Cheryl Spencer Department of Nursing, University of Haifa, Haifa, Israel.
J Am Geriatr Soc. 2011 Feb;59(2):266-73. doi: 10.1111/j.1532-5415.2010.03276.x.
To examine the association between mobility levels of older hospitalized adults and functional outcomes.
Prospective cohort study.
A 900-bed teaching hospital in Israel.
Five hundred twenty-five older (≥70) acute medical patients hospitalized for a nondisabling condition.
In-hospital mobility was assessed using a previously validated scale. The main outcomes were decline from premorbid baseline functional status at discharge (activities of daily living (ADLs)) and at 1-month follow-up (ADLs and instrumental ADLs (IADLs)). Hospital mobility levels and functional outcomes were assessed according to prehospitalization functional trajectories. Logistic regressions were modeled for each outcome, controlling for functional status, morbidity, and demographic characteristics.
Forty-six percent of participants had declined in ADLs at discharge and 49% at follow-up; 57% had declined in IADLs at follow-up. Mobility during hospitalization was twice as high in participants with no preadmission functional decline. Low versus high in-hospital mobility was associated with worse basic functional status at discharge (adjusted odds ratio (AOR)=18.03, 95% confidence interval (CI)=7.68-42.28) and at follow-up (AOR=4.72, 95% CI=1.98-11.28) and worse IADLs at follow-up (AOR=2.00, 95% CI=1.05-3.78). The association with poorer discharge functional outcomes was present in participants with preadmission functional decline (AOR for low vs high mobility=15.26, 95% CI=4.80-48.42) and in those who were functionally stable (AOR for low vs high mobility=10.12, 95% CI=2.28-44.92).
In-hospital mobility is an important modifiable factor related to functional decline in older adults in immediate and short-term (1-month follow-up) functional outcomes.
研究老年住院患者的活动水平与功能结局之间的关系。
前瞻性队列研究。
以色列一家 900 张床位的教学医院。
525 名年龄≥70 岁的急性内科患者，因非致残性疾病住院。
使用先前验证过的量表评估住院期间的活动能力。主要结局为出院时（日常生活活动 (ADLs)）和 1 个月随访时（ADLs 和工具性日常生活活动 (IADLs)）与发病前基线功能状态相比的功能下降。根据住院前的功能轨迹评估医院活动水平和功能结局。为每个结局建模逻辑回归，控制功能状态、发病率和人口统计学特征。
46%的参与者在出院时 ADLs 下降，49%在随访时下降；57%在随访时 IADLs 下降。在无入院前功能下降的参与者中，住院期间的活动能力提高了一倍。与高活动水平相比，低活动水平与出院时基本功能状态较差相关（调整后优势比（AOR）=18.03，95%置信区间（CI）=7.68-42.28）和随访时（AOR=4.72，95% CI=1.98-11.28），以及随访时 IADLs 更差（AOR=2.00，95% CI=1.05-3.78）。在有入院前功能下降的参与者（低活动水平与高活动水平相比的 AOR=15.26，95% CI=4.80-48.42）和功能稳定的参与者（低活动水平与高活动水平相比的 AOR=10.12，95% CI=2.28-44.92）中，与较差的出院功能结局相关。
住院期间的活动能力是与老年患者即时和短期（1 个月随访）功能结局相关的重要可改变因素。
