Covinsky Kenneth E, Palmer Robert M, Fortinsky Richard H, Counsell Steven R, Stewart Anita L, Kresevic Denise, Burant Christopher J, Landefeld C Seth
Division of Geriatrics, University of California at San Francisco, San Francisco, California, USA.
J Am Geriatr Soc. 2003 Apr;51(4):451-8. doi: 10.1046/j.1532-5415.2003.51152.x.
To describe the changes in activities of daily living (ADL) function occurring before and after hospital admission in older people hospitalized with medical illness and to assess the effect of age on loss of ADL function.
Prospective observational study.
The general medical service of two hospitals.
Two thousand two hundred ninety-three patients aged 70 and older (mean age 80, 64% women, 24% nonwhite).
At the time of hospital admission, patients or their surrogates were interviewed about their independence in five ADLs (bathing, dressing, eating, transferring, and toileting) 2 weeks before admission (baseline) and at admission. Subjects were interviewed about ADL function at discharge. Outcome measures included functional decline between baseline and discharge and functional changes between baseline and admission and between admission and discharge.
Thirty-five percent of patients declined in ADL function between baseline and discharge. This included the 23% of patients who declined between baseline and admission and failed to recover to baseline function between admission and discharge and the 12% of patients who did not decline between baseline and admission but declined between hospital admission and discharge. Twenty percent of patients declined between baseline and admission but recovered to baseline function between admission and discharge. The frequency of ADL decline between baseline and discharge varied markedly with age (23%, 28%, 38%, 50%, and 63% in patients aged 70-74, 75-79, 80-84, 85-89, and > or =90, respectively, P <.001). After adjustment for potential confounders, age was not associated with ADL decline before hospitalization (odds ratio (OR) for patients aged > or =90 compared with patients aged 70-74 = 1.26, 95% confidence interval (CI) = 0.88-1.82). In contrast, age was associated with the failure to recover ADL function during hospitalization in patients who declined before admission (OR for patients aged > or =90 compared with patients aged 70-74 = 2.09, 95% CI = 1.20-3.65) and with new losses of ADL function during hospitalization in patients who did not decline before admission (OR for patients aged > or =90 compared with patients aged 70-74 = 3.43, 95% CI = 1.92-6.12).
Many hospitalized older people are discharged with ADL function that is worse than their baseline function. The oldest patients are at particularly high risk of poor functional outcomes because they are less likely to recover ADL function lost before admission and more likely to develop new functional deficits during hospitalization
描述因内科疾病住院的老年人入院前后日常生活活动（ADL）功能的变化，并评估年龄对ADL功能丧失的影响。
前瞻性观察性研究。
两家医院的普通内科服务部门。
2293名70岁及以上的患者（平均年龄80岁，64%为女性，24%为非白人）。
在入院时，对患者或其代理人就入院前2周（基线）和入院时在五项ADL（洗澡、穿衣、进食、转移和如厕）方面的独立性进行访谈。在出院时对受试者进行ADL功能访谈。结果指标包括基线至出院之间的功能下降以及基线至入院之间、入院至出院之间的功能变化。
35%的患者在基线至出院之间ADL功能下降。这包括23%在基线至入院之间功能下降且在入院至出院之间未恢复至基线功能的患者，以及12%在基线至入院之间未下降但在入院至出院之间功能下降的患者。20%的患者在基线至入院之间功能下降但在入院至出院之间恢复至基线功能。基线至出院之间ADL下降的频率随年龄有显著差异（70 - 74岁、75 - 79岁、80 - 84岁、85 - 89岁和≥90岁的患者分别为23%、28%、38%、50%和63%，P <.001）。在对潜在混杂因素进行调整后，年龄与住院前ADL下降无关（≥90岁患者与70 - 74岁患者相比的优势比（OR）= 1.26，95%置信区间（CI）= 0.88 - 1.82）。相比之下，年龄与入院前功能下降的患者在住院期间未能恢复ADL功能有关（≥90岁患者与70 - 74岁患者相比的OR = 2.09，95% CI = 1.20 - 3.65），并且与入院前未下降的患者在住院期间出现新的ADL功能丧失有关（≥90岁患者与70 - 74岁患者相比的OR = 3.43，95% CI = 1.92 - 6.12）。
许多住院的老年人出院时ADL功能比基线功能更差。年龄最大者功能结局不佳的风险特别高，因为他们入院前丧失的ADL功能恢复的可能性较小，且在住院期间出现新的功能缺陷的可能性更大。
