Physical Function and Disability After Acute Care and Critical Illness Hospitalizations in a Prospective Cohort of Older Adults.
Physical Function and Disability After Acute Care and Critical Illness Hospitalizations in a Prospective Cohort of Older Adults.
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DOI：
10.1111/jgs.13663
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发表时间：
2015-10
影响因子：
6.3
通讯作者：
Hough CL
中科院分区：
文献类型：
--
作者：
Ehlenbach WJ;Larson EB;Curtis JR;Hough CL
调查急性护理和危重病住院与身体功能测量和日常生活活动（ADL）表现之间的相关性。前瞻性队列研究。大型健康维护组织。2,926名参与者参与了成人思想变化，这是一项老年化研究，招募了1994年至2008年9月30日期间未居住在养老院的65岁及以上无痴呆症个体（N= 2，926）。关注的暴露是研究参与期间的住院治疗，根据是否存在危重疾病细分。结果包括步态速度，握力，椅子站立速度，以及在两年一次的访问中测量的进行ADL的困难和依赖性。急性护理住院后出院至下一次研究访视的中位时间为311天（四分位距（IQR）151-501天），危重症住院后为359天（IQR 181-420天）。在急性护理（-0.05 m/s，95%置信区间（CI）=0.01-0.04 m/s，P<0.001）和危重病（-0.16 m/s，95% CI=-0.22至-0.10，P<0.001）后，步态速度较慢。急性护理住院后握力较弱（-0. 8 kg，95% CI=-1. 0至-0. 6，P<0. 001），但危重病住院后无显著差异。在急性护理住院（-0.04站/秒，95%CVI =-0.05至-0.04，P< .001）和危重病住院（-0.09，95%CI =-0.15至-0.03，P=.003）后，椅子站立速度较慢。在这一点上（比值比（OR）=1.4，95% CI=1.2-1.6，P<0.001）或依赖于（OR=2.0，95% CI=1.2-3.2，P= 0.006）急性护理住院后一种或多种ADL较高，（OR=1.9，95% CI=1.1-3.6，P= 0.03）或依赖（OR=7.9，95% CI=2.5-25.7，P= 0.001）一种或多种ADL。在老年人中，住院治疗（尤其是危重病）与临床相关的步态和椅子站立速度下降相关，与ADL困难和依赖性密切相关。
To investigate associations between acute care and critical illness hospitalizations and performance on physical functional measures and activities of daily living (ADLs). Prospective cohort study. Large health maintenance organization. 2926 Participants in Adult Changes in Thought, a study of aging enrolling dementia-free individuals aged 65 and older not living in a nursing home from 1994 to September 30, 2008 (N=2,926). The exposure of interest was hospitalization during study participation, subdivided by presence of critical illness. Outcomes included gait speed, grip strength, chair stand speed, and difficulty and dependence in performing ADLs measured at biennial visits. Median time between hospital discharge and the next study visit was 311 days (interquartile range (IQR) 151–501 days) after acute care hospitalization and 359 days (IQR 181–420 days) after critical illness hospitalization. Gait speed was slower after acute care (–0.05 m/s, 95% confidence interval (CI)=0.01–0.04 m/s slower, P< .001) and critical illness (–0.16 m/s, 95% CI=–0.22 to –0.10, P< .001). Grip was weaker after acute care hospitalization (–0.8 kg, 95% CI=–1.0 to –0.6, P<.001) but not significantly different after critical illness hospitalization. Chair-stand speed was slower after acute care hospitalization (–0.04 stands/s, 95% CVI=–0.05 to –0.04, P< .001) and critical illness hospitalization (–0.09, 95% CI=–0.15 to –0.03, P=.003). The odds of difficulty with (odds ratio (OR)=1.4, 95% CI=1.2–1.6, P<.001) or dependence in (OR=2.0, 95% CI=1.2–3.2, P=.006) one or more ADLs was higher after acute care hospitalization, as were the odds of difficulty with (OR=1.9, 95% CI=1.1–3.6, P=.03) or dependence in (OR=7.9, 95% CI=2.5–25.7, P=.001) one or more ADLs after critical illness. In older adults, hospitalization, especially for critical illness, was associated with clinically relevant decline in gait and chair stand speed and strongly associated with difficulty with and dependence in ADLs.