Prediction of Recovery, Dependence or Death in Elders Who Become Disabled During Hospitalization
Prediction of Recovery, Dependence or Death in Elders Who Become Disabled During Hospitalization
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DOI：
10.1007/s11606-012-2226-y
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发表时间：
2013-02-01
影响因子：
5.7
通讯作者：
Landefeld, C. Seth
中科院分区：
文献类型：
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作者：
Barnes, Deborah E.;Mehta, Kala M.;Landefeld, C. Seth
许多老年人在住院时对一项或多项日常生活活动（ADL：穿衣、洗澡、转移、进食、如厕）产生依赖，出院后的预后尚不清楚。制定一个预后指数来估计因 ADL 依赖事件出院的老年住院患者一年内康复、依赖或死亡的概率。回顾性队列研究。449 名 70 岁千分之一的成年人因急性疾病住院并因 ADL 依赖事件出院。潜在预测因素包括人口统计学（年龄、性别、种族、教育、婚姻状况）、功能测量（ADL依赖性、日常生活工具性活动[IADL]依赖性、步行能力）、慢性病（例如充血性心力衰竭、痴呆、癌症）、入院原因（例如神经系统、心血管）和实验室值（肌酐、白蛋白、血细胞比容）。使用多项逻辑回归来制定预后指数，用于估计一年内康复、残疾或死亡的概率。根据 c 统计量对每个结果的指数歧视进行评估。住院后一年内，36% 的患者康复，27% 的患者仍处于依赖状态，37% 的患者死亡。康复、依赖或死亡的关键预测因素是年龄、性别、入院前 2 周 IADL 依赖数量、出院时 ADL 依赖数量、痴呆、癌症、其他慢性病数量、入院原因和肌酐水平。最终的预后指数基于 c 统计量对所有三种结果具有良好到极好的区分度（康复：0.81，依赖性：0.72，死亡：0.78）。该指数准确估计了 70 岁或以上因住院后发生残疾而出院的成年人的康复、依赖性或死亡的概率。该工具在临床环境中可能有用，可指导护理讨论并为与出院后护理相关的决策提供信息。
Many older adults become dependent in one or more activities of daily living (ADLs: dressing, bathing, transferring, eating, toileting) when hospitalized, and their prognosis after discharge is unclear.To develop a prognostic index to estimate one-year probabilities of recovery, dependence or death in older hospitalized patients who are discharged with incident ADL dependence.Retrospective cohort study.449 adults aged a parts per thousand yen 70 years hospitalized for acute illness and discharged with incident ADL dependence.Potential predictors included demographics (age, sex, race, education, marital status), functional measures (ADL dependencies, instrumental activities of daily living [IADL] dependencies, walking ability), chronic conditions (e.g., congestive heart failure, dementia, cancer), reason for admission (e.g., neurologic, cardiovascular), and laboratory values (creatinine, albumin, hematocrit). Multinomial logistic regression was used to develop a prognostic index for estimating the probabilities of recovery, disability or death over 1 year. Discrimination of the index was assessed for each outcome based on the c statistic.During the year following hospitalization, 36 % of patients recovered, 27 % remained dependent and 37 % died. Key predictors of recovery, dependence or death were age, sex, number of IADL dependencies 2 weeks prior to admission, number of ADL dependencies at discharge, dementia, cancer, number of other chronic conditions, reason for admission, and creatinine levels. The final prognostic index had good to excellent discrimination for all three outcomes based on the c statistic (recovery: 0.81, dependence: 0.72, death: 0.78).This index accurately estimated the probabilities of recovery, dependence or death in adults aged 70 years or older who were discharged with incident disability following hospitalization. This tool may be useful in clinical settings to guide care discussions and inform decision-making related to post-hospitalization care.