Norberg Eva-Britt, Boman Kurt, Löfgren Britta
Skellefteå County Hospital, Skellefteå, Sweden.
Scand J Caring Sci. 2008 Jun;22(2):203-10. doi: 10.1111/j.1471-6712.2007.00514.x.
Chronic heart failure (CHF) is a common condition among Europe's aging population. Findings indicate that CHF patients must make significant changes in many aspects of daily life. Previous studies of older primary health-care participants and their activities of daily living (ADL)-ability are rare. The aim of this study was to describe ADL-ability in older people with CHF syndrome. The factors considered were dependence on others, perceived strain, quality of performance, and the association between The New York Heart Association classification (NYHA) and ADL-ability. The participants, recruited from a primary health-care centre, had symptoms indicating CHF and were diagnosed by a cardiologist. Forty persons over 65 years (mean age 81), participated in the study and self-reported co-morbidity was frequent. The Assessment of Motor and Process Skills (AMPS) and the Staircase of ADL were used to describe ADL-ability. Most participants were independent with respect to personal activities of daily living (PADL), and 75% were dependent in one or more instrumental activities of daily living (IADL), usually shopping. Most participants perceived strain, and only three could perform all ADL without strain. Age had a significant impact on ADL performance (motor measures: OR 7.11, CI 1.19-42.32, p = 0.031 and process measures: OR 8.49, CI 1.86-38.79, p = 0.006). However, participants showed lower ADL motor and process ability in AMPS compared with well persons of the same age. Participants in NYHA III/IV (adjusted for age), had significantly increased effort (under motor cut-off) when performing ADL-tasks (OR: 15.5, CI 2.40-100.1, p = 0.004) compared to those in NYHA I/II. Older persons in primary health care with CHF exhibit a high amount of dependence, perceived strain and increased effort during performance of ADL. There is an association between NYHA class III/IV and a decreased ADL-ability (AMPS motor ability) even when adjusted for age.
慢性心力衰竭（CHF）在欧洲老龄化人口中是一种常见病症。研究结果表明，CHF患者必须在日常生活的许多方面做出重大改变。以往针对老年初级医疗保健参与者及其日常生活活动（ADL）能力的研究很少。本研究的目的是描述患有CHF综合征的老年人的ADL能力。所考虑的因素包括对他人的依赖、感知到的压力、表现质量，以及纽约心脏协会分级（NYHA）与ADL能力之间的关联。参与者从一个初级医疗保健中心招募，有CHF症状并由心脏病专家诊断。40名65岁以上（平均年龄81岁）的人参与了研究，自我报告的合并症很常见。使用运动和过程技能评估（AMPS）以及ADL阶梯来描述ADL能力。大多数参与者在个人日常生活活动（PADL）方面是独立的，75%的人在一项或多项工具性日常生活活动（IADL）方面存在依赖，通常是购物。大多数参与者感到有压力，只有三人能够毫无压力地完成所有ADL。年龄对ADL表现有显著影响（运动指标：比值比[OR]7.11，置信区间[CI]1.19 - 42.32，p = 0.031；过程指标：OR 8.49，CI 1.86 - 38.79，p = 0.006）。然而，与同年龄的健康人相比，参与者在AMPS中的ADL运动和过程能力较低。与NYHA I/II级的参与者相比，NYHA III/IV级（年龄校正后）的参与者在执行ADL任务时（低于运动临界值）努力程度显著增加（OR：15.5，CI 2.40 - 100.1，p = 0.004）。初级医疗保健中患有CHF的老年人在ADL执行过程中表现出高度的依赖性、感知到的压力和增加的努力程度。即使在年龄校正后，NYHA III/IV级与ADL能力（AMPS运动能力）下降之间也存在关联。
