State University of New York (SUNY) at Albany, School of Public Health, Rensselaer, NY 12144, USA.
J Am Med Dir Assoc. 2010 Feb;11(2):100-5. doi: 10.1016/j.jamda.2009.09.005. Epub 2010 Jan 6.
To compare physiological and functional impairments and their impact on health care use patterns among disabled older women with and without hip fracture.
Data from the 3-year longitudinal Women's Health and Aging Study I (WHAS-I) and Medicare Current Beneficiaries Survey (MCBS) were used for this comparison study. Outcome variables include physiological measures (eg, hip and knee strength, functional reach), functional impairments (ADLs, IADLs), and health care use (physician visits). Generalized Estimation Equation (GEE) models were used to examine the differences between groups on physiological and functional change and health service use over time.
Three-year crude mortality rates were significantly higher in the hip fracture group (25%) than in the comparison group (18%); however, statistical significance did not persist after adjusting for age, race, education, living arrangement, depression, and comorbidity (RR = 1.5; P = .17). All physiological and functional measures deteriorated over time, regardless of presence or absence of hip fractures. After adjusting for covariates, the fracture group was significantly worse in knee strength (beta = -0.91; P = .01), usual walking speed (beta = -0.04; P = .01) and rapid walking speed (beta = -0.05; P = .02), and worse IADL function (beta = 0.26; P = .002) than the non-hip fracture group. The rate of additional impairment for both hip fracture group and non-hip fracture group was 0.013 IADL units per month (P = .001). However, there were no significant differences in health care use between the groups.
In spite of worse physiological and IADL impairments, once the women recovered from hip fracture surgery, they did not necessarily use more health care resources than non-hip fracture patients. To prevent functional deterioration, interventions need to focus on knee strength and mobility training.
比较有和无髋部骨折的残疾老年女性的生理和功能障碍及其对医疗保健使用模式的影响。
本比较研究使用了为期 3 年的纵向妇女健康与衰老研究 I（WHAS-I）和 Medicare 当前受益调查（MCBS）的数据。结果变量包括生理测量（例如，髋部和膝关节力量、功能伸展）、功能障碍（ADL、IADL）和医疗保健使用（医生就诊）。使用广义估计方程（GEE）模型来检查两组在生理和功能变化以及随时间推移的健康服务使用方面的差异。
髋部骨折组（25%）的 3 年粗死亡率明显高于对照组（18%）；然而，在调整年龄、种族、教育、居住安排、抑郁和合并症后，统计学意义并不显著（RR=1.5；P=0.17）。无论是否存在髋部骨折，所有生理和功能测量均随时间恶化。在调整了混杂因素后，骨折组的膝关节力量（β=-0.91；P=0.01）、通常的步行速度（β=-0.04；P=0.01）和快速步行速度（β=-0.05；P=0.02）以及 IADL 功能更差（β=0.26；P=0.002），与非髋部骨折组相比。髋部骨折组和非髋部骨折组的额外损伤率均为每月 0.013 个 IADL 单位（P=0.001）。然而，两组在医疗保健使用方面没有显著差异。
尽管有更严重的生理和 IADL 障碍，但一旦女性从髋部骨折手术后恢复，她们并不一定比非髋部骨折患者使用更多的医疗保健资源。为了防止功能恶化，干预措施需要集中在膝关节力量和移动性训练上。
