422.
20. Naruishi, K,Yumoto, H,Kido, JI(2018).Clinical effects of low body mass index on geriatric status in elderly patients.Exp Gerontol,110,86-91.
21. Peng, CJ,Chang, CM,Yang, KS(2000).Using simple anthropometric parameters to develop formulas for estimating weight and height in Chinese adults.Ann N Y Acad Sci,904,327-332.
22. Riquelme, R,Torres, A,El-Ebiary, M(1996).Community-acquired pneumonia in the elderly: A multivariate analysis of risk and prognostic factors.Am J Respir Crit Care Med.,154,1450-1455.
23. Rofes, L,Arreola, V,Almirall, J(2010).Diagnosis and management of oropharyngeal dysphagia and its nutritional and respiratory complications in the elderly.Gastroenterol Res Pract,2011
24. Shang, J,Larson, E,Liu, J,Stone, P(2015).Infection in home health care: results from national Outcome and Assessment Information Set data.Am J Infect Control,43,454-459.
25. Shang, J,Ma, C,Poghosyan, L,Dowding, D,Stone, P(2014).The prevalence of infections and patient risk factors in home health care: a systematic review.Am J Infect Control,42,479-484.
26. Tay, WY,Low, LL,Tan, SY(2014).Evidence-based measures for preventing aspiration pneumonia in patients with dysphagia.Proceedings of Singapore Healthcare,23,158-165.
27. World Health Organization: Global health and aging. https://www.who.int/ageing/publications/global_health.pdf. Accessed January 3, 2019.
28. Yang, Y,Brown, CJ,Burgio, KL(2011).Undernutrition at baseline and health services utilization and mortality over a one-year period in older adults receiving Medicare home health services.J Am Med Dir Assoc,12,287-294.
29. 中華民國國家發展委員會：中華民國人口推估（2018至2065年）報告。2019年1月3日，取自https://pop-proj.ndc.gov.tw/
30. 中華民國衛生福利部國民健康署.台灣肺阻塞臨床照護指引.
31. 中華民國衛生福利部統計處：106年死因統計結果分析。2019年1月3日，取自https://dep.mohw.gov.tw/DOS/cp-3960-41756-113.html

1. 簡翠薇,李采婷(2021)。運用口腔照護於一位反覆肺炎老年病人之護理經驗。榮總護理，38(3)，322-329。
2. 楊麗玉,沈季香(2020)。肺炎住院病人特性及住院天數之影響因子。台灣公共衛生雜誌，39(6)，686-695。
3. 楊麗玉,沈季香(2020)。探討胸腔物理治療對肺部感染病人住院天數、醫療費用之影響。護理雜誌，67(2)，58-64。
4. (2024)。居家醫療管灌個案營養不良風險預測。長期照護雜誌，27(1)，21-41。
5. (2024)。一位肺炎病人因跌倒導致肋骨骨折併血胸之急診照護經驗。志為護理-慈濟護理雜誌，23(2)，121-130。