Section of Pulmonary and Critical Care Medicine, Department of Medicine, Yale University School of Medicine, 333 Cedar Street, PO Box 208057, New Haven, CT 06520-8057 USA.
Health Qual Life Outcomes. 2011 Feb 5;9:9. doi: 10.1186/1477-7525-9-9.
Accurate measurement of quality of life in older ICU survivors is difficult but critical for understanding the long-term impact of our treatments. Activities of daily living (ADLs) are important components of functional status and more easily measured than quality of life (QOL). We sought to determine the cross-sectional associations between disability in ADLs and QOL as measured by version one of the Short Form 12-item Health Survey (SF-12) at both one month and one year post-ICU discharge.
Data was prospectively collected on 309 patients over age 60 admitted to the Yale-New Haven Hospital Medical ICU between 2002 and 2004. Among survivors an assessment of ADL's and QOL was performed at one month and one-year post-ICU discharge. The SF-12 was scored using the version one norm based scoring with 1990 population norms. Multivariable regression was used to adjust the association between ADLs and QOL for important covariates.
Our analysis of SF-12 data from 110 patients at one month post-ICU discharge showed that depression and ADL disability were associated with decreased QOL. Our model accounted for 17% of variability in SF12 physical scores (PCS) and 20% of variability in SF12 mental scores (MCS). The mean PCS of 37 was significantly lower than the population mean whereas the mean MCS score of 51 was similar to the population mean. At one year mean PCS scores improved and ADL disability was no longer significantly associated with QOL. Mortality was 17% (53 patients) at ICU discharge, 26% (79 patients) at hospital discharge, 33% (105 patients) at one month post ICU admission, and was 45% (138 patients) at one year post ICU discharge.
In our population of older ICU survivors, disability in ADLs was associated with reduced QOL as measured by the SF-12 at one month but not at one year. Although better markers of QOL in ICU survivors are needed, ADLs are a readily observable outcome. In the meantime, clinicians must try to offer realistic estimates of prognosis based on available data and resources are needed to assist ICU survivors with impaired ADLs who wish to maintain their independence. More aggressive diagnosis and treatment of depression in this population should also be explored as an intervention to improve quality of life.
准确测量老年 ICU 幸存者的生活质量是困难的，但对于了解我们治疗的长期影响至关重要。日常生活活动（ADLs）是功能状态的重要组成部分，比生活质量（QOL）更容易测量。我们试图确定 ADL 残疾与 ICU 出院后一个月和一年时使用 12 项简短健康调查（SF-12）版本 1 测量的 QOL 之间的横断面关联。
前瞻性收集了 2002 年至 2004 年在耶鲁-纽黑文医院内科 ICU 住院的 309 名年龄超过 60 岁的患者的数据。在幸存者中，在 ICU 出院后一个月和一年时进行了 ADL 和 QOL 的评估。SF-12 使用基于 1990 年人群标准的版本 1 标准评分进行评分。多变量回归用于调整 ADL 和 QOL 之间的关联，以适应重要的协变量。
我们对 110 名 ICU 出院后一个月患者的 SF-12 数据进行了分析，结果表明抑郁和 ADL 残疾与 QOL 下降有关。我们的模型解释了 SF12 身体评分（PCS）变异的 17%和 SF12 心理评分（MCS）变异的 20%。37 的平均 PCS 明显低于人群平均值，而 51 的平均 MCS 分数与人群平均值相似。在一年时，平均 PCS 评分有所提高，ADL 残疾不再与 QOL 显著相关。ICU 出院时的死亡率为 17%（53 例），出院时为 26%（79 例），ICU 入住一个月后为 33%（105 例），ICU 出院一年后为 45%（138 例）。
在我们的老年 ICU 幸存者人群中，ADL 残疾与 SF-12 测量的一个月时的 QOL 降低有关，但与一年时无关。尽管 ICU 幸存者需要更好的 QOL 指标，但 ADLs 是一个易于观察的结果。与此同时，临床医生必须根据现有数据尝试提供预后的现实估计，并为希望保持独立的 ADL 受损的 ICU 幸存者提供资源。还应探讨在该人群中更积极地诊断和治疗抑郁症，作为改善生活质量的一种干预措施。
