Geriatric Medicine Research Unit, Dalhousie University & Capital District Health Authority, Halifax, NS, Canada.
J Gen Intern Med. 2011 Dec;26(12):1471-8. doi: 10.1007/s11606-011-1821-7. Epub 2011 Aug 16.
Archetypal symptoms and signs are commonly absent in frail older people who are acutely unwell. This challenges both recognition of illness and monitoring of disease progression in people at high risk of prolonged hospital stays, institutionalization and death.
To determine whether bedside assessment of balance and mobility could track acute changes in the health status of older people admitted to hospital.
Prospective cohort study.
Four hundred nine patients, with a mean age of 81.8 years, admitted to general medical and rehabilitation wards at a tertiary care teaching hospital in Halifax, Nova Scotia. No patient refused assessment, and the only exclusion criterion was age.
The Hierarchical Assessment of Balance and Mobility (HABAM) was completed daily during the first 2 weeks of admission. For each patient, frailty status was measured on admission by a Frailty Index based on a Comprehensive Geriatric Assessment (FI-CGA).
Death and discharge destination.
Poor performance in balance, transfers and mobility was associated with adverse outcomes. Forty-eight percent of patients with the lowest scores in all three domains died, compared with none with the highest scores. The relative risk of death for people who deteriorated during the first 48 h of admission was 17.1 (95% confidence interval: 4.9-60.3). Changes in HABAM scores were related to the discharge destination: patients discharged home showed the greatest rate of improvement, whereas those discharged to institutions stabilised at a lower level of performance. Fitter patients tended to have better performance on admission and faster recovery.
Daily bedside observation of mobility and balance allows assessment of acute changes in the health of older people. Frailty slows recovery of mobility and balance, and reduces recovery potential. By identifying patients most vulnerable to adverse outcomes, the HABAM and FI-CGA may facilitate risk stratification in older people admitted to hospital.
虚弱的老年人在急性病发作时通常没有典型的症状和体征。这不仅对识别疾病构成挑战，也对监测那些有长时间住院、住院后转入疗养院或死亡风险较高的患者的疾病进展构成挑战。
确定床边评估平衡和活动能力是否可以跟踪住院老年患者健康状况的急性变化。
前瞻性队列研究。
409 名患者，平均年龄 81.8 岁，入住新斯科舍省哈利法克斯一家三级保健教学医院的普通内科和康复病房。没有患者拒绝评估，唯一的排除标准是年龄。
在入院后的头 2 周内，每天进行分层平衡和活动能力评估（HABAM）。每位患者入院时，根据综合老年评估（FI-CGA）的衰弱指数（FI）来评估衰弱状态。
死亡和出院去向。
平衡、转移和活动能力较差与不良结局相关。在所有三个领域得分最低的 48%患者死亡，而得分最高的患者无一例死亡。入院前 48 小时病情恶化患者的死亡相对风险为 17.1（95%置信区间：4.9-60.3）。HABAM 评分的变化与出院去向有关：出院回家的患者改善程度最大，而转至疗养院的患者则稳定在较低的活动能力水平。身体更健康的患者在入院时的表现往往更好，恢复速度也更快。
每天床边观察活动能力和平衡能力可以评估老年人健康状况的急性变化。衰弱会减缓活动能力和平衡能力的恢复，并降低恢复的可能性。HABAM 和 FI-CGA 通过识别最易发生不良结局的患者，可能有助于对住院老年患者进行风险分层。
