TRAJECTORY OF RECOVERY OF LIFE-SPACE MOBILITY AFTER HOSPITALIZATION

描述(由申请人提供)： 根据世界卫生组织(WHO)的说法，残疾是指身体功能或结构、活动和参与三个领域中的一个领域的功能下降。大约30%的老年人将因出院而经历新的ADL残疾，几乎没有恢复的迹象。ADL残疾只包括三个残疾领域中的一个，即活动限制。UAB生活空间评估(LSA)是一种经过验证的工具，它衡量社区的流动性，并根据一个人报告在评估前四周内移动的距离来反映对社会的参与。生活空间的“层次”从一个人的住所内到一个人的城镇之外。根据生活空间水平、达到每一水平的独立程度和达到每一水平的频率计算生活空间综合得分。根据初步数据，以生活空间衡量的参与度恢复到入院前水平似乎没有发生在许多老年住院成年人身上。方法：采用前瞻性队列研究设计，参与者在住院期间被招募，出院后被跟踪6个月。在住院期间将定期进行评估，住院后每月通过电话进行一次评估。具体目标1：描述老年退伍军人住院后生活空间流动性的变化。虽然ADL残疾在住院后很常见，但我们基于人口的初步研究表明，行动不便也很明显。到目前为止，还没有研究考察在住院后的最初6个月内，个人层面的参与度发生了什么变化。具体目标2：比较老年人住院后生活空间流动性的变化与日常生活基本和工具性活动的变化。与具体目标1一样，鉴于残疾的动态过程，每月关于ADL、IADL和生活空间变化的额外数据将有助于改进对残疾的这三个重要组成部分之间的相互关系的评估。具体目标3：通过生活空间评估确定住院后生活空间活动能力恢复的预测因素。在个人层面上，各种因素可能会预测谁将恢复生活空间。这些因素可能包括与患者相关的、与医院相关的和住院后的因素。这项研究的主要目标是确定生命空间流动性恢复的潜在可修改预测因素，这些因素可能是未来干预的目标。对退伍军人医疗保健的潜在影响：根据NSV 2001年的数据，大约21%的住院退伍军人年龄为65岁，随着美国人口老龄化，这一数字预计还会增加。活动和参与障碍似乎是住院的常见后果，这可能需要干预。归根结底，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很多，未来的研究结果可以通过退伍军人管理局系统在全国范围内传播。 公共卫生相关性： 简介：住院后，30%-60%的老年人在进行一项或多项基本日常生活活动(ADL)时遇到更多困难，如洗澡或穿衣。我们的研究表明，通过UAB生活空间评估衡量的社区流动性在住院后也会下降，即使在长达两年的随访后也没有改善。生活空间评估(LSA)是一种经过验证的工具，它衡量社区的流动性，并根据一个人在评估前四周内报告的移动距离来反映对社会的参与。生活空间的“层次”从一个人的住所内到一个人的城镇之外。根据生活空间水平、达到每一水平的独立程度和达到每一水平的频率计算生活空间综合得分。我们计划在住院期间招募65岁的退伍军人，并在他们出院后6个月内每月电话跟踪他们。将对他们的功能能力、认知能力和一般健康进行各种评估。这项研究的主要目标是确定生命空间流动性恢复的潜在可修改预测因素，这些因素可能是未来干预的目标。归根结底，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很多，未来的研究结果可以通过退伍军人管理局系统在全国范围内传播。

DESCRIPTION (provided by applicant): 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. PUBLIC HEALTH RELEVANCE: Narrative: After hospitalization, 30-60% of older adults experience more difficulty performing one or more of their basic activities of daily living (ADLs) like bathing or dressing. Our has shown community mobility, measured by the UAB Life-Space Assessment, also decreases after hospitalization and does not improve even after up to two years of follow-up. The 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 before 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. We plan to recruit veterans 65 years of age during hospitalization and followed them with monthly telephone calls for 6-months after discharge. A variety of assessments of their functional ability, cognitive ability and general health will be done. 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. 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.