Geriatric Research, Education and Clinical Center Veterans Affairs Tennessee Valley Healthcare, Nashville, Tennessee 37212, USA.
J Am Geriatr Soc. 2012 Sep;60(9):1632-7. doi: 10.1111/j.1532-5415.2012.04121.x.
To determine whether cumulative symptom burden predicts hospitalization or emergency department (ED) visits in a cohort of older adults.
Prospective, observational study with a baseline in-home assessment of symptom burden.
Central Alabama.
Nine hundred eighty community-dwelling adults aged 65 and older (mean 75.3 ± 6.7) recruited from a random sample of Medicare beneficiaries stratified according to sex, race, and urban/rural residence.
Symptom burden score (range 0-10). One point was given for each symptom reported: shortness of breath, tiredness or fatigue, problems with balance or dizziness, leg weakness, poor appetite, pain, stiffness, constipation, anxiety, and loss of interest in activities. Dependent variables were hospitalizations and ED visits, assessed every 6 months during the 8.5-year follow-up period. Using Cox proportional hazards models, time from the baseline in-home assessment to the first hospitalization and first hospitalization or ED visit was determined.
During the 8.5-year follow-up period, 545 (55.6%) participants were hospitalized or had an ED visit. Participants with greater symptom burden had higher risk of hospitalization (hazard ratio (HR) = 1.09, 95% confidence interval (CI) = 1.05-1.14) and hospitalization or ED visit (HR = 1.10, 95% CI = 1.06-1.14) than those with lower scores. Participants living in rural areas had significantly lower risk of hospitalization (HR = 0.83, 95% CI = 0.69-0.99) and hospitalization or ED visit (HR = 0.80, 95% CI = 0.70-0.95) than individuals in urban areas, independent of symptom burden and comorbidity.
Greater symptom burden was associated with higher risk of hospitalization and ED visits in community-dwelling older adults. Healthcare providers treating older adults should consider symptom burden to be an additional risk factor for subsequent hospital utilization.
在一组老年患者中，确定累积症状负担是否预测住院或急诊就诊。
前瞻性观察研究，在基线进行家庭评估症状负担。
阿拉巴马州中部。
980 名年龄在 65 岁及以上的社区居住成年人（平均年龄 75.3 ± 6.7），从按性别、种族和城乡居住分层的 Medicare 受益人的随机样本中招募。
症状负担评分（范围 0-10）。报告的每个症状计 1 分：呼吸急促、疲倦或疲劳、平衡或头晕问题、腿部无力、食欲不振、疼痛、僵硬、便秘、焦虑和对活动失去兴趣。依赖变量是住院和急诊就诊，在 8.5 年随访期间每 6 个月评估一次。使用 Cox 比例风险模型，确定从基线家庭评估到首次住院和首次住院或急诊就诊的时间。
在 8.5 年的随访期间，545 名（55.6%）参与者住院或急诊就诊。症状负担较高的参与者住院风险更高（风险比（HR）=1.09，95%置信区间（CI）=1.05-1.14）和住院或急诊就诊（HR = 1.10，95% CI = 1.06-1.14）比得分较低的参与者。与城市地区的个体相比，居住在农村地区的参与者住院风险显著降低（HR = 0.83，95% CI = 0.69-0.99）和住院或急诊就诊（HR = 0.80，95% CI = 0.70-0.95），独立于症状负担和合并症。
在社区居住的老年人中，更大的症状负担与更高的住院和急诊就诊风险相关。治疗老年人的医疗保健提供者应将症状负担视为后续住院利用的附加风险因素。
