THE TIMED “UP & GO” TEST AND MANUAL BUTTON SCORE ARE USEFUL PREDICTORS OF FUNCTIONAL DECLINE IN BASIC AND INSTRUMENTAL ADL IN COMMUNITY‐DWELLING OLDER PEOPLE
THE TIMED “UP & GO” TEST AND MANUAL BUTTON SCORE ARE USEFUL PREDICTORS OF FUNCTIONAL DECLINE IN BASIC AND INSTRUMENTAL ADL IN COMMUNITY‐DWELLING OLDER PEOPLE
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定时“UP & GO”测试和手动按钮评分是社区老年人基本和工具性 ADL 功能下降的有用预测指标
DOI：
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发表时间：
1999
影响因子：
6.3
通讯作者：
T. Ozawa
中科院分区：
文献类型：
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作者：
K. Okumiya;K. Matsubayashi;Tomoko Nakamura;M. Fujisawa;Y. Osaki;Yoshinori Doi;T. Ozawa
无法行走，26% 的人被限制或卧床不起。 43% 的人有记忆问题，71% 的人需要帮助来完成适应性任务。尽管只有 23% 的人独居，但 41% 的人的照顾者也受到限制。两个主要的健康问题是中风（15%）和癌症（17%）。进入项目后的中位随访时间为 2.5 年，中位住院时间 (LOS) 为 98 天。最终出院到疗养院的患者的中位 LOS 最长（183 天）。在总样本中，44% 的患者死亡 (n = 161)，其中 41 名患者在计划中死亡 (11%)，120 名患者在出院后死亡（中位死亡时间约为 3 个月）。患者被非排他地分为几个类别，以寻找与种族（非白人，n = 101）、年龄大于 75 岁（n = 168）、功能状态改善（n = 26）、重新入院计划（n = 63）、出院后死亡（n = 120）、少于 3 个月的 s:ay 长度（n = 175）和大于 % 个月的 LOS（n = 189）。除了“好转”和“出院后死亡”类别外，任何组别和总人口之间都没有显着差异。与总人口平均值相比，功能改善组的社会支持率相对较高（60% 已婚 vs 39%，P < .05；53% 与配偶同住 vs. 31%，P < .05），并且入住疗养院的比率较低（8% vs 28%，P < .05）。出院后死亡的患者的总 IADL 依赖率较低（57% vs 71%，P < .05），癌症发生率较高（25% vs 17%，P < .05），再入院率分别为 27% vs 17%（P < .05）。还使用出院状态考虑由结果确定的相互排斥类别：在计划中死亡（n = 41）、出院到疗养院（NH，n = 65）、出院到社区护理（n = 37）和出院到医院（n = 114）。已婚患者在该计划中死亡或出院至 NH 的比例很高（分别为 56% 和 52% vs 39%，P < .05）。出院至 NH 类别的患者中分居或离婚的患者较少（20% vs 32%，P <,.05），并且在计划期间死亡的患者与配偶同住的比例很高（49% vs 31%，P <.05）。从 HBPC 出院到社区的患者死亡率最低（27% vs 44%，P < .05），并且神经系统诊断较多（16% vs 6%，P < .05）。这些出院患者的 HBPC 再入院率较高（28% vs 17%，P < .05），穿衣和肠失禁困难较少（分别为 1% 和 3 % vs 6 和 9%，P < .05），且有中度至重度限制的护理人员比例较低（31% vs 41%，P < .05），但列出的没有护理人员的患者比例最高（34% vs 34%） 24%，P < .05)。 PAVAHCS HBPC 项目的选择过程选择了年龄较大、体弱的患者，这些患者死亡风险很高，而且其护理人员也往往受到限制。有社会支持（已婚或与配偶同住）的患者更有可能在家中死亡或延迟 NH 安置。很少有患者的功能状态得到改善，几乎三分之一从 HBPC 入院或最终死亡的患者再次入院。接受 PAVA HBPC 计划的患者中有近一半在中位 2.5 年随访期间死亡； 11% 的入院患者在该计划期间死亡；退出该计划后死亡的中位时间为 3 个月。
could not walk, and 26% were confined or bed-bound. Forty-three percent had memory problems, and 71 % needed help with adaptive tasks. Although only 23% lived alone, 41% had a caregiver with limitations as well. The two major health problems were stroke (15%) and cancer (17%). The median follow-up from program entry was 2.5 years, and the median length of stay (LOS) was 98 days. Median LOS was longest (183 days) in those patients eventually discharged to the nursing home. Of the total sample, 44% died (n = 161), with 41 patients dying in the program (11%) and 120 patients dying after discharge (median time to death approximately 3 months). Patients were nonexclusively divided into several categories to look for differences relating to ethnicity (non-white, n = 101), age greater than 75 (n = 168), improvement in functional status (n = 26), readmission to the program (n = 63) , death after discharge (n = 120), less than 3-month length of s:ay (n = 175), and greater than %month LOS (n = 189). There were no significant differences between any of the groups and the total population except in the “improved” and “died after discharge” categories. The functionally improved group had relatively high rates of social support compared with the mean for the total population (60% were married vs 39%, P < .05; 53% lived with a spouse vs. 31%, P < .05) and low admission rates to the nursing home (8% vs 28%, P < .05). The patients who died after discharge had lower rates of total IADL dependency (57% vs 71%, P < .05), higher rates of cancer (25% vs 17%, P < .05) and a 27% vs 17% readmission rate (P < .05). Mutually exclusive categories determined by outcome were also considered using discharge status: died in program (n = 41), discharged to a nursing home (NH, n = 65), discharged to community care (n = 37), and discharged to the hospital (n = 114). A high percentage of patients who were married died in the program or were discharged to a NH (56% and 52%, respectively vs 39%, P < .05). Fewer patients in the discharge to NH category were separated or divorced (20% vs 32%, P <,.05), and a high percentage of patients who died while in program lived with a spouse (49% vs 31%, P < .05). Patients discharged from HBPC to the community had the lowest mortality (27% vs 44%, P < .05) and had more neurological diagnoses (16% vs 6%, P < .05). Those patients discharged to the hospital had high readmission rates to HBPC (28% vs 17%, P < .05), less difficulty with dressing and bowel incontinence (1% and 3 % vs 6 and 9%, respectively, P < .05), and lower rates of caregivers with moderate to severe limitations (31% vs 41%, P < .05) but had the highest percentage of patients listed without a caregiver (34% vs 24%, P < .05). The selection process for the PAVAHCS HBPC program chose older, frail patients who were at high risk of dying and whose caregivers were often limited as well. Patients with social support (married or living with spouse) were more likely to be able to die at home or delay N H placement. Few patients improved their functional status, and almost onethird of the patients admitted to the hospital from HBPC or who eventually died were readmitted into HBPC. Nearly half of the patients admitted into the PAVA HBPC program died within a the median 2.5-year follow-up; 11 % of those admitted died while in the program; the median time to death after discharge from the program was 3 months.