Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 303

There is considerable evidence that older people suffer a higher incidence of adverse events than their younger counterparts in the hospital. The landmark, international, adverse event studies described in Table 11.1 investigated the incidence and types of adverse events in hospital inpatients of all ages. This was achieved by a two‐stage retrospective case record review in the majority of cases. Table 11.1 also shows that if the results of these large studies are re‐analysed to consider specifically the effects of age on patterns and frequencies of adverse events, they all show that age is a risk factor for adverse events. However, when this relationship is examined more closely, it emerges that comorbidity, rather than age alone, appears to be responsible for this association. In addition to experiencing more adverse events, older people also suffer more serious consequences of adverse events in the majority of studies in terms of morbidity and mortality, increased dependence, increased hospital stay, and a greater chance of institutionalization;²⁸ again, this seems to be related to their physical vulnerability in terms of frailty and diminished physiological reserve. A recent meta‐analysis confirmed that the incidences of adverse events in the elderly varied in different studies, increasing to 60% if geriatric syndromes like falls and delirium were included.²⁹ Besides age, important causative factors were found to be comorbidity, clinical complexity, severity of illness, functional status, and poor quality of care. As might be expected, data from these studies show that older people in the hospital tend to experience different types of adverse events than their younger counterparts, such as falls, hospital‐acquired infections, and drug errors, rather than complications related to invasive procedures. In general, it seems that it is controversial as to whether adverse events are more preventable in elderly than in younger patients.