Impact of blunted perception of dyspnea on medical care use and expenditure, and mortality in elderly people.
Impact of blunted perception of dyspnea on medical care use and expenditure, and mortality in elderly people.
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DOI：
10.3389/fphys.2012.00238
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发表时间：
2012
影响因子：
4
通讯作者：
Tsuji I
中科院分区：
文献类型：
--
作者：
Ebihara S;Niu K;Ebihara T;Kuriyama S;Hozawa A;Ohmori-Matsuda K;Nakaya N;Nagatomi R;Arai H;Kohzuki M;Tsuji I
呼吸困难是一种令人担忧的症状，每年有数百万患者就诊。对呼吸困难的感觉不佳可能合理地归因于不适当的低恐惧水平和对患者和医生的早期医疗治疗不足，导致随后的重症监护。本研究旨在评估社区居住长者呼吸困难的医疗服务使用、费用及死亡率。我们分析了2002年社区综合老年评估的基线数据。本文于2002年8月对479名肺功能正常的日本社区老年人进行了呼吸困难感知测试。呼吸时的呼吸困难感，线性吸气阻力分别为10、20和30 cmH2O/L/s，采用Borg量表进行评分。根据呼吸困难的感觉，我们将老年人分为四组，并通过与2002年8月至2008年3月国民健康保险受益人索赔历史档案的计算机链接，比较了所有住院、门诊就诊、费用和死亡情况。随着呼吸困难感知的减弱，患者住院天数和医疗费用显著增加，导致呼吸困难感知减弱的总医疗费用增加。以低知觉组为参照，中等知觉组全因死亡率的危险比为0.65 (95% CI 0.23 ~ 1.89)，高知觉组全因死亡率的危险比为0.31 (95% CI 0.10 ~ 0.97)，说明多因素校正后，呼吸困难知觉的钝化也显著增加了死亡率（p = 0.04）。在社区居住的老年人中，呼吸困难的感觉迟钝与住院、高额医疗费用和全因死亡率有关。这些发现为通过对老年人客观条件的仔细监测来预防严重疾病提供了合理的依据。
Dyspnea is an alarming symptom responsible for millions of patient visits each year. Poor perception of dyspnea might be reasonably attributed to an inappropriately low level of fear and inadequate earlier medical treatment for both patients and physicians, resulting in subsequent intensive care. This study was conducted to evaluate medical care use and cost, and mortality according to the perception of dyspnea in community-dwelling elderly people. We analyzed baseline data from a community-based Comprehensive Geriatric Assessment in 2002. The perception of dyspnea in 479 Japanese community-dwelling elderly people with normal lung function was measured in August 2002. The sensation of dyspnea during breathing with a linear inspiratory resistance of 10, 20, and 30 cmH2O/L/s was rated using the Borg scale. According to the perception of dyspnea, we divided the elderly into tertiles and compared all hospitalizations, out-patient visits, costs, and death through computerized linkage with National Health Insurance beneficiaries claims history files between August 2002 and March 2008. In-patient hospitalization days and medical care costs significantly increased with the blunted perception of dyspnea, resulting in an increase in total medical-costs with blunted perception of dyspnea. With low perception group as reference, the hazard ratios of all-cause mortality were 0.65 (95% CI 0.23–1.89) for intermediate perception group and 0.31 (0.10–0.97) for high perception group, indicating the mortality rate also significantly increased with the blunted perception of dyspnea after multivariates adjustment (p = 0.04). The blunted perception of dyspnea is related to hospitalization, large medical costs, and all-cause mortality in community-dwelling elderly people. These findings provide a rational for preventing serious illness with careful monitoring of objective conditions in the elderly.
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影响因子：
24.3
作者：
Barreiro, E;Gea, J;Milic-Emili, J
通讯作者：
Milic-Emili, J
影响因子：
3.5
作者：
Pickering, G;Jourdan, D;Dubray, C
通讯作者：
Dubray, C
影响因子：
5.4
作者：
Niu, K;Hozawa, A;Nagatomi, R
通讯作者：
Nagatomi, R
DOI：
10.1093/geronj/34.2.234
发表时间：
1979-01-01
期刊：
JOURNALS OF GERONTOLOGY
影响因子：
--
作者：
WALSH, DA;WILLIAMS, MV;HERTZOG, CK
通讯作者：
HERTZOG, CK
影响因子：
6
作者：
BOUCHE, P;CATTELIN, F;SIMUNEK, P
通讯作者：
SIMUNEK, P