Older patients' health-related quality of life around an episode of emergency illness
Older patients' health-related quality of life around an episode of emergency illness
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DOI：
10.1016/s0196-0644(99)70161-7
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发表时间：
1999-11-01
影响因子：
6.2
通讯作者：
Friedmann, PD
中科院分区：
文献类型：
--
作者：
Chin, MH;Jin, L;Friedmann, PD
研究目标：我们试图描述老年患者在急诊科就诊前后4个月内的健康相关生活质量，并找出与康复较差相关的因素。方法：我们前瞻性地研究了983名65岁或65岁以上的患者，他们在1995-1996年间到城市学术教育中心就诊。80%的患者是非裔美国人，63%是女性。主要结果是在急诊室就诊前1个月、就诊时间、2周和3个月的随访期采用Katz日常生活活动指数和修订后的医学结局研究健康调查问卷。结果：总体上，患者在疾病期间明显恶化，然后有所改善，但未达到基线水平。在调整人口和社会因素后，最一致的预测康复不良的因素是在基线的日常生活能力方面的更多缺陷，在日常任务中需要更多帮助的报告，增加Charlson合并症指数得分，以及需要初始调查的替代物。结论：急诊医生和初级保健医生应该考虑询问功能状态和家庭帮助的充分性，以及他们的急病老年患者的共病情况，以针对那些康复不良的最高风险的人。未来的工作需要测试干预措施，这些干预措施可能会改善这些脆弱患者与健康相关的生活质量。
Study objectives: We sought to describe older patients' health-related quality of life during a 4-month period surrounding a visit to the emergency department and to identify factors associated with less recovery.Methods: We prospectively studied 983 patients 65 years or older who presented to an urban academic ED in 1995 and 1996. Eighty percent of the patients were African American, and 63% were women. The primary outcome measures were the Katz Index of Activities of Daily Living and revised validated questions from the Medical Outcomes Study Health Survey at 1 month before the ED visit, the time of the ED visit, and 2-week and 3-month follow-up periods.Results: in general, patients worsened markedly during the illness and then improved, although not to baseline levels. After adjustment for demographic and social factors, the most consistently powerful predictors of poor recovery were more deficiencies in activities of daily living at baseline, reports of needing more help with everyday tasks, increasing Charlson Comorbidity index scores, and requiring a proxy for the initial survey.Conclusion: Emergency physicians and primary care physicians should consider inquiring about functional status and the adequacy of help at home in addition to comorbid conditions for their acutely ill older patients to target those at greatest risk for poor recovery. Future work needs to test interventions that may improve the health-related quality of life of these vulnerable patients.