TRAJECTORY OF RECOVERY OF LIFE-SPACE MOBILITY AFTER HOSPITALIZATION

根据世界卫生组织(WHO)的说法，残疾是指以下三个领域之一的功能下降 包括身体功能或结构、活动和参与度。约30%的老年人将 经历了新的ADL残疾出院，几乎没有恢复观察到。ADL残疾捕获 三个残疾领域中只有一个，即活动限制。UAB生活空间评估(LSA)是一项 一种经过验证的工具，可根据距离测量社区流动性并反映社会参与度 一个人通过它报告在评估前四周内的活动情况。生活空间的“层次” 范围从一个人的住所到一个人的城镇之外。基于以下公式计算生活空间综合得分 生活空间水平，达到每一水平的独立程度，达到每一水平的频率。 根据初步数据，以生活空间衡量的参与度恢复到入院前的水平确实 在许多住院的老年人中似乎不会发生这种情况。方法：采用前瞻性队列研究设计， 参与者将在住院期间被招募，并在出院后被跟踪6个月。评估将 在住院期间定期打一次电话，住院后每月打一次电话。特定目标 1：描述老年退伍军人住院后生活空间流动性的变化。而ADL残疾是 住院后很常见，我们初步的基于人群的研究表明，行动不便也是 很明显。到目前为止，还没有一项研究研究在最初的6个月内参与度发生了什么变化 个人层面的住院治疗。具体目标2：比较生活空间流动性的变化和变化 在老年人住院后的基本和工具性日常生活活动中。与具体目标1一样， 鉴于残疾的动态过程，关于ADL、IADL和生活空间变化的补充数据 每个月都可以改进对这三个重要因素之间相互关系的评估 残疾的组成部分。具体目标3：确定生活空间活动能力恢复的预测因素 住院时间，由生活空间评估来衡量。在个人层面上，各种因素 可能会预测谁会恢复生命空间。这些因素可能包括与患者相关的、医院- 相关因素和入院后因素。这项研究的主要目标是确定潜在的可修改 生命空间流动性恢复的预测指标，可能成为未来干预的目标。对……的潜在影响 退伍军人医疗保健：根据NSV 2001年的数据，大约21%的住院退伍军人年龄为65岁 这一数字预计将随着美国人口老龄化而增加。活动和参与残疾 这似乎是住院的常见后果，这可能是可以干预的。最终， 我们的目标是改善住院后的康复，减少老年退伍军人的残疾。退伍军人事务部医疗 中心系统非常适合这种类型的研究，因为住院的老年患者人数较多 是高的，未来的研究结果可以通过退伍军人管理局系统在全国传播。

According to the World Health Organization (WHO), disability is a reduction in function in one of three domains that include body function or structure, activity and participation. Approximately 30% of older adults will experience a new ADL disability by hospital discharge, with little recovery observed. ADL disability captures only one of the three disability domains, activity limitation. The UAB Life-Space Assessment (LSA) is a validated tool that measures community mobility and reflects participation in society based on the distance through which a person reports moving during the four weeks preceding the assessment. Life-space "levels" range from within one's dwelling to beyond one's town. A life-space composite score is calculated based on life-space level, degree of independence in achieving each level, and the frequency of attaining each level. Based on preliminary data, recovery of participation as measured by life-space, to pre-admission levels does not appear to occur for many older hospitalized adults. Methods: Using a prospective cohort study design, participants will be recruited during hospitalization and followed for 6-months after discharge. Assessments will be made regularly during the hospital stay, and once a month by telephone after hospitalization. Specific Aim 1: To describe changes in life-space mobility after hospitalization in older veterans. While ADL disability is common after hospitalization, our preliminary population-based research shows mobility restrictions are also apparent. No study to date has examined what changes in participation occur during the initial 6 months after hospitalization at the individual level. Specific Aim 2: To compare changes in life-space mobility with changes in basic and instrumental activities of daily living after hospitalization in older adults. As with specific aim 1, given the dynamic process of disability, additional data regarding the changes in ADLs, IADLs and life-space each month would allow improved assessment of the inter-relationship between these three important components of disability. Specific Aim 3: To determine predictors of recovery of life-space mobility after hospitalization, as measured by the Life-Space Assessment. At the level of the individual, a variety of factors might be expected to predict who will recover life-space. These factors may include patient-related, hospital- related and post-hospitalization factors. The major goal of this study is to identify potentially modifiable predictors of recovery of life-space mobility that could be future targets for intervention. Potential Impact on Veterans Health Care: According to NSV 2001 data, approximately 21% of hospitalized veterans were e 65 years, and this number is expected to increase as the US population ages. Activity and participation disability appear to be a frequent consequence of hospitalization, which may be amenable to intervention. Ultimately, our goal is to improve recovery after hospitalization and reduce disability in our older veterans. The VA medical center system is well suited for this type of research as the population of older patients admitted to the hospital is high and results of future studies can be disseminated nationally through the VA system.