Boyd Cynthia M, Xue Qian-Li, Guralnik Jack M, Fried Linda P
Division of Geriatric Medicine and Gerontology, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
J Gerontol A Biol Sci Med Sci. 2005 Jul;60(7):888-93. doi: 10.1093/gerona/60.7.888.
Changes in self-reported function in older adults are known to occur in the 2 weeks prior to, during, and in the first few months after hospitalization. The long-term outcome of hospitalization on functional status in disabled older adults is not known. The objective of this study was to determine whether hospitalization predicts long-term Activities of Daily Living (ADL) dependence in previously ADL independent, although disabled, older women.
The Women's Health and Aging Study I is a population-based, prospective cohort study of disabled, community-dwelling women > or =65 years old. We evaluated participants who were independent in ADLs at baseline and excluded women with incident stroke, lower extremity joint surgery, amputation, or hip fracture. We examined the association between self-reported incident hospitalization at three consecutive 6-month intervals and incident dependence in at least one ADL at 18 months (n = 595).
Of 595 women evaluated, 32% had at least one hospitalization. Women who were hospitalized were more likely to become dependent in ADLs than were women who were not hospitalized (17% vs 8%, p =.001). In a multivariate model, hospitalization was independently predictive of development of ADL dependence that persisted at 18 months after baseline (odds ratio [OR], 3.2; 95% confidence interval [CI], 1.7-5.8), adjusting for age, race, education, baseline walking speed, difficulty with ADLs, self-reported health status, depressive symptoms, cognitive status, and presence of congestive heart failure, diabetes, or pulmonary disease. Increasing numbers of 6-month intervals with hospitalizations were independently predictive of higher risk in an adjusted model: one (OR, 2.3; 95% CI, 1.1-4.6), two (OR, 5.8; 95% CI, 2.4-14.4), and three (OR, 12.5; 95% CI, 2.7-57.6).
These results suggest that hospitalization has an independent and dose-response effect on loss of ADL independence in disabled older women over an 18-month period.
已知老年人自我报告的功能变化会在住院前2周、住院期间以及住院后的头几个月内出现。住院对残疾老年人功能状态的长期影响尚不清楚。本研究的目的是确定住院是否能预测以前日常生活活动（ADL）独立但残疾的老年女性长期的ADL依赖情况。
妇女健康与衰老研究I是一项基于人群的前瞻性队列研究，研究对象为年龄≥65岁的残疾社区居住女性。我们评估了基线时ADL独立且排除了发生中风、下肢关节手术、截肢或髋部骨折的女性。我们在三个连续的6个月间隔中检查了自我报告的住院事件与18个月时至少一项ADL依赖事件之间的关联（n = 595）。
在评估的595名女性中，32%至少有一次住院。住院的女性比未住院的女性更有可能出现ADL依赖（17%对8%，p =.001）。在多变量模型中，住院独立预测了基线后18个月持续存在的ADL依赖的发展（优势比[OR]，3.2；95%置信区间[CI]，1.7 - 5.8），对年龄、种族、教育程度、基线步行速度、ADL困难程度、自我报告的健康状况、抑郁症状、认知状态以及充血性心力衰竭、糖尿病或肺部疾病的存在进行了调整。在调整模型中，住院间隔6个月的次数增加独立预测了更高的风险：一次（OR，2.3；95% CI，1.1 - 4.6）、两次（OR，5.8；95% CI，2.4 - 14.4）和三次（OR，12.5；95% CI，2.7 - 57.6）。
这些结果表明，在18个月的时间里，住院对残疾老年女性ADL独立性丧失具有独立的剂量反应效应。
