Trajectories of quality of life in older persons with advanced illness.
Trajectories of quality of life in older persons with advanced illness.
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患有晚期疾病的老年人的生活质量轨迹。
DOI：
10.1111/j.1532-5415.2010.02817.x
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发表时间：
2010
影响因子：
6.3
通讯作者：
Fried,TerriR
中科院分区：
文献类型：
--
作者：
Solomon,Rachel;Kirwin,Paul;VanNess,PeterH;O'Leary,John;Fried,TerriR
目的：评估晚期疾病老年患者的生活质量主观评分。设计：在1999年12月至2002年12月期间进行的观察性队列研究，至少每4个月进行一次访谈，为期两年。收集：参与者的家。对象：185名60岁及以上的晚期癌症、心力衰竭或慢性阻塞性肺病患者。测量：参与者被问及如何评价他们的总体生活质量。结果：在死亡的参与者中，46%的人在最后一次访问时报告良好或最好的生活质量，21%的人报告从倒数第二次访问到最后一次访问的生活质量有所改善，39%的人报告没有变化。49%的参与者报告他们的生活质量轨迹有两次或两次以上的变化(例如，生活质量改善后下降)。多因素纵向回归分析显示，日常生活活动能力较强(调整后优势比(AOR)=0.85，95%可信区间(CI)=0.75-0.95)和情绪低落(AOR=0.42，95%CI=0.27-0.66)与较差的生存质量有关，而自我评价较好的健康(AOR=4.79，95%CI=2.99-7.69)和离教堂更近(AOR=1.99，95%CI=1.17-3.39)与较好的生活质量有关。结论：虽然生活质量下降不是疾病进展的必然结果，个人对QOL的评分随着时间的推移而变化很大，这表明暂时性因素可能会影响主观QOL。功能状态、抑郁和与宗教社区的联系是影响生活质量的共同决定因素。
OBJECTIVES:To examine subjective ratings of quality of life (QoL) in older adults with advanced illness.DESIGN:Observational cohort study with interviews at least every 4 months for up to 2 years conducted between December 1999 and December 2002.SETTING:Participants' homes.PARTICIPANTS:One hundred eighty‐five community‐dwelling individuals aged 60 and older with advanced cancer, heart failure, or chronic obstructive pulmonary disease.MEASUREMENTS:Participants were asked how they would rate their overall QoL.RESULTS:Of participants who died, 46% reported good or best possible QoL at their final interview, 21% reported improvement in QoL from their penultimate to final interview, and 39% reported no change. Forty‐nine percent of participants reported two or more changes in the direction of their QoL trajectories (e.g., QoL improved then declined). As measured over time in a multivariable longitudinal regression analysis, greater activity of daily living disability (adjusted odds ratio (AOR)=0.85, 95% confidence interval (CI)=0.75–0.95) and depressed mood (AOR=0.42, 95%CI=0.27–0.66) were associated with poorer QoL, whereas better self‐rated health (AOR=4.79, 95% CI=2.99–7.69) and having grown closer to one's church (AOR=1.99, 95% CI=1.17–3.39) were associated with better QoL.CONCLUSION:Although declining QoL is not an inevitable consequence of advancing illness, individuals' ratings of QoL are highly variable over time, suggesting that temporary factors may influence subjective QoL. Functional status, depression, and connection to one's religious community are shared determinants of QoL.