Gill Thomas M, Baker Dorothy I, Gottschalk Margaret, Peduzzi Peter N, Allore Heather, Byers Amy
Department of Internal Medicine, Yale University School of Medicine, Dorothy Adler Geriatric Assessment Center, New Haven, Conn 06504, USA.
N Engl J Med. 2002 Oct 3;347(14):1068-74. doi: 10.1056/NEJMoa020423.
Functional decline in physically frail, elderly persons is associated with substantial morbidity. It is uncertain whether such functional decline can be prevented.
We randomly assigned 188 persons 75 years of age or older who were physically frail and living at home to undergo a six-month, home-based intervention program that included physical therapy and that focused primarily on improving underlying impairments in physical abilities, including balance, muscle strength, ability to transfer from one position to another, and mobility, or to undergo an educational program (as a control). The primary outcome was the change between base line and 3, 7, and 12 months in the score on a disability scale based on eight activities of daily living: walking, bathing, upper- and lower-body dressing, transferring from a chair, using the toilet, eating, and grooming. Scores on the scale ranged from 0 to 16, with higher scores indicating more severe disability.
Participants in the intervention group had less functional decline over time, according to their disability scores, than participants in the control group. The disability scores in the intervention and control groups were 2.3 and 2.8, respectively, at base line; 2.0 and 3.6 at 7 months (P=0.008 for the comparison between the groups in the change from base line); and 2.7 and 4.2 at 12 months (P=0.02). The benefit of the intervention was observed among participants with moderate frailty but not those with severe frailty. The frequency of admission to a nursing home did not differ significantly between the intervention group and the control group (14 percent and 19 percent, respectively; P=0.37).
A home-based program targeting underlying impairments in physical abilities can reduce the progression of functional decline among physically frail, elderly persons who live at home.
身体虚弱的老年人功能衰退与较高的发病率相关。目前尚不确定这种功能衰退是否可以预防。
我们将188名75岁及以上、身体虚弱且居家生活的老人随机分组，一组接受为期6个月的居家干预项目，该项目包括物理治疗，主要侧重于改善身体能力的潜在损伤，如平衡能力、肌肉力量、从一个姿势转换到另一个姿势的能力以及活动能力；另一组接受教育项目（作为对照）。主要结局是基于八项日常生活活动（行走、洗澡、上身和下身穿衣、从椅子上起身、使用厕所、进食和梳洗）的残疾量表评分在基线与3个月、7个月和12个月之间的变化。该量表评分范围为0至16分，分数越高表明残疾越严重。
根据残疾评分，干预组参与者随时间推移的功能衰退程度低于对照组参与者。干预组和对照组在基线时的残疾评分分别为2.3分和2.8分；7个月时分别为2.0分和3.6分（两组从基线开始的变化比较，P=0.008）；12个月时分别为2.7分和4.2分（P=0.02）。在中度虚弱的参与者中观察到了干预的益处，但在重度虚弱的参与者中未观察到。干预组和对照组入住养老院的频率无显著差异（分别为14%和19%；P=0.37）。
针对身体能力潜在损伤的居家项目可以减少居家生活的身体虚弱老年人功能衰退的进展。
