Predictive role of single diseases and their combination on recovery of balance and gait in disabled elderly patients
Predictive role of single diseases and their combination on recovery of balance and gait in disabled elderly patients
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DOI：
10.1016/j.jamda.2005.12.008
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发表时间：
2006-05-01
影响因子：
7.6
通讯作者：
Trabucchi, Marco
中科院分区：
文献类型：
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作者：
Di Fazio, Ignazio;Franzoni, Simone;Trabucchi, Marco
目的：在老年人群中，慢性疾病是活动受限的常见决定因素，合并症始终显示与功能状态密切相关。本研究旨在评估单一慢性疾病及其组合对残疾老年患者康复治疗后功能恢复的作用。设计：根据致残程度的不同，将疾病分为两组：“致残程度较高”的疾病（慢性阻塞性肺病、心力衰竭、外周动脉疾病、糖尿病和不危及生命的癌症）和“致残程度较低”的疾病（贫血、肾脏、胃肠道和肝脏疾病）。设置：35张床位的老年评估和康复科。参与者：我们研究了710例患者（年龄77.8±7.4岁，76.2%为女性），连续因中风、帕金森病和骨关节炎入院。测量方法：对活动能力（tinetti评分）、认知状态（MMSE）和躯体健康（Greenfield个体疾病严重程度指数- ids、疾病负担- bod）进行多维评估。功能恢复的判定依据Delta-Tinetti值，即入院与出院值的差值。结果：我们在一个多元回归模型中测试了单一慢性疾病及其组合对功能恢复的预测作用，在调整了哪些疾病是残疾的直接原因（中风、帕金森病和骨关节炎）和其他潜在的预测因素（年龄、性别、认知功能、抑郁症状、白蛋白和c反应蛋白）之后。“更致残”疾病组对功能恢复的预测为负。康复不良的决定因素的特点是“更多致残性疾病”的组合，而不是单一条件的影响，独立地由年龄、认知和入院时的功能状态决定。结论：我们的研究为慢性阻塞性肺病、心力衰竭、外周动脉疾病、糖尿病和非危及生命的癌症对老年人功能恢复的作用提供了新的视角，强调了它们对老年人功能恢复的综合影响。
Objectives: In the elderly population, chronic diseases are common determinants of mobility limitations and comorbidity consistently shows a strong association with functional status. This study was designed to evaluate the role of single chronic diseases and of their combination on functional recovery after rehabilitative treatment in disabled elderly patients.Design: With respect to the difference in magnitude of their disabling effect, diseases were classified into 2 groups: "more disabling" diseases (COPD, heart failure, peripheral artery diseases, diabetes, and not life-threatening cancer) and "less disabling" diseases (anemia, kidney, gastrointestinal, and liver diseases).Setting: 35-bed Geriatric Evaluation and Rehabilitation Unit.Participants: We studied 710 patients (age 77.8 +/- 7.4 years, 76.2% females), consecutively admitted for stroke, Parkinson's disease, and osteoarthritis.Measurements: A multidimensional evaluation for mobility (Tinetti-score), cognitive status (MMSE), and somatic health (Greenfield's Individual Disease Severity Index-IDS, Burden of diseases-BoD) was performed. Functional recovery was decided based on the Delta-Tinetti, which is the difference of the values between admission and discharge.Results: We tested, in a multivariate regression model, the predictive role of single chronic conditions and of their combinations on functional recovery, after having adjusted for which diseases are direct causes of disability (stroke, Parkinson's disease, and osteoarthritis) and other potential predictors (age, sex, cognitive function, depressive symptoms, albumin, and c-reactive protein). A negative prediction of functional recovery was expressed by the "more disabling" diseases group. The determinants of poor recovery were characterized by the combination of "more disabling diseases" rather than single condition effects, independently by age, cognitive, and functional status on admission.Conclusion: Our study adds a new perspective about the role of COPD, heart failure, peripheral artery diseases, diabetes and not life-threatening cancer on functional recovery, emphasizing their combined impact in elderly people.