认知衰弱对共病老年人住院费用的影响研究

doi:10.12114/j.issn.1007-9572.2020.00.070

摘要/Abstract

摘要： 背景　随着老年人口的不断增多，认知衰弱人群也逐渐增多，认知衰弱人群跌倒发生率、失能率、入院率及死亡率均较高，给社会和家庭带来了沉重的经济负担，然而目前关于认知衰弱老年人住院费用的相关研究较为缺乏。目的　了解认知衰弱对共病老年人住院费用的影响。方法　采用回顾性研究方法，选择2015年11月—2016年6月于四川省成都市第五人民医院神经内科和老年科住院的≥60周岁的共病患者188例为研究对象。分别采用中国版衰弱风险筛查工具（FRAIL）量表、简易智力状况量表（MMSE）及日常生活能力量表（ADL）对老年人进行衰弱评估、认知功能评估及日常生活能力评估，通过医院信息系统后台提取实验室检查、住院费用明细等信息。按照住院当时是否存在衰弱和轻度认知功能障碍分为4组，即无衰弱无认知功能障碍组（N组）、无衰弱有认知功能障碍组（C组）、有衰弱无认知功能障碍组（F组）、同时合并衰弱和认知功能障碍组（CF组）。比较4组人群社会人口学、生活习惯、人体测量、实验室检查结果、住院费用及住院天数，采用Logistic回归分析共病老年人住院费用的影响因素。结果　CF组年龄、住院总费用高于其余3组，白蛋白水平高于N组和C组，F组白蛋白水平、住院总费用高于N组，差异有统计学意义（P<0.05）。C组和F组患者一般医疗费用、诊断费、总治疗费、中医治疗费高于N组；CF组患者一般医疗费高于N组和C组，诊断费高于N组和F组，总治疗费、西药治疗费、中医治疗费高于N组、C组及F组，耗材费用高于N组，差异有统计学意义（P<0.05）。Logistic回归分析结果显示，在未校正模型，校正年龄、性别、婚姻状况模型，校正年龄、性别、婚姻状况、吸烟情况、饮酒情况模型，校正年龄、性别、婚姻状况、吸烟情况、饮酒情况、白细胞计数、血红蛋白、血小板计数、白蛋白、低密度脂蛋白胆固醇模型中，认知衰弱均可增加共病老年人住院总费用（P<0.05）。结论　认知衰弱可增加共病老年人住院总费用，认知衰弱共病老年人住院总费用较高，住院费用主要来源于药物治疗。认知衰弱住院患者的康复锻炼相对缺乏，营养支持力度较差。因此，减少认知衰弱老年人药物使用，加强老年综合征的防治可能减少认知衰弱共病患者的住院费用。

关键词: 认知衰弱, 共病, 多学科, 住院费用, 老年综合征管理

Abstract: Background　With an increasing number of elderly people，the prevalence of cognitive frailty is gradually growing at the same time. In fact，patients with cognitive frailty have a high incidence of falls，functional disability and hospitalization，and an increased risk of death，which brings a heavy economic burden to the society and the family. However，there is a lack of relevant studies on the hospitalization expenses of the elderly with cognitive frailty. Objective　To understand the effect of cognitive frailty on the hospitalization expenses of the elderly with comorbidity. Methods　Using the retrospective study method，118 inpatients with comorbidity aged ≥60 years old in the Department of Neurology and Department of Gerontology and Geriatrics of Chengdu Fifth People's Hospital were selected as the study objects from November 2015 to June 2016. Chinese version of the FRAIL scale，MMSE scale and ADL scale were used to assess the frailty status，cognitive function and activities of daily living among the elderly，respectively. The laboratory examination expenses and hospitalization expenses were extracted from the information system of Chengdu Fifth People's Hospital. According to whether there were frailty and mild cognitive dysfunction at the time of admission，the patients were divided into four groups：group N（no frailty or cognitive dysfunction），group C（no frailty but with cognitive dysfunction），group F（with frailty but no cognitive dysfunction），and group CF（with both frailty and cognitive dysfunction）. The social demographic data，living habits，anthropometric data，laboratory examination results，hospitalization expenses and hospitalization days of the four groups were compared，and the influencing factors of hospitalization expenses among the elderly with comorbidity were analyzed by Logistic regression. Results　The age and total hospitalization expenses of group CF were higher than those of the other three groups，and the albumin（ALB） level was higher than those of group N and group C；ALB level and total hospitalization expenses of group F were higher than those of group N（P<0.05）. The general medical cost，diagnosis cost，total treatment cost and traditional Chinese medicine treatment cost of group C and group F were higher than those of group N；the general medical cost of group CF was higher than that of group N and group C，while the diagnosis cost was higher than that of group N and group F，and the total treatment cost，Western medicine treatment cost and traditional Chinese medicine treatment cost were higher than that of group N，group C and group F，and the cost of consumables was higher than that of group N（P<0.05）. The results of Logistic regression analysis showed that among all the unadjusted model，the model with adjusted age，gender and marital status，the model with adjusted age，gender，marital status，smoking status and drinking status，and the model with adjusted age，gender，marital status，smoking status，drinking status，white blood cell count（WBC），hemoglobin（HB），platelet count（PLT），ALB and low density lipoprotein cholesterol（LDL-C），cognitive frailty increased the total hospitalization expenses of the elderly with comorbidity（P<0.05）. Conclusion　Cognitive frailty could increase the total hospitalization expenses of the elderly with comorbidity. The high hospitalization expenses of the elderly with comorbidity mainly come from drug treatment. The elderly inpatients with cognitive frailty relatively lack the rehabilitation exercise and have poor nutritional support. Therefore，reducing the drug use among elderly patients with cognitive frailty and strengthening the prevention and treatment of their combidities may reduce the total hospitalization expenses.

Key words: Cognitive frailty, Comorbidity, Multidisciplinary, Hospitalization expenses, Geriatric syndrome management

张榕,杨颖,李铮,等. 认知衰弱对共病老年人住院费用的影响研究[J]. 中国全科医学, 2020, 23(22): 2846-2851. DOI: 10.12114/j.issn.1007-9572.2020.00.070.
ZHANG Rong1,YANG Ying2,LI Zheng1, et al. The Effect of Cognitive Frailty on the Hospitalization Expenses of the Elderly with Comorbidity[J]. Chinese General Practice, 2020, 23(22): 2846-2851. DOI: 10.12114/j.issn.1007-9572.2020.00.070.

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