Minemawari Y, Kato T, Aso K
Keijinkai Nishimaruyama Hospital.
Nihon Ronen Igakkai Zasshi. 2000 Mar;37(3):225-32. doi: 10.3143/geriatrics.37.225.
To elucidate the clinical characteristics of disability due to various basic disease groups, by using Japanese Minimum Data Set (MDS), Nishimura's mental scale (NM) and activity of daily living scale (N-ADL), cognitive function and basic activity of daily living (ADL) together with the grading scale of nursing care (freedom-grade of daily living: N1. frequency of bedside visits by a nurse: N2) and nutritional function (serum albumin: SA) were assessed in 926 elderly disabled inpatients in April 1998 in our long-stay chronic care hospital. Basic diseases were divided into five groups: cerebrovascular (C), senile dementia (D), bone and joint (B), Parkinson's disease (P) and other diseases (O). (1) In all patients, women were 2.9 years significantly older than men. Mean age in disease groups was significantly greater in the following decreasing order, B > D > C > P. (2) In all patients and patients with C, significant negative correlations were found between age and the scores of various scales (NM, N-ADL, N1, SA). In patients with D and B, significant negative correlations were found only between age and N-ADL and N1, but not NM or SA. In patients with P, no correlations were found between age and the various scales. (3) The cognitive function score decreased significantly as follows, B > C > P > D and the score of ADL decreased significantly as follows, B > D > C > P. (4) In patients with C and P, significant positive correlations were found between 3 scores (Cognition, ADL, SA). In patients with D, significant positive correlation was found between only two scores (ADL, SA) and in patients with B, no correlations were found between SA and other scores. (5) Because in all patients and in patients with all disease groups, significant positive correlations were found between the scores of cognition, ADL by MDS and the scores of NM, N-ADL respectively, the scales of cognition and ADL evaluated by MDS were validated for us to assess cognitive function and ADL and are probably suitable tools for evaluating elderly disabled patients. The other various functional states should also be assessed in elderly disabled patients where the quality of life of the patients must take priority over other considerations in decision making for medical interventions, including care. We should discuss care in detail and continue more medical studies to improve the quality of care.
为阐明各类基础疾病组导致残疾的临床特征，我们于1998年4月，在我院长期慢性护理医院，运用日本最小数据集（MDS）、西村精神量表（NM）和日常生活活动量表（N-ADL），对926例老年残疾住院患者的认知功能、日常生活基本活动能力（ADL），以及护理分级量表（日常生活自由度：N1；护士床边访视频率：N2）和营养功能（血清白蛋白：SA）进行了评估。基础疾病分为五组：脑血管疾病（C）、老年痴呆（D）、骨关节疾病（B）、帕金森病（P）和其他疾病（O）。（1）所有患者中，女性比男性平均年龄大2.9岁。疾病组的平均年龄按以下降序排列，差异有统计学意义：B＞D＞C＞P。（2）在所有患者以及C组患者中，年龄与各量表（NM、N-ADL、N1、SA）得分之间存在显著负相关。在D组和B组患者中，仅年龄与N-ADL和N1之间存在显著负相关，而与NM或SA无显著负相关。在P组患者中，年龄与各量表之间无相关性。（3）认知功能得分显著下降顺序为：B＞C＞P＞D，ADL得分显著下降顺序为：B＞D＞C＞P。（4）在C组和P组患者中，认知、ADL、SA三项得分之间存在显著正相关。在D组患者中，仅ADL和SA两项得分之间存在显著正相关，而在B组患者中，SA与其他得分之间无相关性。（5）因为在所有患者以及所有疾病组患者中，MDS评估的认知、ADL得分分别与NM、N-ADL得分之间存在显著正相关，所以MDS评估的认知和ADL量表经我们验证，可用于评估认知功能和ADL，可能是评估老年残疾患者的合适工具。对于老年残疾患者，还应评估其他各种功能状态，在包括护理在内的医疗干预决策中，患者的生活质量应优先于其他考虑因素。我们应详细讨论护理问题，并继续开展更多医学研究以提高护理质量。
