University of Reims Champagne-Ardenne, Faculty of Medicine, EA3797, Reims, France.
J Am Med Dir Assoc. 2012 Jun;13(5):453-8. doi: 10.1016/j.jamda.2011.10.002. Epub 2011 Nov 13.
To assess whether health-related quality of life is an independent prognostic factor for mortality or nursing home placement in frail elderly patients.
A prospective, multicenter study with a 12-month follow-up.
Nine French hospitals.
A total of 1306 patients aged 75 and older hospitalized through an emergency department.
Data obtained from sociodemographic characteristics, Comprehensive Geriatric Assessment and the Duke Health Profile (DHP) were used into a Cox model to identify prognostic variables for 12-month mortality and institutionalization.
Crude mortality and nursing home placement rates were 34.1% (n = 445) and 16.1% (n = 210), respectively. Independent prognostic factors identified for mortality were: Comorbidity level (moderate: hazard ratio [HR] [95% confidence interval (CI)] = 1.40 [1.09-1.78]; severe: 2.70 [1.63-4.46]), dependence for activities of daily living (1.68 [1.06-2.67]), pressure sore risk (1.49 [1.16-1.90]), risk of malnutrition (2.09 [1.46-3.00]), delirium (2.25 [1.75-2.90]), and 10-point increase in the DHP perceived health score (0.96 [0.93-0.99]). Independent prognostic factors identified for nursing home placement were the following: living alone at home (1.82 [1.30-2.55]), having 2 children or more (0.71 [0.51-0.99]), dependence for activities of daily living (2.48 [1.39-4.44]), dementia (1.93 [1.39-2.69]), unplanned hospital readmission during follow-up (2.05 [1.45-2.91]), and 10-point increase in the DHP social health score (0.90 [0.83-0.99]). Balance troubles and risk of malnutrition were no more significant when adjusted for the DHP scores and other clinical variables.
The perceived health and social health scores of the DHP were independent prognostic factors of survival and nursing home placement among hospitalized elderly patients, respectively. When associated with Comprehensive Geriatric Assessment, they could help screen frail patients to set up as early as possible targeted interventions to restore/maintain modifiable prognostic factors, such as nutritional status, functional ability, and social support.
评估健康相关生活质量是否为虚弱老年人患者死亡率或入住养老院的独立预后因素。
一项具有 12 个月随访的前瞻性、多中心研究。
法国 9 家医院。
1306 名年龄在 75 岁及以上并通过急诊住院的患者。
使用社会人口统计学特征、综合老年评估和杜克健康状况问卷（DHP）的数据，建立 Cox 模型以确定 12 个月死亡率和机构化的预后变量。
粗死亡率和养老院入住率分别为 34.1%（n=445）和 16.1%（n=210）。死亡率的独立预后因素包括：合并症程度（中度：风险比[HR] [95%置信区间（CI）]=1.40 [1.09-1.78]；严重：2.70 [1.63-4.46]）、日常生活活动能力依赖（1.68 [1.06-2.67]）、压疮风险（1.49 [1.16-1.90]）、营养不良风险（2.09 [1.46-3.00]）、谵妄（2.25 [1.75-2.90]）和 DHP 感知健康评分增加 10 分（0.96 [0.93-0.99]）。养老院入住的独立预后因素包括：独自在家居住（1.82 [1.30-2.55]）、有 2 个或更多孩子（0.71 [0.51-0.99]）、日常生活活动能力依赖（2.48 [1.39-4.44]）、痴呆（1.93 [1.39-2.69]）、随访期间计划外住院再入院（2.05 [1.45-2.91]）和 DHP 社会健康评分增加 10 分（0.90 [0.83-0.99]）。调整 DHP 评分和其他临床变量后，平衡问题和营养不良风险不再显著。
DHP 的感知健康和社会健康评分分别是住院老年患者生存和入住养老院的独立预后因素。与综合老年评估相结合，它们可以帮助筛选虚弱患者，尽早进行有针对性的干预，以恢复/维持可改变的预后因素，如营养状况、功能能力和社会支持。
