School of Industrial Engineering, Purdue University, West Lafayette, IN, USA.
Int J Gen Med. 2013;6:145-51. doi: 10.2147/IJGM.S40576. Epub 2013 Mar 14.
Two primary objectives when caring for older adults are to slow the decline to a worsened frailty state and to prevent disability. Telemedicine may be one method of improving care in this population. We conducted a secondary analysis of the Tele-ERA study to evaluate the effect of home telemonitoring in reducing the rate of deterioration into a frailty state and death in older adults with comorbid health problems.
This trial involved 205 adults over the age of 60 years with a high risk of hospitalization and emergency department visits. For 12 months, the intervention group received usual medical care and telemonitoring case management, and the control group received usual care alone. The primary outcome was frailty, which was based on five criteria, ie, weight loss, weakness, exhaustion, low activity, and slow gait speed. Participants were classified as frail if they met three or more criteria; prefrail if they met 1-2 criteria; and not frail if they met no criteria. Both groups were assessed for frailty at baseline, and at 6 and 12 months. Frailty transition analyses were performed using a multiple logistic regression method. Kaplan-Meier and Cox proportional hazards methods were used to evaluate each frailty criteria for mortality and to compute unadjusted hazard ratios associated with being telemonitored, respectively. A retrospective power analysis was computed.
During the first 6 months, 19 (25%) telemonitoring participants declined in frailty status or died, compared with 17 (19%) in usual care (odds ratio 1.41, 95% confidence interval [CI] 0.65-3.06, P = 0.38). In the subsequent 6 months, there was no transition to a frailty state, but seven (7%) participants from the telemonitoring and one (1%) from usual care group died (odds ratio 5.94, 95% CI 0.52-68.48, P = 0.15). Gait speed (hazards ratio 3.49, 95% CI 1.42-8.58) and low activity (hazards ratio 3.10, 95% CI 1.25-7.71) were shown to predict mortality.
This study did not provide sufficient evidence to show that the telemonitoring group did better than usual care in reducing the decline of frailty states and death. Transitions occurred primarily in the first 6 months.
照顾老年人的两个主要目标是减缓向更严重虚弱状态的下降速度和预防残疾。远程医疗可能是改善该人群护理的一种方法。我们对 Tele-ERA 研究进行了二次分析，以评估家庭远程监测在降低患有合并健康问题的老年人恶化至虚弱状态和死亡的速度方面的效果。
这项试验涉及 205 名年龄在 60 岁以上、有住院和急诊就诊高风险的成年人。在 12 个月的时间里，干预组接受常规医疗护理和远程监测病例管理，对照组仅接受常规护理。主要结局是虚弱，基于五个标准，即体重减轻、虚弱、疲惫、低活动量和缓慢的步行速度。如果满足三个或更多标准，则将参与者归类为虚弱；如果满足 1-2 个标准，则归类为虚弱前期；如果没有满足任何标准，则归类为不虚弱。两组均在基线、6 个月和 12 个月时评估虚弱状态。使用多因素逻辑回归方法进行虚弱状态转移分析。使用 Kaplan-Meier 和 Cox 比例风险方法分别评估每个虚弱标准的死亡率，并计算与远程监测相关的未调整风险比。进行了回顾性功效分析。
在最初的 6 个月内，19 名（25%）远程监测参与者的虚弱状态或死亡状况恶化，而常规护理组有 17 名（19%）（比值比 1.41，95%置信区间 [CI] 0.65-3.06，P = 0.38）。在随后的 6 个月内，没有向虚弱状态转变，但远程监测组有 7 名（7%）参与者和常规护理组有 1 名（1%）参与者死亡（比值比 5.94，95% CI 0.52-68.48，P = 0.15）。步行速度（风险比 3.49，95% CI 1.42-8.58）和低活动量（风险比 3.10，95% CI 1.25-7.71）被证明可预测死亡率。
本研究没有提供足够的证据表明远程监测组在降低虚弱状态和死亡的下降速度方面优于常规护理。转变主要发生在最初的 6 个月内。
