Comorbidity and 1-year mortality risks in nursing home residents
Comorbidity and 1-year mortality risks in nursing home residents
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DOI：
10.1111/j.1532-5415.2005.53216.x
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发表时间：
2005-04-01
影响因子：
6.3
通讯作者：
Ribbe, MW
中科院分区：
文献类型：
--
作者：
van Dijk, PTM;Mehr, DR;Ribbe, MW
目的：研究慢性病和疾病组合对疗养院居民1年死亡率的影响。设计：回顾性队列研究，使用电子提交的最小数据集（MDS）信息和密苏里州死亡证明数据。设置：密苏里州的522家疗养院。参与者：43510名疗养院居民，1999年进行了完整的MDS评估。测量：从1999年第一次完整的MDS 2.0评估中获得的有关慢性疾病、年龄、性别和日常生活活动能力（ADL）的信息; 1999年第一次完整的MDS评估后1年内的死亡。结果：在调整年龄和性别后，8个变量可预测1年死亡率：七种慢性疾病（痴呆、癌症、心力衰竭、肾衰竭、肺气肿/慢性阻塞性肺病、糖尿病和贫血）和包含年龄和癌症的交互变量。增加疾病组合的术语（例如，糖尿病和心力衰竭）并不能提高生存预测。当也有调整ADL性能测量使用MDS-ADL简表，痴呆和贫血不包括在内，因为他们没有以上的其他variable.CONCLUSION：几种慢性疾病的预后价值与1年的死亡率在制度化的老年人调整后的ADL性能，年龄和性别。缺乏疾病组合对死亡率产生协同效应的证据。
OBJECTIVES: To investigate the effect of chronic diseases and disease combinations on 1-year mortality in nursing home residents.DESIGN: Retrospective cohort study using electronically submitted Minimum Data Set (MDS) information and Missouri death certificate data.SETTING: Five hundred twenty-two nursing homes in Missouri.PARTICIPANTS: Forty-three thousand five hundred ten nursing home residents with a full MDS assessment in 1999.MEASUREMENTS: Information about chronic diseases, age, sex, and performance in activities of daily living (ADLs) available from the first full MDS 2.0 assessment in 1999; death within 1 year after the first full MDS-assessment in 1999.RESULTS: After adjustment for age and sex, eight variables were predictive for 1-year mortality: seven chronic diseases (dementia, cancer, heart failure, renal failure, emphysema/chronic obstructive pulmonary disease, diabetes mellitus, and anemia) and an interaction variable containing age and cancer. Adding terms for disease combinations (e.g., diabetes mellitus and heart failure) did not enhance survival prediction. When there was also adjustment for ADL performance as measured using the MDS-ADL Short Form, dementia and anemia were not included, because they had no prognostic value above that of the other variables.CONCLUSION: Several chronic diseases were associated with 1-year mortality in the institutionalized elderly after adjustment for ADL performance, age, and sex. Evidence of a synergistic effect of disease combinations on mortality is lacking.