Sund-Levander Märtha, Grodzinsky Ewa, Wahren Lis Karin
Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden.
Scand J Caring Sci. 2007 Mar;21(1):18-24. doi: 10.1111/j.1471-6712.2007.00431.x.
This study focus on predicting factors of survival possible to modify by nursing care, and the incidence and mortality rate of nursing-home-acquired pneumonia, allocated to 1, 2 and 3 years of follow ups. The residents consisted of 156 women and 78 men living in special housing for the elderly. Data on chronic disease and medication were obtained at baseline, and activities of daily living (ADL) status, nutritional status and body temperature were assessed. The incidence of pneumonia was noted prospectively for 1 year and retrospectively for the following 2 years. Predictive factors for survival were explored by Cox hazard regression analysis. The results showed that age, functional and cognitive impairment were predictors of mortality irrespective of gender, while poor nutritional status in women and chronic obstructive pulmonary disease, heart disease and medication with sedatives in men were gender-specific predictors. ADL correlated positively with dementia and negatively with S-albumin irrespective of gender, while malnutrition correlated positively with ADL in women and positively with chronic obstructive pulmonary disease in men. To promote the quality of daily living in elderly individuals, it is of importance to improve the capabilities in daily functions and nutritional status, especially in women with functional impairment, and to prevent anxiety particularly in men. The findings also clarify that pneumonia is as common as cerebral vascular insult and heart failure as cause of death in this population.
本研究聚焦于可通过护理干预改变的生存预测因素，以及养老院获得性肺炎的发病率和死亡率，并进行了1年、2年和3年的随访。研究对象为居住在老年特殊住房中的156名女性和78名男性居民。在基线时获取慢性病和用药数据，并评估日常生活活动（ADL）状态、营养状况和体温。前瞻性记录1年的肺炎发病率，后2年进行回顾性记录。通过Cox风险回归分析探索生存的预测因素。结果显示，无论性别，年龄、功能和认知障碍都是死亡率的预测因素，而女性营养状况差以及男性慢性阻塞性肺疾病、心脏病和使用镇静剂则是特定性别的预测因素。无论性别，ADL与痴呆呈正相关，与血清白蛋白呈负相关，而营养不良在女性中与ADL呈正相关，在男性中与慢性阻塞性肺疾病呈正相关。为提高老年人的日常生活质量，提高日常功能能力和营养状况非常重要，尤其是对于有功能障碍的女性，并且要特别预防男性的焦虑情绪。研究结果还表明，在该人群中，肺炎作为死亡原因与脑血管意外和心力衰竭一样常见。
