Association Between Physical Activity Levels in the Hospital Setting and Hospital-Acquired Functional Decline in Elderly Patients
Association Between Physical Activity Levels in the Hospital Setting and Hospital-Acquired Functional Decline in Elderly Patients
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DOI：
10.1001/jamanetworkopen.2019.20185
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发表时间：
2020-01-31
影响因子：
13.8
通讯作者：
Mean, Marie
中科院分区：
文献类型：
--
作者：
Tasheva, Plamena;Vollenweider, Peter;Mean, Marie
老年患者住院体力活动与住院获得性功能衰退之间的关系是什么？本队列研究纳入177例65岁及以上的患者，其中63例（35.6%）出现功能衰退；体力活动水平和功能衰退之间没有关联。能够回家的患者的体力活动水平明显高于那些住院的患者（多变量调整后的平均值，白天14毫克vs 12毫克，24小时11毫克vs 10毫克）。在本研究中，许多老年住院患者在出院时出现功能下降，较高的住院体力活动水平与住院呈负相关，但与功能下降无关。本队列研究评估了因急性内科疾病住院的老年患者的身体活动水平，并检查了医院环境中身体活动与功能衰退之间的关系。住院体育活动（PA）对老年患者预后的影响很少被评估。目的评估急性内科疾病住院老年患者的PA水平，并探讨PA水平与出院时功能衰退和其他临床结局之间的关系。设计、环境和参与者本单中心队列研究于2018年2月1日至11月30日在瑞士洛桑大学医院内科病房因急性内科疾病入院的65岁及以上患者中进行。分析了2019年1月1日至12月2日的数据。通过手腕加速度计评估白天和24小时的PA水平，并以毫克单位测量(mG; 1mg = 9.80665 x 10（-3) m/s(2)）。平均结果和测量功能下降（定义为修正Barthel指数>= 5点下降）、褥疮风险、住院时间（LOS）和无法返回家园。结果共纳入177例患者，其中男性106例（59.9%），中位年龄83岁（四分位间距74 ~ 87岁）。入院前使用助行器的患者平均（SD） PA水平较低（白天，12 [6]vs 15 [7] mG； 24小时，10 [3]vs 11 [5] mG），因功能衰退相关原因入院的患者（白天，12 [6]vs 14 [7] mG； 24小时，10 [4]vs 11 [4] mG），或接受物理治疗的患者（白天，12 [5]vs 15 [7] mG； 24小时，10 [4]vs 12 [5] mG）。出院时，63例患者出现功能下降（35.6%,95% CI, 25.6%-43.1%）， 78例患者出现褥疮风险（44.1%,95% CI, 36.6%-51.7%）， 82例患者无法回家（46.3%,95% CI, 38.8%-54.0%）。多变量分析后，发现PA水平与功能衰退之间没有关联（多变量调整平均[SE]，白天水平为13 [1]vs 13 [1] mG [P = .69]， 24小时PA水平为10 [1]vs 11 [1] mG [P = .45]）或LOS （Spearman秩相关，白天PA水平为-0.06 [P = .93]， 24小时PA水平为-0.01 [P = .52]）。有褥疮风险的患者的PA水平明显低于无风险的患者（多变量调整平均值[SE]，白天PA水平为12 [1]vs 15 [1] mG [P = 0.008]； 24小时PA水平为10 [1]vs 12 [1] mG [P = 0.01]）。能够回家的患者的PA水平明显高于住院患者（多变量调整平均值[SE]，白天PA水平14 [1]vs 12 [1] mG [P = .04]； 24小时PA水平11 [1]vs 10 [1] mG [P = .009]）。结论和相关性在本研究中，较低的住院日间和24小时PA水平与褥疮和出院后无法回家的风险相关。鉴于三分之一的老年患者存在医院获得性功能衰退，这些发现很重要。
Question What is the association between in-hospital physical activity and hospital-acquired functional decline in elderly patients? Findings This cohort study included 177 patients 65 years or older, of whom 63 (35.6%) presented with functional decline; no association was found between physical activity levels and functional decline. Patients able to return home had significantly higher physical activity levels than those institutionalized (multivariable-adjusted mean, 14 vs 12 mG for daytime levels and 11 vs 10 mG for 24-hour levels). Meaning In this study, many elderly hospitalized patients presented with functional decline on discharge, and higher in-hospital physical activity levels were inversely associated with institutionalization but were not associated with functional decline.This cohort study assesses physical activity levels among elderly patients hospitalized for acute medical illness and examines the association between physical activity in the hospital setting and functional decline.Importance The effects of in-hospital physical activity (PA) on outcomes among elderly patients has seldom been assessed. Objectives To assess PA levels among elderly patients hospitalized for acute medical illness and to examine the association between PA levels and functional decline and other clinical outcomes at discharge. Design, Setting, and Participants This monocentric cohort study was performed among patients 65 years or older who were admitted for acute medical illness to the internal medicine ward of Lausanne University Hospital, Lausanne, Switzerland, from February 1 through November 30, 2018. Data were analyzed from January 1 through December 2, 2019. Exposures Daytime and 24-hour PA levels assessed via wrist accelerometers and measured in millig units (mG; 1 mG = 9.80665 x 10(-3) m/s(2)). Mean Outcomes and Measures Functional decline (defined as a >= 5-point decrease in the modified Barthel Index), risk of bedsores, length of stay (LOS), and inability to return home. Results A total of 177 patients (106 [59.9%] men; median age, 83 [interquartile range, 74-87] years) were included. Lower mean (SD) PA levels were found in patients using walking aids before admission (daytime, 12 [5] vs 15 [7] mG; 24-hour, 10 [3] vs 11 [5] mG), those admitted for a reason associated with functional decline (daytime, 12 [6] vs 14 [7] mG; 24-hour, 10 [4] vs 11 [4] mG), or those prescribed physiotherapy (daytime, 12 [5] vs 15 [7] mG; 24-hour, 10 [4] vs 12 [5] mG). At discharge, functional decline was found in 63 patients (35.6%; 95% CI, 25.6%-43.1%), bedsore risk in 78 (44.1%; 95% CI, 36.6%-51.7%), and inability to return home in 82 (46.3%; 95% CI, 38.8%-54.0%). After multivariate analysis, no association was found between PA levels and functional decline (multivariable-adjusted mean [SE], 13 [1] vs 13 [1] mG for daytime levels [P = .69] and 10 [1] vs 11 [1] mG for 24-hour PA levels [P = .45]) or LOS (Spearman rank correlation, rho = -0.06 for daytime PA levels [P = .93] and -0.01 for 24-hour PA levels [P = .52]). Patients at risk of bedsores had significantly lower PA levels than those not at risk (multivariable-adjusted mean [SE], 12 [1] vs 15 [1] mG for daytime PA levels [P = .008]; 10 [1] vs 12 [1] mG for 24-hour PA levels [P = .01]). Patients able to return home had significantly higher PA levels than those institutionalized (multivariable-adjusted mean [SE], 14 [1] vs 12 [1] mG for daytime PA levels [P = .04]; 11 [1] vs 10 [1] mG for 24-hour PA levels [P = .009]). Conclusions and Relevance In this study, lower in-hospital daytime and 24-hour PA levels were associated with risk of bedsores and inability to return home on discharge. These findings are important given that one-third of elderly patients present with hospital-acquired functional decline.