TRAJECTORY OF RECOVERY OF LIFE-SPACE MOBILITY AFTER HOSPITALIZATION

根据世界卫生组织（世卫组织），残疾是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。大约30%的老年人将 出院时出现新的ADL残疾，几乎没有观察到恢复。ADL残疾捕获 只有三个残疾领域之一，活动受限。UAB生命空间评估（LSA）是一项 经验证的工具，用于衡量社区流动性，并反映基于距离的社会参与情况 一个人在评估之前的四周内通过它报告移动。生活空间“层次” 范围从一个人的住所到一个人的城镇之外。生活空间综合评分的计算基于 生命空间级别、实现每个级别的独立程度以及实现每个级别的频率。 根据初步数据，按生活空间衡量的参与恢复到入院前的水平， 对于许多住院的老年人来说，似乎并没有发生这种情况。方法：采用前瞻性队列研究设计， 参与者将在住院期间招募，并在出院后随访6个月。评估将 住院期间定期进行，住院后每月电话咨询一次。具体目标 1：描述老年退伍军人住院后生活空间移动性的变化。虽然ADL残疾是 常见的住院后，我们初步的人口为基础的研究表明，流动性限制也 很明显到目前为止，还没有研究调查参与后的最初6个月内发生了什么变化。 个人住院治疗。具体目标2：将生活空间移动性的变化与 老年人住院后的基本和工具性日常生活活动。与具体目标1一样， 考虑到残疾的动态过程，关于ADL、IADL和生活空间变化的额外数据 每个月都可以更好地评估这三个重要因素之间的相互关系， 残疾的组成部分。具体目标3：确定术后生命空间活动性恢复的预测因素 住院治疗，如生活空间评估所测量。在个人层面，各种因素 可能会预测谁将恢复生命空间。这些因素可能包括患者相关，医院- 相关因素和住院后因素。这项研究的主要目的是确定潜在的可修改的 生命空间活动性恢复的预测因素，可能是未来干预的目标。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在65岁以上。 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 这似乎是住院治疗的常见后果，可能需要进行干预。最后， 我们的目标是改善住院后的恢复，减少老年退伍军人的残疾。弗吉尼亚州医疗 中心系统非常适合这种类型的研究，因为入院的老年患者群体 未来的研究结果可以通过VA系统在全国范围内传播。

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.