Longitudinal functional recovery after postacute rehabilitation in older hip fracture patients: the role of cognitive impairment and implications for long-term care.
Longitudinal functional recovery after postacute rehabilitation in older hip fracture patients: the role of cognitive impairment and implications for long-term care.
复制标题
老年髋部骨折患者急性康复后的纵向功能恢复：认知障碍的作用及其对长期护理的影响。
DOI：
10.1016/j.jamda.2010.08.005
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发表时间：
2011
影响因子：
7.6
通讯作者：
Pruzek,RobertM
中科院分区：
文献类型：
--
作者：
Young,Yuchi;Xiong,Kuangnan;Pruzek,RobertM
目的比较接受髋部骨折手术的认知受损和非认知受损老年人的功能恢复模式，并确定相关的长期护理需求。方法纵向研究(n=231)。数据收集在急性康复机构入院和出院前72小时内，以及急性康复后出院后2、6和12个月。采用6种功能独立性评定量表(FIM)评定功能恢复情况。采用简易精神状态检查量表(MMSE)评定认知功能。结果多因素分析结果显示，认知功能受损患者的功能恢复模式明显不同，FIM总分显著低于对照组(P<；.001)。对于1年后的运动功能，认知正常患者需要很少的监督(平均FIM=5.6)，而认知受损患者需要50%的人工辅助(FIM=3.9)。除了需要运动辅助外，认知受损患者还需要25%的人工辅助进行转移(FIM=4.8)，25%的患者需要自我护理(FIM平均值=5.3)，25%的患者需要控制括约肌(FIM=5.0)。结论认知受损患者在2个月和6个月后恢复，但在急性康复出院后1年无法保留运动、转移、自我护理和括约肌控制方面的康复成果，他们仍然需要人工帮助才能留在社区内的家中。为了防止或延迟进入养老院，建议对认知受损的髋部骨折患者进行适当的长期护理规划和对照顾者的社会支持。
OBJECTIVETo compare functional recovery patterns of cognitively impaired and nonimpaired older adults who had hip fracture surgeries, and to identify associated long-term care needs.METHODSLongitudinal study (n = 231). Data were collected within 72 hours of admission to and before discharge from the postacute rehabilitation facilities and at 2, 6, and 12 months following postacute rehabilitation discharge. Six functional independence measures (FIM) were used to assess functional recovery. Mini-mental status examination (MMSE) was used to gauge cognitive function. Mixed-effects analyses quantify differences of FIM functional recovery patterns between groups while adjusting for potential confounders.RESULTSMultivariate results showed that patients with impaired cognition had notably different functional recovery patterns and significantly worse overall FIM scores (P < .001) than their counterparts in all 6 FIM functions. For locomotion function at 1 year, cognitively nonimpaired patients needed little supervision (mean FIM = 5.6), whereas patients with impaired cognition needed 50% human assistance (FIM = 3.9). In addition to needing locomotion assistance, cognitively impaired patients also required 25% human assistance in transfers (FIM = 4.8), 25% in self-care (FIM mean = 5.3), and 25% in sphincter control (FIM mean = 5.0).CONCLUSIONCognitively impaired patients experienced recovery at 2 and 6 months but were unable to retain rehabilitation gains in locomotion, transfers, self-care, and sphincter control at 1 year following postacute rehabilitation discharge, and they still required human assistance to stay in their homes within the community. To prevent or delay nursing home entry, it is suggested that appropriate long-term care planning and social support for caregivers are needed for cognitively impaired hip fracture patients.