Skrøpelighet blant eldre pasienter med hjemmesykepleie

Factors Associated With Care Trajectory Following Acute Functional Decline in Older Home Nursing Care Patients: A Prospective Observational Study

“…The increased need for higher level of care at the initial acute illness and death within 3 months, could be related to comorbidity which has a known association with female gender 10 and frailty which is related to comorbidity and death. 6 Level of community care was strongly associated with the initial clinical response and final level of care; patients living in private homes at T 1 , were more likely to be admitted to MAU, hospital, or short-time skilled nursing homes than patients living in community care homes. This may be explained by several social and contextual factors in the services, 7 such as unwillingness to risk further deterioration at home without proper monitoring, geographical distance to the home nursing care office and limited staffing resources and inability to increase visit frequency.…”

“…These findings strengthen the perception of this patient group as particularly vulnerable and at high risk of acute illness and consequently functional decline, which are in line with similar studies. [3][4][5][6]39,40 Despite contemporary health reforms and health policies, the discussion of whether to diagnose and medically treat older patients in hospitals or primary care is contested, and research shows both advantages and disadvantages of hospitalizing older patients. [12][13][14][15] However, there's is reason to question if this particularly vulnerable older patient group, with several acute incidences in need of subsequent medical treatment and transitions to different levels of care in a short period of time, could have postponed transfer to higher level of community care or death with a specialized comprehensive geriatric approach in hospital.…”

“…Age was associated with the level of clinical response in this study. Age has previously been shown to be associated with comorbidity, frailty, and hospital admissions, 6 which may reflect the patients' reduced functional and psychological reserves. 22 Advanced age may thus reflect a need for higher level of clinical response such as hospital admissions when acute clinical deterioration is detected.…”

“…2 Older patients receiving home nursing care are typically comorbid and frail, with complex diseases, and in need of comprehensive health care. [3][4][5][6] Several factors are known to be associated with advancements through care trajectories in community and specialist care settings. A mix of social and health problems in elderly persons are associated with hospital admissions.…”

“…Likewise, age, frailty, comorbidity, and cancer are factors associated with increased risk of death. 6 Hospitalization and acute diseases in older patients are often associated with functional decline, increased disability, loss of ability to live at home, and mortality. 11 A study exploring consequences of transferring aged-care facility residents to hospitals, showed that it was not clear whether the benefits of in-hospital emergency care outweigh potential adverse complications such as pressure ulcers and delirium, invasive interventions, and mortality after transfer.…”