Functional status before hospitalization in acutely ill older adults: Validity and clinical importance of retrospective reports
Functional status before hospitalization in acutely ill older adults: Validity and clinical importance of retrospective reports
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DOI：
10.1111/j.1532-5415.2000.tb03907.x
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发表时间：
2000-02-01
影响因子：
6.3
通讯作者：
Chren, MM
中科院分区：
文献类型：
--
作者：
Covinsky, KE;Palmer, RM;Chren, MM
目的：住院前患者功能状态的回顾性报告经常用于纵向研究和临床医生照顾住院患者。然而，这些报告的有效性尚未得到证实。我们的目的是检查的有效性的回顾性报告，通过测试假设的关系，这些措施将与其他临床measures，如果他们是valid.Design：一个前瞻性队列study.PARTICIPANTS和设置：共2877老年患者（平均年龄81，36%的妇女）住院的一般医疗服务在两家医院。1953年的主题，病人是主要的受访者，而924名受试者，代理人是主要responder.MEASUREMENTS：入院后不久，患者或代理人报告，无论是独立的五个日常生活活动（ADL）入院和基线入院前2周。结果指标包括报告的独立性，在每个ADL 3个月后住院和生存1 year.RESULTS：患者的回顾性报告，他们的ADL功能入院前2周有一个临床合理的关系与ADL功能在入院时，在独立的ADL入院患者很少报告，他们依赖于ADL入院前2周（范围2-6%）。代孕妈妈比患者更有可能报告入院时独立的患者在入院前2周就有依赖性（范围5-14%）。住院前ADL功能的回顾性报告证明了患者和替代者报告的预测有效性的强有力证据。例如，在入院时依赖洗澡的患者中，入院前2周被报告为独立的患者比入院前2周被报告为依赖的患者更有可能在住院后3个月独立（68% vs 20%，患者受访者P <0.001; 30% vs 5%，替代受访者P <0.001）。同样，在入院时依赖洗澡的患者中，入院前2周独立洗澡的患者住院后1年的生存率远高于入院前2周依赖洗澡的患者（76% vs 59%，P <0.001，患者应答者60% vs 45%，P <0.001，替代应答者）。其他四种ADL的结果相似。在一个逻辑回归模型中，控制了入院时报告的依赖性ADL的数量，入院前2周报告的依赖性ADL的数量与2例患者的1年死亡率显著相关，（比值比（OR）= 1.39/依赖性ADL，95%置信区间（CI）= 1.26-1.54）和替代结论：住院患者在住院前对自己进行日常生活能力的评估具有表面效度和预测效度。这些措施是重要的健康结果，如功能和生存的强有力的预测。特别是，在住院依赖于ADL功能的患者中，这些结果突出了在急性疾病发作前询问患者的功能状态的预后重要性。
OBJECTIVES: Retrospective reports of patients' functional status before hospital admission are often used in longitudinal studies and by clinicians caring for hospitalized patients. However, the validity of these reports has not been established. Our aim was to examine the validity of retrospective reports by testing hypotheses about the relationships these measures would have with other clinical measures if they were valid.DESIGN: A prospective cohort study.PARTICIPANTS AND SETTING: A total of 2877 older patients (mean age 81, 36% women) hospitalized on the general medical service at two hospitals. For 1953 of the subjects, the patient was the primary respondent, whereas for 924 subjects, a surrogate was the primary respondent.MEASUREMENTS: Shortly after hospital admission, patients or surrogates reported whether the patient was independent in each of five activities of daily living (ADLs) on admission and at baseline 2 weeks before admission. Outcome measures included reported independence in each ADL 3 months after the hospitalization and survival to 1 year.RESULTS: Patients' retrospective reports of their ADL function 2 weeks before admission had a clinically plausible relationship with ADL function at the time of admission, in that patients independent in an ADL on admission rarely reported they were dependent in that ADL 2 weeks before admission (range 2-6%). Surrogates were somewhat more likely than patients to report that patients independent on admission were dependent 2 weeks before admission (range 5-14%). Retrospective reports of prehospitalization ADL function demonstrated strong evidence of predictive validity for both patients' and surrogates' reports. For example, among patients dependent in bathing on admission, patients who were reported as independent 2 weeks before admission were much more likely than those reported as dependent 2 weeks before admission to be independent 3 months after hospitalization (68% vs 20%, P < .001 for patient respondents; 30% vs 5%, P < .001 for surrogate respondents). Similarly, among patients dependent in bathing on hospital admission, survival 1 year after hospitalization was much higher in patients who were independent in bathing 2 weeks before admission than patients who were dependent 2 weeks before admission (76% vs 59%, P < .001 for patient respondents 60% vs 45%, P < .001 for surrogate respondents). Results were similar for each of the other four ADLs. In a logistic regression model controlling fur the number of ADLs reported as dependent on admission, the number of ADLs reported as dependent 2 weeks before admission was significantly associated with 1-year mortality among both patient (odds ratio (OR) = 1.39 per dependent ADL, 95% confidence interval (CI) = 1.26-1.54) and surrogate (OR = 1.14, 95% CI = 1.06-1.24) respondents.CONCLUSIONS: Hospitalized patients' assessments of their ability to perform ADLs before their hospitalization have evidence of face and predictive validity. These measures are strong predictors of important health outcomes such as functioning and survival. In particular, among patients dependent in ADL function on hospital admission, these results highlight the prognostic importance of inquiring about the patient's functional status hc fore the onset of the acute illness.