Büla Christophe J, Ghilardi Giuseppe, Wietlisbach Vincent, Petignat Christiane, Francioli Patrick
Division of Geriatric Medicine, Department of Internal Medicine, University of Lausanne, Lausanne, Switzerland.
J Am Geriatr Soc. 2004 May;52(5):700-6. doi: 10.1111/j.1532-5415.2004.52205.x.
To determine the relationship between infections and functional impairment in nursing home residents.
Prospective cohort study (follow-up period, 6 months).
Thirty-nine nursing homes in western Switzerland.
A total of 1,324 residents aged 65 and older (mean age 85.7; 76.6% female) who agreed to participate, or their proxies, by oral informed consent.
Functional status measured every 3 months. Two different outcomes were used: (a) functional decline defined as death or decreased function at follow-up and (b) functional status score using a standardized measure.
At the end of follow-up, mortality was 14.6%, not different for those with and without infection (16.2% vs 13.1%, P=.11). During both 3-month periods, subjects with infection had higher odds of functional decline, even after adjustment for baseline characteristics and occurrence of a new illness (adjusted odds ratio (AOR)=1.6, 95% confidence interval (CI)=1.2-2.2, P=.002, and AOR=1.5, 95% CI=1.1-2.0, P=.008, respectively). The odds of decline increased in a stepwise fashion in patients with zero, one, and two or more infections. The analyses predicting functional status score (restricted to subjects who survived) gave similar results. A survival analysis predicting time to first infection confirmed a stepwise greater likelihood of infection in subjects with moderate and severe impairment at baseline than in subjects with no or mild functional impairment at baseline.
Infections appear to be both a cause and a consequence of functional impairment in nursing home residents. Further studies should be undertaken to investigate whether effective infection control programs can also contribute to preventing functional decline, an important component of these residents' quality of life.
确定疗养院居民感染与功能障碍之间的关系。
前瞻性队列研究（随访期6个月）。
瑞士西部的39所疗养院。
共有1324名65岁及以上的居民（平均年龄85.7岁；76.6%为女性），经口头知情同意后同意参与，或由其代理人参与。
每3个月测量一次功能状态。使用了两种不同的结果：(a) 功能衰退，定义为随访时死亡或功能下降；(b) 使用标准化测量方法的功能状态评分。
随访结束时，死亡率为14.6%，感染组和未感染组无差异（16.2%对13.1%，P = 0.11）。在两个3个月期间，即使在调整了基线特征和新发病情况后，感染患者功能衰退的几率更高（调整后的优势比（AOR）= 1.6，95%置信区间（CI）= 1.2 - 2.2，P = 0.002；以及AOR = 1.5，95% CI = 1.1 - 2.0，P = 0.008）。感染零次、一次和两次或更多次的患者中，衰退几率呈逐步增加。预测功能状态评分的分析（仅限于存活的受试者）得出了类似的结果。预测首次感染时间的生存分析证实，基线时中度和重度功能障碍的受试者比基线时无功能障碍或轻度功能障碍的受试者感染的可能性逐步增加。
感染似乎既是疗养院居民功能障碍的原因，也是其后果。应进一步开展研究，以调查有效的感染控制项目是否也有助于预防功能衰退，而功能衰退是这些居民生活质量的一个重要组成部分。
