Gill Thomas M, Gahbauer Evelyne A, Han Ling, Allore Heather G
Department of Internal Medicine, Yale University School of Medicine, Dorothy Adler Geriatric Assessment Center, 20 York Street, New Haven, CT 06504, USA.
J Gerontol A Biol Sci Med Sci. 2009 Dec;64(12):1296-303. doi: 10.1093/gerona/glp115. Epub 2009 Aug 6.
The objective of this study was to identify the factors associated with recovery of prehospital function among older persons admitted to a nursing home with disability after an acute hospitalization.
The analytic sample included 292 participants of an ongoing cohort study who had one or more admissions to a nursing home with disability after an acute hospitalization during nearly 10 years of follow-up, yielding a total of 364 "index" nursing home admissions. Information on nursing home admissions, hospitalizations, and disability in essential activities of daily living was ascertained during monthly telephone interviews. Data on potential predictors of functional recovery were collected during comprehensive assessments, which were completed every 18 months for 90 months. Participants were considered to have recovered if they were discharged home within 6 months of their nursing home admission at (or above) their prehospital level of function.
Recovery of prehospital function was observed for 115 (31.6%) of the 364 index nursing home admissions. In the multivariate analysis, the strongest associations were observed for the best category of performance, relative to the poorest category, for gross motor coordination (hazard ratio [HR] 13.5, 95% confidence interval [CI] 4.02-45.0) and manual dexterity (HR 10.0, 95% CI 2.94-34.3). Only two other factors were independently associated with recovery of prehospital function: not cognitively impaired (HR 3.0, 95% CI 1.46-6.14) and no significant weight loss (HR 1.96, 95% CI 1.06-3.63).
In the setting of an acute hospitalization leading to a nursing home admission with disability, the likelihood of recovering prehospital function is low. The factors associated with recovery include faster performance on tests of gross motor coordination and manual dexterity and the absence of cognitive impairment and significant weight loss.
本研究的目的是确定急性住院后入住残疾护理院的老年人院前功能恢复的相关因素。
分析样本包括一项正在进行的队列研究中的292名参与者，他们在近10年的随访期间因急性住院后有一次或多次入住残疾护理院，共产生364次“索引”护理院入院。在每月的电话访谈中确定护理院入院、住院情况以及日常生活基本活动中的残疾信息。在每18个月进行一次、共90个月的综合评估中收集功能恢复潜在预测因素的数据。如果参与者在护理院入院后6个月内出院回家时功能达到（或高于）院前水平，则认为其已恢复。
364次索引护理院入院中有115次（31.6%）观察到院前功能恢复。在多变量分析中，相对于最差类别，在粗大运动协调（风险比[HR]13.5，95%置信区间[CI]4.02 - 45.0）和手部灵活性（HR 10.0，95% CI 2.94 - 34.3）方面表现最佳的类别与恢复的关联最强。只有另外两个因素与院前功能恢复独立相关：无认知障碍（HR 3.0，95% CI 1.46 - 6.14）和无显著体重减轻（HR 1.96，95% CI 1.06 - 3.63）。
在导致入住残疾护理院的急性住院情况下，院前功能恢复的可能性较低。与恢复相关的因素包括粗大运动协调和手部灵活性测试表现更快，以及无认知障碍和显著体重减轻。
