Wong Daniel D, Wong Reginald P C, Caplan Gideon A
The Prince of Wales Hospital, Sydney, New South Wales, Australia.
Emerg Med Australas. 2007 Jun;19(3):196-202. doi: 10.1111/j.1742-6723.2007.00924.x.
Self-rated health (SRH) has been shown to be a reliable predictor of functional decline and mortality. These studies, however, have largely focused on well community-dwelling elderly. We assessed whether the predictive value of SRH would still be valid for the acutely unwell older person presenting to the ED.
The present study was a secondary analysis of data obtained from the Discharge of Elderly from Emergency Department (DEED II) study. The sample consisted of 741 older people sent home from an ED. On enrollment, patients were asked the SRH question, 'In general, would you say your health is excellent, very good, good, fair or poor?' Phone interviews were conducted at 3, 6, 12 and 18 months. Functional status was assessed using the Barthel index of activities of daily living (ADL), modified instrumental activities of daily living (IADL) and the Short Portable Mental Status Questionnaire (MSQ).
An SRH of fair/poor produced a hazard ratio of 3.1 (95% confidence interval 1.3-7.2, P = 0.010) for predicting mortality after controlling for confounders. The rate of decline in ADL and IADL (but not MSQ) over time was also more pronounced for those with an SRH of fair/poor (P < 0.001 for both ADL and IADL). An SRH of fair/poor had a relative risk of 3.4 for predicting decline in ADL at 18 months (95% confidence interval 1.7-7.1, P = 0.001). The effects of SRH on IADL and MSQ were not statistically significant.
The ability of SRH to predict functional decline and mortality persists for the acutely unwell elderly presenting to the ED. SRH is a simple and valuable tool to assess the elderly in the ED and to identify high-risk patients who would benefit from comprehensive geriatric assessment aimed at delaying such outcomes.
自我评估健康状况（SRH）已被证明是功能衰退和死亡率的可靠预测指标。然而，这些研究主要集中在健康的社区老年人身上。我们评估了SRH对于急诊就诊的急性病老年患者的预测价值是否仍然有效。
本研究是对从急诊科老年患者出院（DEED II）研究中获得的数据进行的二次分析。样本包括741名从急诊科出院回家的老年人。在入组时，询问患者SRH问题：“总体而言，您会说您的健康状况是极佳、非常好、良好、一般还是差？”在3、6、12和18个月时进行电话访谈。使用日常生活活动能力（ADL）的巴氏指数、改良的工具性日常生活活动能力（IADL）和简短便携式精神状态问卷（MSQ）评估功能状态。
在控制混杂因素后，一般/差的SRH预测死亡率的风险比为3.1（95%置信区间1.3 - 7.2，P = 0.010）。对于一般/差的SRH患者，ADL和IADL（但不包括MSQ）随时间的下降率也更为明显（ADL和IADL均P < 0.001）。一般/差的SRH在18个月时预测ADL下降的相对风险为3.4（95%置信区间1.7 - 7.1，P = 0.001）。SRH对IADL和MSQ的影响无统计学意义。
SRH预测功能衰退和死亡率的能力在急诊就诊的急性病老年患者中仍然存在。SRH是评估急诊科老年患者以及识别那些将从旨在延缓此类结局的综合老年评估中获益的高危患者的简单且有价值的工具。
