Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: Increased vulnerability with age
Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: Increased vulnerability with age
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DOI：
10.1046/j.1532-5415.2003.51152.x
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发表时间：
2003-04-01
影响因子：
6.3
通讯作者：
Landefeld, CS
中科院分区：
文献类型：
--
作者：
Covinsky, KE;Palmer, RM;Landefeld, CS
目的：描述因内科疾病住院的老年人入院前后日常生活活动（ADL）功能的变化，并评估年龄对ADL功能丧失的影响。设计：前瞻性观察性研究。单位：两所医院的综合医务处。参与者：2,293例70岁及以上的患者（平均年龄80岁，64%女性，24%非白人）。测量方法：入院时，对患者或其代理人在入院前（基线）和入院时2周的5个adl（洗澡、穿衣、进食、转移和如厕）中的独立性进行访谈。出院时对受试者进行ADL功能访谈。结果测量包括基线和出院之间的功能下降，基线和入院之间以及入院和出院之间的功能变化。结果：35%的患者在基线和出院期间ADL功能下降。这包括23%的患者在基线和入院之间功能下降，在入院和出院之间未能恢复到基线功能，12%的患者在基线和入院之间没有下降，但在入院和出院之间下降。20%的患者在入院前病情有所下降，但在入院后恢复到出院前的水平。基线至出院ADL下降的频率随年龄变化显著（70-74岁、75-79岁、80-84岁、85-89岁和≥90岁患者分别为23%、28%、38%、50%和63%，P < 0.001）。校正潜在混杂因素后，年龄与住院前ADL下降无关(大于或等于90岁患者与70-74岁患者的比值比（OR) = 1.26, 95%可信区间(CI) = 0.88-1.82）。相比之下,与未能恢复ADL功能相关的年龄是在病人住院期间拒绝承认之前(或患者年龄大于或等于to90比患者年龄70 - 74 = 2.09,95% CI = 1.20 - -3.65)和新的ADL的损失函数在病人住院期间没有下降之前承认(或患者年龄大于或等于to90比患者年龄70 - 74 = 3.43,95% CI = 1.92 - -6.12)。结论：许多住院老年人出院时ADL功能较基线差。年龄较大的患者功能不良的风险特别高，因为他们入院前失去的ADL功能不太可能恢复，住院期间更有可能出现新的功能缺陷。
OBJECTIVES: To describe the changes in activities of daily living (ADL) function occurring before and after hospital admission in older people hospitalized with medical illness and to assess the effect of age on loss of ADL function.DESIGN: Prospective observational study.SETTING: The general medical service of two hospitals.PARTICIPANTS: Two thousand two hundred ninety-three patients aged 70 and older (mean age 80, 64% women, 24% nonwhite).MEASUREMENTS: At the time of hospital admission, patients or their surrogates were interviewed about their independence in five ADLs (bathing, dressing, eating, transferring, and toileting) 2 weeks before admission (baseline) and at admission. Subjects were interviewed about ADL function at discharge. Outcome measures included functional decline between baseline and discharge and functional changes between baseline and admission and between admission and discharge.RESULTS: Thirty-five percent of patients declined in ADL function between baseline and discharge. This included the 23% of patients who declined between baseline and admission and failed to recover to baseline function between admission and discharge and the 12% of patients who did not decline between baseline and admission but declined between hospital admission and discharge. Twenty percent of patients declined between baseline and admission but recovered to baseline function between admission and discharge. The frequency of ADL decline between baseline and discharge varied markedly with age (23%, 28%, 38%, 50%, and 63% in patients aged 70-74, 75-79, 80-84, 85-89, and greater than or equal to90, respectively, P < .001). After adjustment for potential confounders, age was not associated with ADL decline before hospitalization (odds ratio (OR) for patients aged greater than or equal to90 compared with patients aged 70-74 = 1.26, 95% confidence interval (CI) = 0.88-1.82). In contrast, age was associated with the failure to recover ADL function during hospitalization in patients who declined before admission (OR for patients aged greater than or equal to90 compared with patients aged 70-74 = 2.09, 95% CI = 1.20-3.65) and with new losses of ADL function during hospitalization in patients who did not decline before admission (OR for patients aged greater than or equal to90 compared with patients aged 70-74 = 3.43, 95% CI = 1.92-6.12).CONCLUSION: Many hospitalized older people are discharged with ADL function that is worse than their baseline function. The oldest patients are at particularly high risk of poor functional outcomes because they are less likely to recover ADL function lost before admission and more likely to develop new functional deficits during hospitalization.