系統識別號 U0026-1908201813322600
論文名稱(中文) 重症老人疾病前後老年綜合徵候的歷程變化
論文名稱(英文) Trajectory of Geriatric Syndromes Changes Among Elderly Patients Receiving Intensive Care
校院名稱 成功大學
系所名稱(中) 護理學系
系所名稱(英) Department of Nursing
學年度 106
學期 2
出版年 107
研究生(中文) 唐心如
研究生(英文) Hsin-Ju Tang
學號 TA8981063
學位類別 博士
語文別 中文
論文頁數 60頁
口試委員 共同指導教授-張家銘
中文關鍵字 重症  老人  老年綜合徵候  生活功能 
英文關鍵字 Intensive care  older adults  geriatric syndromes  functional decline 
中文摘要 背景: 五成以上老年重症存活者,出院後有中等至嚴重程度的功能衰退。而老年綜合徵候是老人功能喪失的關鍵因素。但老年綜合徵候的變化及對臨床結果和生活功能的影響,在老年重症領域尚未被探討。
目的: 本研究目的為1)描述重症老人住院前、轉出加護病房、出院、出院後一、三及六個月共六個測量時間,六項常見老年綜合徵候的變化,2)了解人口學、健康相關變項及住院前六項老年綜合徵候與住院期間死亡的相關性及預測,3)了解六個測量時間老年綜合徵候與臨床結果的相關性,4)探索人口學、健康相關變項及六項老年綜合徵候與六個測量時間重症老人生活功能變化的相關及預測力。
方法: 為前瞻世代性研究,於南部一間醫學中心的內科加護病房進行。研究對象需符合1)年齡≧65歲,2)自己能夠或有同住的主要照顧者可提供研究所需訊息者。收集人口學、健康相關變項及六個測量時間臨床結果、老年綜合徵候及生活功能的資料。
結果: 共192位重症老人同意參與並納入分析。尿失禁、行走障礙和便失禁是六個測量時間點,最多依賴的老年綜合徵候項目。住院期間新增的老年綜合徵候高於可回復的徵候,且存活者有中至嚴重的生活功能依賴。入院前居住於機構、加護病房期間使用呼吸器、五項老年綜合徵候:壓瘡、譫妄、尿失禁、便失禁及行走障礙為生活功能下降的預測因素。BMI體重過重是生活功能上升的預測因子。
結論: 老年綜合徵候和生活功能衰退與老人生活品質密切相關。重症領域對老年綜合徵候與生活功能的評估和照護指引,需儘速建立,以提高照護品質。
Patients 65 years or older account for more than half of the Intensive Care Unit (ICU) admissions. Approximately 35%-50% of older adults were discharged directly from the ICU to long-term care facilities due to the functioning loss of daily activities. Geriatric syndrome is a major contributing factor for functioning loss in older adults, however, its pattern and trajectory among ICU older adult patients have not been fully understood. This dissertation attempts to describe the patterns of six common geriatric syndromes from admission to post-discharge 6 months in elderly patients receiving intensive care, and the correlation and predictors between geriatric syndromes and the longitudinal functional status changes. With a prospective cohort study design, access to meaningful and valuable results, include:1) Urinary incontinence, impaired mobility, and defection incontinence were the most prevalent geriatric syndrome, 2)The rates of new-onset geriatric syndrome was higher than the resolved rate during the hospitalization, 3) the functional status did not return to the baseline during the follow up, 4) institutionalized prior to hospitalization, use of mechanical ventilation during the ICU stay, pressure sore, existing delirium, urinary incontinence, defection incontinence and impaired mobility were associated with reductions in functional status over 6 months, and overweight was the only factor that was associated with increased functional level. Those important results remind to pay attention to the high prevalence of geriatric syndromes, and the impact on clinical outcomes in older ICU survivors. In order to provide high quality and comprehensive care, to establish the assessment and plan guidelines for geriatric syndromes and introducing the concept of geriatric syndrome into intensive clinical care were pressing and necessary task.
Key Word: Intensive care, older adults, geriatric syndromes, functional decline, Katz's functional index
Nearly 50% of the older Intensive Care Unit (ICU) survivors discharged from the hospital with moderate to severe functional decline. Geriatric Syndromes considered a major contributing factor for functional loss in older adults. However, the pattern of geriatric syndromes and that influence for medical outcomes and functional status changes in older ICU survivors are to be further explored. The purpose of this study was 1) to describe the patterns of six common geriatric syndromes from admission, leave the ICU, discharge and 1, 3 to 6 months post-discharge, and 2) to understand the influence of demographic data, health-related data and geriatric syndromes for the clinical outcome in hospitalization, 3)to assess the correlation between six time points of geriatric syndromes and clinical outcome, and 4)to explore the predictors of the longitudinal functional status changes in older ICU survivors.

This is a prospective cohort study. Convenience sampling was used to recruit participants from two medical ICUs at a medical center in urban southern Taiwan. Inclusion criteria were 1) age ≥ 65 years old, and 2) able to or have a primary caregiver to provide consent and assessment information throughout the study. Demographic information, health-related data, and six times measurements (the past two weeks period prior to ICU admission, the day of leaving ICU, the hospital discharging day, and 1, 3 and 6 months post-discharge) of the clinical outcome, geriatric syndromes, and functional status were collected.

A total of 192 medical ICU older adult survivors were included in the analysis. Urinary incontinence, impaired mobility, and defection incontinence were the most prevalent syndrome at 6-times points. The rate of new-onset geriatric syndrome was higher than the resolved rate during the hospitalization, and the survivors have medium to severe functional dependency post-discharge, the functional status did not return to the baseline, even at the 6-month. Factors associated with reductions in functional status over 6 months were: 1) institutionalized prior to hospitalization, 2) use of mechanical ventilation during the ICU stay, and 3) five common geriatric syndromes, included pressure sore, existing delirium, urinary incontinence, defection incontinence and impaired mobility. Importantly, overweight was the only factor that was associated with increased functional level over 6 months.
Geriatric syndromes and functional decline are significantly related to the quality of life of the elderly. In order to provide high quality and comprehensive care, the clinical guidelines of geriatric syndromes assessment and plan in older ICU survivors need to be created immediately.
論文目次 目錄
中文摘要 I
誌謝 V
目錄 i
表目錄 iii
圖目錄 iii
第一章 緒論 1
第一節 研究背景及重要性 1
第二節 研究目的 3
第二章 文獻查證 4
第一節 老年綜合徵候定義 4
第二節 老年綜合徵候盛行率 5
第三節 老年綜合徵候相關因素及對治療成果預測 6
第四節 老年綜合徵候與生活功能的交互影響 7
第三章 研究方法 9
第一節 研究設計、場所及對象 9
第二節 研究過程 9
第三節 研究架構 12
第四節 研究工具 13
第五節 統計分析 17
第六節 倫理考量 17
第四章 研究結果 18
第一節 人口學及健康相關資料 19
第二節 臨床成果 21
第三節 老年綜合徵候盛行率及住院前後的變化 22
第四節 老年綜合徵候與臨床成果的相關 25
第五節 生活功能及其子項目住院前後的變化 26
第六節 各變項與六個測量時間生活功能變化的相關性 29
第五章 討論 31
第一節 人口學、健康相關資料及臨床成果 31
第二節 老年綜合徵候住院前後的變化 32
第三節 老年綜合徵候與臨床成果的相關性 33
第四節 重症老人功能變化與各變項的相關性 34
第六章 結論 37
第一節 結論與建議 37
第二節 研究限制 37
參考文獻 39
附錄一 同意臨床試驗證明書 52
附錄二 研究同意書 53
附錄三 研究問卷 56
參考文獻 Abdulraheem, IS. (2013). Polypharmacy: A risk factor for geriatric syndrome, morbidity & mortality. Journal of Aging Science, 1(2). doi:10.4172/2329-8847.1000e103
Abrams, P., Cardozo, L., Fall, M., Griffiths, D., Rosier, P., Ulmsten, U., Van Kerrebroeck, P., Victor, A., & Wein, A. (2002). The standardisation of terminology of lower urinary tract function: report from the standardisation sub-committee of the international continence society. Neurourology and Urodynamics, 21(2), 167-178. doi:10.1002/nau.10052
Ahmed, N., Mandel, R., & Fain, M. J. (2007). Frailty: An emerging geriatric syndrome. The American Journal of Medicine, 120(9), 748-753. doi: http://dx.doi.org/10.1016/j.amjmed.2006.10.018
Akhtar, A. J., & Padda, M. (2005). Fecal incontinence in older patients. Journal of American Medical Directors Association, 6(1), 54-60. doi:10.1016/j.jamda.2004.12.012
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders 5th ed. (2013). Washington, DC.
Angus, D. C., Shorr, A. F., White, A., Dremsizov, T. T., Schmitz, R. J., & Kelley, M. A. (2006). Critical care delivery in the United States: distribution of services and compliance with Leapfrog recommendations. Critical Care Medicine, 34(4), 1016-1024. doi:10.1097/01.ccm.0000206105.05626.15
Anpalahan, M., & Gibson, S. J. (2008). Geriatric syndromes as predictors of adverse outcomes of hospitalization. Internal Medicine Journal, 38, 16-23. doi:10.1111/j.1445-5994.2007.01398.x
Bahat, G., Tufan, F., Saka, B., Akin, S., Ozkaya, H., Yucel, N., Erten, N., & Karan, M. A. (2012). Which body mass index (BMI) is better in the elderly for functional status? Archives of Gerontology and Geriatrics, 54(1), 78-81. doi: http://dx.doi.org/10.1016/j.archger.2011.04.019
Bell, S. P., Vasilevskis, E. E., Saraf, A. A., Jacobsen, J. M., Kripalani, S., Mixon, A. S., Schnelle, J. E., & Simmons, S. F. (2016). Geriatric syndromes in hospitalized older adults discharged to skilled nursing facilities. Journal of American Geriatrics Society, 64(4), 715-722. doi:10.1111/jgs.14035
Bello-Chavolla, O. Y., Aguilar-Salinas, C. A., & Avila-Funes, J. A. (2017). Geriatric syndromes and not cardiovascular risk factors are associated with cognitive impairment among mexican community-dwelling elderly with type 2 diabetes. Revista de investigacion clinica, 69(3), 166-172.
Bisurgi, G., Caroleo, S., Pezzi, M., Vero, R., Verre, M., & Amantea, B. (2010). Obesity and outcomes in the ICU: an observational study. La Clinica Terapeutica, 161(6), 505-509.
Brorsson, B., & Asberg, K. H. (1984). Katz index of independence in ADL. Reliability and validity in short-term care. Scandinavian Journal of Rehabilitation Medicine, 16(3), 125-132.
Brown-Oʼhara, T. (2013). Geriatric syndromes and their implications for nursing. Nursing, 43(1), 1-3. doi:10.1097/01.nurse.000423097.95416.50
Brown, C. J., Redden, D. T., Flood, K. L., & Allman, R. M. (2009). The underrecognized epidemic of low mobility during hospitalization of older adults. Journal of American Geriatrics Society, 57(9), 1660-1665. doi:10.1111/j.1532-5415.2009.02393.x
Brummel, N. E., Balas, M. C., Morandi, A., Ferrante, L. E., Gill, T. M., & Ely, E. W. (2015). Understanding and reducing disability in older adults following critical illness. Critical Care Medicine, 43(6), 1265-1275. doi:10.1097/ccm.0000000000000924
Callen, B. L., Mahoney, J. E., Grieves, C. B., Wells, T. J., & Enloe, M. (2004). Frequency of hallway ambulation by hospitalized older adults on medical units of an academic hospital. Geriatric Nursing, 25(4), 212-217. doi:10.1016/j.gerinurse.2004.06.016
Caplan, G. A., Williams, A. J., Daly, B., & Abraham, K. (2004). A randomized, controlled trial of comprehensive geriatric assessment and multidisciplinary intervention after discharge of elderly from the emergency department—the DEED II study. Journal of the American Geriatrics Society, 52(9), 1417-1423. doi:10.1111/j.1532-5415.2004.52401.x
Chang, H. H., Tsai, S. L., Chen, C. Y., & Liu, W. J. (2010). Outcomes of hospitalized elderly patients with geriatric syndrome: report of a community hospital reform plan in Taiwan. Archives of Gerontology and Geriatrics, 50(1), S30-33. doi:10.1016/S0167-4943(10)70009-1.
Charlson, M., Szatrowski, T. P., Peterson, J., & Gold, J. (1994). Validation of a combined comorbidity index. Journal of Clinical Epidemiololy, 47(11), 1245–1251. doi:http://dx.doi.org/10.1016/0895-4356(94)90129-5
Charlson, M. E., Pompei, P., Ales, K. L., & MacKenzie, C. R. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. Journal of Chronic Diseases, 40(5), 373-383.
Chen, C. C., Yen, C. J., Dai, Y. T., Wang, C., & Huang, G. H. (2011). Prevalence of geriatric conditions: a hospital-wide survey of 455 geriatric inpatients in a tertiary medical center. Archives of Gerontology and Geriacrics, 53, 46-50. doi: 10.1016/j.archger.2010.06.003
Chen, C. H., Dai, Y. T., Yen, C. J., Huang, G. H., & Wang, C. (2010). Shared risk factors for distinct geriatric syndromes in older Taiwanese inpatients. Nursing Reserch, 59, 340-347. Doi: 10.1097/NNR.0b013e3181eb31f6
Cheng, K. C., Lu, C. L., Chung, Y. C., Huang, M. C., Shen, H. N., Chen, H. M., & Zhang, H. (2014). ICU service in Taiwan. Journal of Intensive care, 2(8). doi:10.1186/2052-0492-2-8
Chou, M. Y., Chou, S. L., Tzeng, Y. M., Chen, L. K., Yen, D. H. T., Hwang, S. J., Huang, C. I., Tu, M. S. & Lee, C. H. (2009). Emergency department (ED) utilization and outcome of oldest old men presenting with geriatric syndromes in a veterans care home in Taiwan. Archives of Gerontology and Geriatrics, 49, S32-S36. doi:10.1016/S0167-4943(09)70010-X
Ciesla, J. R., Shi, L., Stoskopf, C. H., & Samuels, M. E. (1993). Reliability of Katz's Activities of Daily Living Scale when used in telephone interviews. Evaluation & the Health Professions, 16(2), 190-203. doi:10.1177/016327879301600204
Cigolle, C. T., Langa, K. M., Kabeto, M. U., Tian, Z., & Blaum, C. S. (2007). Geriatric conditions and disability: the Health and Retirement Study. Annales of Internal Medicine, 147, 156-164.
Conti, M., Merlani, P., & Ricou, B. (2012). Prognosis and quality of life of elderly patients after intensive care. The European Journal of Medical Science, 142, W13671. doi:10.4414/smw.2012.13671.
Cook, K., & Sobeski, L. M. (2013). Urinary incontinence in the older adult. PSAP. 3-20.
Cornette, P., Swine, C., Malhomme, B., Gillet, J., Meert, P., & D'Hoore, W. (2006). Early evaluation of the risk of functional decline following hospitalization of older patients: development of a predictive tool. The European Journal of Public Health, 16(2), 203-208. doi:10.1093/eurpub/cki054
Covinsky, K. E., Palmer, R. M., Fortinsky, R. H., Counsell, S. R., Stewart, A. L., Kresevic, D., Burant, C. J., & Landefeld, C. S. (2003). Loss of Independence in Activities of Daily living in older adults hospitalized with medical illnesses: increased vulnerability with age. Journal of the American Geriatrics Society, 51(4), 451-458.
Creditor, M. C. (1993). Hazards of hospitalization of the elderly. Annals of Internal Medicine, 118(3), 219-223.
Dagli, R. J., & Sharma, A. (2014). Polypharmacy: a global risk factor for elderly people. Journal of International Oral Health:JIOH, 6(6), i-ii.
Davidson, J. E., Harvey, M. A., Schuller, J., & Black, G. (2013). Post-intensive care syndrome: What it is and how to help prevent it. American Nurse Today, 8(5), 32-38.
Dewey, M. E., Parker, C. J., & the Analysis Group of the MRC-CFA Study. (2000). Survey into health problems of elderly people: a comparison of self-report with proxy information. International Journal of Epidemiology, 29(4), 684-697.
Ferrante, L. E., Pisani, M. A., Murphy, T. E., Gahbauer, E. A., Leo-Summers, L. S., & Gill, T. M. (2015). Functional Trajectories Among Older Persons Before and After Critical Illness. JAMA internal medicine, 175(4), 523-529. doi:10.1001/jamainternmed.2014.7889
Ferrante, L. E., Pisani, M. A., Murphy, T. E., Gahbauer, E. A., Leo-Summers, L. S., & Gill, T. M. (2016). Factors associated with functional recovery among older intensive care unit survivors. American Journal of Respiratory and Critical Care Medicine, 194(3), 299-307. doi:10.1164/rccm.201506-1256OC
Flacker, J. M. (2003). What is a geriatric syndrome anyway? Journal of the American Geriatrics Society, 51(4), 574-576.
Flood, K. L., Carroll, M. B., Le, C. V., Ball, L., Esker, D. A., & Carr, D. B. (2006). Geriatric syndromes in elderly patients admitted to an oncology-acute care for elders unit. Journal of clinical oncology, 24(15), 2298–2303. doi:10.1200/JCO.2005.02.8514
Flood, K. L., Rohlfing, A., Le, C. V., Carr, D. B., & Rich, M. W. (2007). Geriatric syndromes in elderly patients admitted to an inpatient cardiology ward. Journal of Hospital Medicine, 2(6), 394-400. doi:10.1002/jhm.234
Fong, T. G., Tulebaev, S. R., & Inouye, S. H. (2009). Characteristics associated with delirium in older patients in a medical intensive care unit. Nature Reviews Neurology, 5(4), 210-220. doi:10.1038/nrneurol.2009.24
Frantz, R. A. (2004). Evidence-based protocol: prevention of pressure ulcers. Journal of Gerontological Nursing, 30, 4-11.
Fried, L. P., Storer, D. J., King, D. E., & Lodder, F. (1991). Diagnosis of illness presentation in the elderly. Journal of the American Geriatrics Society, 39, 117-123.
Fuchs, L., Chronaki, C. E., Park, S., Novack, V., Baumfeld, Y., Scott, D., McLennan, S. Talmor, D., & Celi, L. (2012). ICU admission characteristics and mortality rates among elderly and very elderly patients. Intensive Care Medience, 38(10), 1654-1661. doi:10.1007/s00134-012-2629-6
Fuchs, L., Novack, V., McLennan, S., Celi, L. A., Baumfeld, Y., Park, S., Howell, M. D., & Talmor, D. S. (2014). Trends in severity of illness on ICU admission and mortality among the elderly. PLOS ONE, 9(4), e93234. doi:10.1371/journal.pone.0093234
Gorina, Y., Schappert, S., Bercovitz, A., Elgaddal, N., & Kramarow, E. (2014). Prevalence of incontinence among older americans. Vital and Health Statistics 3(36), 1-33.
Haas, J. S., Teixeira, C., Cabral, C. R., Fleig, A. H., Freitas, A. P., Treptow, E. C., Rizzotto, M. I., Machado, A. S., Balzano, P. C., Hetzel, M. P., Dallegrave, D. M., Oliveira, R. P., Savi, A., & Vieira, S. R. (2013). Factors influencing physical functional status in intensive care unit survivors two years after discharge. BMJ Anesthesiology, 18(13), 11. doi:10.1186/1471-2253-13-11
Hajjar, E. R., Cafiero, A. C., & Hanlon, J. T. (2007). Polypharmacy in elderly patients The American Journal of Geriatric Pharmacotherapy, 5(4), 345-351. doi:10,1016/j,amj opharm,2007,12,002
Hennessy, D., Juzwishin, K., Yergens, D., Noseworthy, T., & Doig, C. (2005). Outcomes of elderly survivors of intensive care: a review of the literature. Chest, 127(5), 1764-1774.
Herdman, T. H. (2009). NANDA International Nursing Diagnoses: Definitions & Classification, 2009-2011: Wiley-Blackwell.
Hill, A. D., Fowler, R. A., Pinto, R., Herridge, M. S., Cuthbertson, B. H., & Scales, D. C. (2016). Long-term outcomes and healthcare utilization following critical illness - a population-based study. Critical Care, 20(1), 76. doi:10.1186/s13054-016-1248-y
Huang, H. T., Chang, C. M., Liu, L. F., Lin, H. S., & Chen, C. H. (2013). Trajectories and predictors of functional decline of hospitalised older patients. Jounal of Clinical Nursing, 22, 1322-1331. doi:10.1111/jocn.12055
Huisingh-Scheetz, M., Kocherginsky, M., Schumm, P. L., Engelman, M., McClintock, M. K., Dale, W., Magett, E., Rush, P. & Waite, L. (2014). Geriatric syndromes and functional status in NSHAP: rationale, measurement, and preliminary findings. The Journals of Gerontology: Series B, 69 (2), S177-S190. doi:10.1093/geronb/gbu091
Inouye, S. K., Studenski, S., Tinetti, M. E., & Kuchel, G. A. (2007). Geriatric syndromes: clinical, research, and policy implications of a core geriatric concept. Journal of the American Geriatrics Society, 55(5), 780-791. doi:10.1111/j.1532-5415.2007.01156.x
Kane, R. L., Shamliyan, T., Talley, K., & Pacala, J. (2012). The association between geriatric syndromes and survival. Journal of the American Geriatrics Society, 60(5), 896-904. doi:10.1111/j.1532-5415.2012.03942.x
Kane, S. P. (July 1, 2017). Sample Size Calculator. Retrieved from ClinCalc: http://clincalc.com/Stats/SampleSize.aspx
Katz, S., Downs, T. D., VCash, H. R., & Grotz, R. C. (1970). Progress in development of the Index of ADL. Gerontologist, 10(20-30). doi:https://doi.org/10.1093/geront/10.1_Part_1.20
Katz, S., Ford, A. B., Moskowitz, R. W., Jackson, B. A., & Jaffe, M. W. (1963). Studies of illness in the aged. The Index of ADL: A standarized measure of biological and psychological function. JAMA, Sep 21(185), 914-919. doi:10.1001/jama.1963.03060120024016
Knaus, W. A., Draper, E. A., Wagner, D. P., & Zimmerman, J. E. (1985). APACHE II: a severity of disease classification system. Critical Care Medicine, 13(10), 818-829.
Koroukian, S. M., Schiltz, N., Warner, D. F., Sun, J., Bakaki, P. M., Smyth, K. A., Stange, K. C., & Given, C. W. (2016). Combinations of chronic conditions, functional limitations, and geriatric syndromes that predict health outcomes. Journal of General Internal Medicine, 31(6), 630-637. doi:10.1007/s11606-016-3590-9
Kwan, D., & Farrell, B. (2013). Polypharmacy: optimizing medication use in elderly patients. Pharmacy Practice, 29(2), 20-21.
Lakhan, P., Jones, M., Wilson, A., Courtney, M., Hirdes, J., & Gray, L. C. (2011). A prospective cohort study of geriatric syndromes among older medical patients admitted to acute care hospitals. The American Geriatrics Society, 59, 2001-2008. doi:10.1111/j.1532-5415.2011.03663.x.
Lee, P. G., Cigolle, C., & Blaum, C. (2009). The co‐occurrence of chronic diseases and geriatric syndromes: the health and retirement study. Journal of the American Geriatrics Society, 57(3), 511-516. doi: 10.1111/j.1532-5415.2008.02150.x.
Leung, F. W., & Schnelle, J. F. (2008). Urinary and Fecal Incontinence in Nursing Home Residents. Gastroenterology Clinics of North America, 37(3), 697-707. doi:https://doi.org/10.1016/j.gtc.2008.06.005
Levy, C. R., Zargoush, M., Williams, A. E., Williams, A. R., Giang, P., Wojtusiak, J., Kheirbek, R. E. & Alemi, F. (2016). Sequence of functional loss and recovery in nursing homes. Gerontologist, 56(1), 52-61. doi:10.1093/geront/gnv099
Magaziner, J., Zimmerman, S. I., Gruber-Baldini, A. L., Hebel, J. R., & Fox, K. M. (1997). Proxy reporting in five areas of functional status-comparison with self-reports and observations of performance. American Journal of Epidemiology, 146(5), 418-428.
McRae, P. J., Peel, N. M., Walker, P. J., de Looze, J. W. M., & Mudge, A. M. (2014). Geriatric syndromes in individuals admitted to vascular and urology surgical units. Journal of the American Geriatrics Society, 62(6), 1105-1109. doi:10.1111/jgs.12827
Moon, K. J., Piao, J., Jin, Y., & Lee, S. M. (2014). Is delirium an unrecognized threat to patient safety in Korean intensive care units? . Journal of Nursing Care Quality, 29(1), 91-98. doi:10.1097/NCQ.0b013e31829f828b
Mudge, A. M., O'Rourke, P., & Denaro, C. P. (2010). Timing and risk factors for functional changes associated with medical hospitalization in older patients. Journal of Gerontology, 65(8), 866-872. doi: 10.1093/gerona/glq069.
Mukhopadhyay, A., Tai, B. C., See, K. C., Ng, W. Y., Lim, T. K., Onsiong, S., Ee, S., Chua, M. J., Lee, P. R., Loh, M. L., & Phua, J. (2014). Risk factors for hospital and long-term mortality of critically ill elderly patients admitted to an intensive care unit. BioMed Research International, ID 960575. doi:10.1155/2014/960575
Olde Rikkert, M. G. M., Rigaud, A. S., van Hoeyweghen, R. J., & de Graaf, J. (2003). Geriatric syndromes: medical misnomer or progress in geriatrics. The Netherlands journal of medicine, 61(3), 83-87.
Peterson, J. F., Pun, B. T., Dittus, R. S., Thomason, J. W. W., Jackson, J. C., Shintani, A. K., & Ely, E. W. (2006). Delirium and its motoric subtypes: a study of 614 critically ill patients. Journal of the American Geriatrics Society, 54(3), 479-484. doi: 10.1111/j.1532-5415.2005.00621.x
Piotrowicz, K., Skalska, A., Klich-Rączka, A., & Grodzicki, T. (2013). The prevalence of geriatric syndromes among the elderly population of PolSenior Project. Paper presented at the 9th Congress of European Geriatric Medicine, Venice, Italy. http://dx.doi.org/10.1016/j.eurger.2013.07.265
Rao, S. S., & American College of Gastroenterology Practice Parameters Committee. (2004). Diagnosis and management of fecal incontinence. American College of Gastroenterology Practice Parameters Committee. The American Journal of Gastroenterology, 99(8), 1585-1604. doi: 10.1111/j.1572-0241.2004.40105.x
Ray, D. E., Matchett, S. C., Baker, K., Wasser, T., & Young, M. J. (2005). The effect of body mass index on patient outcomes in a medical ICU. Chest, 127(6), 2125-2131. doi:10.1378/chest.127.6.2125
Rosner, B. (2011). Fundamentals of biostatistics: Seventh edition. Boston : Brooks/Cole, Cengage Learning.
Rosso, A. L., Eaton, C. B., Wallace, R., Gold, R., Stefanick, M. L., Ockene, J. K., Curb, J. D., & Michael, Y. L. (2013). Geriatric syndromes and incident disability in older women: results from the women's health initiative observational study. Journal of the American Geriatrics Society, 61(3), 371-379. doi:10.1111/jgs.12147
Saka, B., Kaya, O., Ozturk, G. B., Erten, N., & Karan, M. A. (2010). Malnutrition in the elderly and its relationship with other geriatric syndromes. Clinical Nutrition, 29(6), 745-748. doi:10.1016/j.clnu.2010.04.006
Sánchez, E., Vidán, M. T., Serra, J. A., Fernández-Avilés, F., & Bueno, H. (2011). Prevalence of geriatric syndromes and impact on clinical and functional outcomes in older patients with acute cardiac diseases. Heart, 97(19), 1602-1606. doi:10.1136/hrt.2011.227504.
Schandl, A., Bottai, M., Holdar, U., Hellgren, E., & Sackey, P. (2014). Early prediction of new-onset physical disability after intensive care unit stay: a preliminary instrument. Critical Care, 18(4), 455. doi:10.1186/s13054-014-0455-7.
Shah, B. M. (2012). Polypharmacy, adverse drug reactions, and geriatric syndromes. Clinics in Geriatric Medicine, 28(2), 173-186. doi: 10.1016/j.cger.2012.01.002.
Soundararajan, A. S., Mathew, A. C., Nanjuudan, R., & Ganesh, A. (2017). Association of geriatric syndromes with malnutrition among elderly. International Journal of Medical Research & Health Sciences, 6(5), 14-18.
Thom, D. H., Haan, M. N., & Van Den Eedenm, S. K. (1997). Medically recognized urinary incontinence and risks of hospitalization, nursing home admission and mortality. Age and Ageing, 26, 367-374.
Tinetti, M. E., Inouye, S. K., Gill, T. M., & Doucette, J. T. (1995). Shared risk factors for falls, incontinence, and functional dependence. Unifying the approach to geriatric syndromes. JAMA, 273(17), 1348-1353.
Tripathy, S., Mishra, J. C., & Dash, S. C. (2014). Critically ill elderly patients in a developing world-mortality and functional outcome at 1 year: a prospective single-center study. Journal of Critical Care, 29(3), 474.e7-13. doi:10.1016/j.jcrc.2014.01.007
Villa, P., Pintado, M. C., Luján, J., González-García, N., Trascasa, M., Molina, R., Cambronero, J. A., & de Pablo, R. (2016). Functional status and quality of life in elderly intensive care unit survivors. Journal of the American Geriatrics Society, Mar; 64(3), 536-542. doi:10.1111/jgs.14031.
Wang, S. Y., Shamliyan, T. A., Talley, K. M. C., Ramakrishnan, R., & Kane, R. L. (2013). Not just specific diseases: systematic review of the association of geriatric syndromes with hospitalization or nursing home admission. Archives of Gerontology and Geriatrics, 57(1), 16-26. doi:10.1016/j.archger.2013.03.007
Wass, S., Webster, P. J., & Nair, B. R. (2008). Delirium in the elderly: a review. Oman Medical Journal, 23(3), 150-157.
Webber, S. C., Porter, M. M., & Menec, V. H. (2010). Mobility in older adults: a comprehensive framework. The Gerontologist, 50(4), 443-450. doi:10.1093/geront/gnq013
WHO. (2012). Fall. Retrieved from http://www.who.int/mediacentre/factsheets/fs344/en/
Won, C. W., Yoo, H. J., Yu, S. H., Kim, C. O., Dumlao, L. C. I., Dewiasty, E., Rowland, J., Vhang, H. H., Wang, J., Akishita, M., Tank, T. L., Lum, C., & Prakash, O. (2013). Lists of geriatric syndromes in the Asian-Pacific geriatric societies. European Geriatric Medicine, 4(5), 335-338. doi: 10.1016/j.eurger.2013.07.005
Wu, C. H., Chang, C. I., & Chen, C. Y. (2012). Overview of studies related to geriatric syndrome in Taiwan. Journal of Clinical Gerontology and Geriatrics, 3(1), 14-20. doi:10.1016/j.jcgg.2011.05.002
Zarowitz, B. J. (2011). Polypharmacy: when is enough, enough? Geriatric Nursing, 32(6), 447-449. doi:10.1016/j.gerinurse.2011.09.004
Zisberg, A., Shadmi, E., Sinoff, G., Gur-Yaish, N., Srulovici, E., & Admi, H. (2011). Low mobility during hospitalization and functional decline in older adults. Journal of American Geriatrics Society, 59, 266-273. doi: 10.1111/j.1532-5415.2010.03276.x.
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