老人患者の入院長期化に影響を及ぼす要因--尿道カテ-テルの使用を中心に

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Fifty-nine elderly patients who had been hospitalized more than six months in five hospitals in the city of Mino in Osaka Prefecture, were studied to clarify the factors influencing prolonged hospital stays by the elderly. Their mean age was 82.2 years, and women accounted for 86% of the patients. One-third had suffered a stroke. As for ADL, 44% were completely dependent when walking, eating, bathing and dressing. Moreover, 36% had severe dementia, 19% suffered from decubitus ulcers, 66% were undergoing rehabilitation, 58% were receiving venous infusion therapy, 36% used a urethral catheter, and 10% were receiving tube feeding.The subjects were divided into two groups according to the likelihood of discharge assessed by the doctors in charge: one group consisted of 27 patients who might be discharged and the other of 32 patients with an ongoing need for inpatient care. Multivariate analyses using Hayashi's quantification method II indicated that use of a urethral catheter and not undergoing rehabilitation were the main factors associated with the need for inpatient care, while being a woman, being of advanced age and not having one's own room at home were the non-medical factors which made it difficult for the patients to be discharged from the hospital.As use of a urethral catheter was the factor most strongly related to prolonged hospital stay, multivariate analyses were applied to the 45 patients with urinary incontinence, who were divided into one group of 21 patients with, and one of 24 without a urethral catheter. The factors associated with use of a urethral catheter were then investigated. Use of a urethral catheter was strongly related to venous infusion therapy, not undergoing rehabilitation, the presence of decubitus ulcers and a low ADL level. Our results suggest that, in order to reduce the increase of elderly patients with prolonged hospital stays, more appropriate approaches to urinary incontinence should be developed and more systematic efforts at rehabilitation should be made.

老人患者の入院長期化に影響を及ぼす要因--尿道カテ-テルの使用を中心に

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