住院后生活空间移动轨迹。
Trajectories of life-space mobility after hospitalization.
作者信息
Brown Cynthia J, Roth David L, Allman Richard M, Sawyer Patricia, Ritchie Christine S, Roseman Jeffrey M
机构信息
Birmingham Veterans Affairs Medical Center, 11G, 700 South 19th Street, Birmingham, AL 35233, USA.
出版信息
Ann Intern Med. 2009 Mar 17;150(6):372-8. doi: 10.7326/0003-4819-150-6-200903170-00005.
BACKGROUND
Life space is a measure of where a person goes, the frequency of going there, and the dependency in getting there. It may be a more accurate measure of mobility in older adults because it reflects participation in society as well as physical ability.
OBJECTIVE
To assess effects of hospitalization on life space in older adults, and to compare life-space trajectories associated with surgical and nonsurgical hospitalizations.
DESIGN
Prospective observational study.
SETTING
Central Alabama.
PARTICIPANTS
687 community-dwelling Medicare beneficiaries at least 65 years of age with surgical (n = 44), nonsurgical (n = 167), or no (n = 476) hospitalizations.
MEASUREMENTS
Life-Space Assessment (LSA) scores before and after hospitalization (range, 0 to 120; higher scores reflect greater mobility).
RESULTS
Mean age of participants was 74.6 years (SD, 6.3). Fifty percent were black, and 46% were male. Before hospitalization, adjusted LSA scores were similar in participants with surgical and nonsurgical admissions. Life-space assessment scores decreased in both groups immediately after hospitalization; however, participants with surgical hospitalizations had a greater decrease in scores (12.1 more points [95% CI, 3.6 to 20.7 points]; P = 0.005) than those with nonsurgical hospitalizations. However, participants with surgical hospitalizations recovered more rapidly over time (gain of 4.7 more points [CI, 2.0 to 7.4 points] per ln [week after discharge]; P < 0.001). Score recovery for participants with nonsurgical hospitalizations did not significantly differ from the null (average recovery, 0.7 points [CI, -0.6 to 1.9 points] per ln [week after discharge]).
LIMITATION
Life space immediately before and after hospitalization was self-reported, often after hospital discharge.
CONCLUSION
Hospitalization decreases life space in older adults. Surgical hospitalizations are associated with immediate marked life-space declines followed by rapid recovery, in contrast to nonsurgical hospitalizations, which are associated with more modest immediate declines and little evidence of recovery after several years of follow-up.
PRIMARY FUNDING SOURCE
National Institute on Aging.
背景
生活空间是衡量一个人去哪里、去那里的频率以及到达那里的依赖程度的指标。它可能是衡量老年人活动能力的更准确指标，因为它反映了社会参与度以及身体能力。
目的
评估住院治疗对老年人生活空间的影响，并比较与手术和非手术住院相关的生活空间轨迹。
设计
前瞻性观察性研究。
地点
阿拉巴马州中部。
参与者
687名年龄至少65岁的社区医保受益人，其中有手术住院经历的（n = 44）、非手术住院经历的（n = 167）或无住院经历的（n = 476）。
测量指标
住院前后的生活空间评估（LSA）分数（范围为0至120；分数越高反映活动能力越强）。
结果
参与者的平均年龄为74.6岁（标准差为6.3）。50%为黑人，46%为男性。住院前，手术和非手术入院参与者的调整后LSA分数相似。两组在住院后即刻生活空间评估分数均下降；然而，手术住院参与者的分数下降幅度更大（多下降12.1分[95%置信区间，3.6至 20.7分]；P = 0.005），高于非手术住院参与者。不过，手术住院参与者随着时间推移恢复得更快（出院后每ln[周]增加4.7分[置信区间，2.0至7.4分]；P < 0.001）。非手术住院参与者的分数恢复与零无显著差异（平均恢复，出院后每ln[周]0.7分[置信区间，-0.6至1.9分]）。
局限性
住院前后的生活空间是自我报告的，通常在出院后。
结论
住院会降低老年人的生活空间。与非手术住院相比，手术住院会导致生活空间立即显著下降，随后迅速恢复，而非手术住院则导致生活空间立即下降幅度较小，且在数年随访后几乎没有恢复迹象。
主要资金来源
美国国立衰老研究所。
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