Functional outcomes of acute medical illness and hospitalization in older persons
Functional outcomes of acute medical illness and hospitalization in older persons
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DOI：
10.1001/archinte.156.6.645
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发表时间：
1996-03-25
影响因子：
--
通讯作者：
Winograd, CH
中科院分区：
文献类型：
--
作者：
Sager, MA;Franke, T;Winograd, CH
背景资料：老年患者的短期住院往往与功能丧失有关，这可能导致需要出院后援助和长期住院。由于对住院治疗的不良结局知之甚少，因此进行本研究的目的是（1）确定因医学疾病住院的大型老年人队列的出院和出院后3个月的功能结局，（2）确定患者出院后能够恢复到入院前功能水平的程度，（3）确定与急性疾病和住院相关的残疾风险增加相关的患者因素。共有1279名70岁及以上的社区居民因急性内科疾病住院，前瞻性队列研究。出院时获得的功能测量值（日常生活活动）和出院后3个月（日常生活活动和工具性日常生活活动）与入院前的基线功能水平进行比较，以记录功能的丧失和恢复。出院时，与入院前基线相比，59%的研究人群报告日常生活活动无变化，10%改善，31%下降。在3个月随访时，与入院前基线相比，51%的原始研究人群（出院后数据可用，n=1206）死亡（11%）或报告新的日常生活活动和/或日常生活工具活动障碍（40%）。在幸存者中，19%的人报告了新的日常生活活动，40%的人在随访时报告了新的工具性日常生活活动障碍。3个月的结果是指标住院期间的功能丧失，许多患者出院后未能恢复，以及新的出院后残疾的发展。患者在随访中不良功能结局的风险最大的是老年人，入院前工具性日常生活活动障碍和入院时较低的精神状态评分，并已rehospital.Conclusions：本研究记录了急性内科疾病住院后功能下降的高发病率。虽然这些发现有几个潜在的解释，这项研究表明，有必要重新审视目前的住院和出院后的做法，可能会影响老年患者的功能。
Background: Short-stay hospitalization in older patients is frequently associated with a loss of function, which can lead to a need for postdischarge assistance and longer-term institutionalization. Because little is known about this adverse outcome of hospitalization, this study was conducted to (1) determine the discharge and 3-month postdischarge functional outcomes for a large cohort of older persons hospitalized for medical illness, (2) determine the extent to which patients were able to recover to preadmission levels of functioning after hospital discharge, and (3) identify the patient factors associated with an increased risk of developing disability associated with acute illness and hospitalization.Methods: A total of 1279 community-dwelling patients, aged 70 rears and older, hospitalized for acute medical illness were enrolled in this multicenter, prospective cohort study. Functional measurements obtained at discharge (Activities of Daily Living) and at 3 months after discharge (Activities of Daily Living and Instrumental Activities of Daily Living) were compared with a preadmission baseline level of functioning to document loss and recovery of functioning.Results: At discharge, 59% of the study population reported no-change, 10% improved, and 31% declined in Activities of Daily Living when compared with the preadmission baseline. At the 3-month follow-up, 51% of the original study population, for whom postdischarge data were available (n=1206),were found to have died (11%) or to report new Activities of Daily Living and/or Instrumental Activities of Daily Living disabilities (40%) when compared with the preadmission baseline. Among survivors, 19% reported a new Activities of Daily Living and 40% reported a new Instrumental Activities of Daily Living disability at follow-up. The 3-month outcomes were the result of the loss of function during the index hospitalization, the failure of many patients to recover after discharge, and the development of new postdischarge disabilities. Patients at greatest risk of adverse functional outcomes at follow-up were older, had preadmission Instrumental Activities of Daily Living disabilities and lower mental status scores on admission, and had been rehospitalized.Conclusions: This study documents a high incidence of functional decline after hospitalization for acute medical illness. Although there are several potential explanations for these findings, this study suggests a need to reexamine current inpatient and postdischarge practices that might influence the functioning of older patients.