van Dijk Pieter T M, Mehr David R, Ooms Marcel E, Madsen Richard, Petroski Greg, Frijters Dinnus H, Pot Anne Margriet, Ribbe Miel W
Institute for Research in Extramural Medicine, VU University Medical Center, van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands.
J Am Geriatr Soc. 2005 Apr;53(4):660-5. doi: 10.1111/j.1532-5415.2005.53216.x.
To investigate the effect of chronic diseases and disease combinations on 1-year mortality in nursing home residents.
Retrospective cohort study using electronically submitted Minimum Data Set (MDS) information and Missouri death certificate data.
Five hundred twenty-two nursing homes in Missouri.
Forty-three thousand five hundred ten nursing home residents with a full MDS assessment in 1999.
Information about chronic diseases, age, sex, and performance in activities of daily living (ADLs) available from the first full MDS 2.0 assessment in 1999; death within 1 year after the first full MDS-assessment in 1999.
After adjustment for age and sex, eight variables were predictive for 1-year mortality: seven chronic diseases (dementia, cancer, heart failure, renal failure, emphysema/chronic obstructive pulmonary disease, diabetes mellitus, and anemia) and an interaction variable containing age and cancer. Adding terms for disease combinations (e.g., diabetes mellitus and heart failure) did not enhance survival prediction. When there was also adjustment for ADL performance as measured using the MDS-ADL Short Form, dementia and anemia were not included, because they had no prognostic value above that of the other variables.
Several chronic diseases were associated with 1-year mortality in the institutionalized elderly after adjustment for ADL performance, age, and sex. Evidence of a synergistic effect of disease combinations on mortality is lacking.
探讨慢性病及疾病组合对疗养院居民1年死亡率的影响。
利用电子提交的最低数据集（MDS）信息和密苏里州死亡证明数据进行回顾性队列研究。
密苏里州的522家疗养院。
1999年接受完整MDS评估的43510名疗养院居民。
从1999年首次完整的MDS 2.0评估中获取的有关慢性病、年龄、性别及日常生活活动（ADL）表现的信息；1999年首次完整MDS评估后1年内的死亡情况。
在对年龄和性别进行调整后，有8个变量可预测1年死亡率：7种慢性病（痴呆、癌症、心力衰竭、肾衰竭、肺气肿/慢性阻塞性肺疾病、糖尿病和贫血）以及一个包含年龄和癌症的交互变量。增加疾病组合（如糖尿病和心力衰竭）的项并未增强生存预测能力。当使用MDS-ADL简表对ADL表现进行调整时，痴呆和贫血未被纳入，因为它们的预后价值不高于其他变量。
在对ADL表现、年龄和性别进行调整后，几种慢性病与机构养老老年人的1年死亡率相关。缺乏疾病组合对死亡率产生协同效应的证据。
