Prevalence and outcomes of low mobility in hospitalized older patients
Prevalence and outcomes of low mobility in hospitalized older patients
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DOI：
10.1111/j.1532-5415.2004.52354.x
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发表时间：
2004-08-01
影响因子：
6.3
通讯作者：
Inouye, SK
中科院分区：
文献类型：
--
作者：
Brown, CJ;Friedkin, RJ;Inouye, SK
目的：估计住院老年队列中不同活动水平的患病率，测量与不同活动水平相关的不良结果的程度和比率，并检查最低活动组的医生活动订单和卧床休息的记录原因。498名70岁以上的住院病人。使用从0到12的平均流动水平，低流动性组被定义为具有4或更低的分数，中间为高于4到8的分数，并且高至高于8。结果是功能下降，新的制度化，死亡，死亡或新institutionalization.Results：低和中等水平的流动性是常见的，分别占80（16%）和157（32%）研究患者。总体而言，该队列中29%的患者发生了日常生活活动（ADL）下降，13%的患者发生了新的机构化，7%的患者死亡，22%的患者死亡或新的机构化。与高活动性组相比，低活动性组和中等活动性组与不良结局呈分级相关，即使在控制了多种混杂因素后也是如此。低流动性组的调整优势比（OR）为5.6（95%置信区间（CI）= 2.9-11.0），ADL下降，6.0（95% CI = 2.5-14.8），死亡为34.3（95% CI = 6.3-185.9），死亡或新机构为7.2（95% CI = 3.6-14.4）。中间组的ADL下降、新机构化、死亡和死亡或新机构化的校正OR分别为2.5（95% CI = 1.5-4.1）、2.9（95% CI = 1.4-6.0）、10.1（95% CI = 1.9-52.9）和3.3（95% CI = 1.8-5.9）。165例（33%）患者在住院期间的某个时间点要求卧床休息。对于大多数患者来说，流动性是有限的，不自觉的（卧床休息订单），几乎60%的卧床休息发作在最低流动性组没有记录的医疗indication.CONCLUSION：低流动性和卧床休息是常见的住院老年患者和不良后果的重要预测因素。本研究表明，与活动度低和卧床休息相关的不良结局可视为导致并发症（如功能下降）的医源性事件。
OBJECTIVES: To estimate the prevalence of different levels of mobility in a hospitalized older cohort, to measure the degree and rate of adverse outcomes associated with different mobility levels, and to examine the physician activity orders and documented reasons for bedrest in the lowest mobility group.DESIGN: A prospective cohort study.SETTING: An 800-bed university teaching hospital.PARTICIPANTS: Four hundred ninety-eight hospitalized medical patients, aged 70 and older.MEASUREMENTS: Using average mobility level, scored from 0 to 12, the low-mobility group was defined as having a score of 4 or less, intermediate as a score of higher than 4 to 8, and high as higher than 8. Outcomes were functional decline, new institutionalization, death, and death or new institutionalization.RESULTS: Low and intermediate levels of mobility were common, accounting for 80 (16%) and 157 (32%) study patients, respectively. Overall, any activity of daily living (ADL) decline occurred in 29%, new institutionalization in 13%, death in 7%, and death or new institutionalization in 22% of patients in this cohort. When compared with the high mobility group, the low and intermediate groups were associated with the adverse outcomes in a graded fashion, even after controlling for multiple confounders. The low-mobility group had an adjusted odds ratio (OR) of 5.6 (95% confidence interval (CI) = 2.9-11.0) for ADL decline, 6.0 (95% CI = 2.5-14.8) for new institutionalization, 34.3 (95% CI = 6.3-185.9) for death, and 7.2 (95% CI = 3.6-14.4) for death or new institutionalization. The intermediate group had adjusted ORs of 2.5 (95% CI = 1.5-4.1), 2.9 (95% CI = 1.4-6.0), 10.1 (95% CI = 1.9-52.9), and 3.3 (95% CI = 1.8-5.9) for ADL decline, new institutionalization, death, and death or new institutionalization, respectively. Bedrest was ordered at some point during hospitalization in 165 (33%) patients. For most patients, mobility was limited involuntarily (bedrest orders), and almost 60% of bedrest episodes in the lowest mobility group had no documented medical indication.CONCLUSION: Low mobility and bedrest are common in hospitalized older patients and are important predictors of adverse outcomes. This study demonstrated that the adverse outcomes associated with low mobility and bedrest may be viewed as iatrogenic events leading to complications, such as functional decline.