A program to prevent functional decline in physically frail, elderly persons who live at home
A program to prevent functional decline in physically frail, elderly persons who live at home
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DOI：
10.1056/nejmoa020423
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发表时间：
2002-10-03
影响因子：
158.5
通讯作者：
Byers, A
中科院分区：
文献类型：
--
作者：
Gill, TM;Baker, DI;Byers, A
背景：身体虚弱的老年人的功能下降与大量的发病率有关。目前尚不确定是否可以预防这种功能下降。我们随机分配了188名75岁或75岁以上的身体虚弱和住在家里的人，接受为期6个月的家庭干预计划，包括物理治疗，主要集中在改善身体能力的潜在障碍，包括平衡，肌肉力量，从一个位置转移到另一个位置的能力，和流动性，或接受教育计划（作为对照）。主要结局是基线与3个月、7个月和12个月之间残疾量表评分的变化，该量表基于8种日常生活活动：行走、洗澡、上身和下身穿衣、从椅子上转移、使用厕所、进食和修饰。评分范围从0到16，分数越高，表明更严重的disability.Results：在干预组的参与者随着时间的推移，功能下降较少，根据他们的残疾评分，比对照组的参与者。干预组和对照组的残疾评分在基线时分别为2.3和2.8;在7个月时分别为2.0和3.6（两组相比基线的变化P=0.008）;在12个月时分别为2.7和4.2（P=0.02）。在中度虚弱的参与者中观察到干预的益处，但在重度虚弱的参与者中没有观察到干预的益处。入住疗养院的频率在干预组和对照组之间没有显著差异（分别为14%和19%; P=0.37）。结论：针对身体能力潜在障碍的家庭计划可以减少身体虚弱的老年人住在家里的功能衰退的进展。
Background: Functional decline in physically frail, elderly persons is associated with substantial morbidity. It is uncertain whether such functional decline can be prevented.Methods: We randomly assigned 188 persons 75 years of age or older who were physically frail and living at home to undergo a six-month, home-based intervention program that included physical therapy and that focused primarily on improving underlying impairments in physical abilities, including balance, muscle strength, ability to transfer from one position to another, and mobility, or to undergo an educational program (as a control). The primary outcome was the change between base line and 3, 7, and 12 months in the score on a disability scale based on eight activities of daily living: walking, bathing, upper- and lower-body dressing, transferring from a chair, using the toilet, eating, and grooming. Scores on the scale ranged from 0 to 16, with higher scores indicating more severe disability.Results: Participants in the intervention group had less functional decline over time, according to their disability scores, than participants in the control group. The disability scores in the intervention and control groups were 2.3 and 2.8, respectively, at base line; 2.0 and 3.6 at 7 months (P=0.008 for the comparison between the groups in the change from base line); and 2.7 and 4.2 at 12 months (P=0.02). The benefit of the intervention was observed among participants with moderate frailty but not those with severe frailty. The frequency of admission to a nursing home did not differ significantly between the intervention group and the control group (14 percent and 19 percent, respectively; P=0.37).Conclusions: A home-based program targeting underlying impairments in physical abilities can reduce the progression of functional decline among physically frail, elderly persons who live at home.