Binder E F, Robins L N
Department of Medicine, Jewish Hospital at Washington University, St. Louis, MO 63110.
J Am Geriatr Soc. 1990 Jul;38(7):759-66. doi: 10.1111/j.1532-5415.1990.tb01466.x.
We looked at performance on the Folstein Mini-Mental State Exam (MMSE) as a predictor of hospitalization and length of stay in the coming year in community-dwelling older persons from the National Institute of Mental Health Epidemiologic Catchment Area program. They had been assessed with the MMSE at the outset and were re-evaluated with the MMSE and a Health Services Questionnaire 1 year later. Subjects were more likely to be hospitalized in the subsequent year if they were older than 75 years or if they scored poorly on the MMSE. Severe cognitive impairment increased the risk more than mild impairment. Multivariate analyses that controlled for demographic variables demonstrate that MMSE performance is a significant predictor of any subsequent hospitalization (medical or psychiatric) among whites and among those at both high and low educational levels. This effect was not explained solely by the increased rate of psychiatric hospitalizations. We also determined that a decline in MMSE score over 1 year was associated with an increased risk of hospitalization, more hospital days, longer average length of stay, and a prolonged (greater than 20 days) hospital stay. We conclude that both initial poor performance on the MMSE and deterioration increase the risk of hospital use and lead to more extended hospital stays. However, even with poor MMSE performance, most older persons remain out of the hospital and most of those hospitalized do not have prolonged stays; thus, MMSE score alone is insufficient as a predictor of impending hospitalization. Further studies are needed to add other measures of risk for hospitalization and prolonged hospital stays.
我们研究了福尔斯坦简易精神状态检查表（MMSE）的测试结果，以此作为国立精神卫生研究所流行病学区域项目中社区居住老年人来年住院率及住院时长的预测指标。这些老年人在一开始接受了MMSE测试，并在一年后再次接受MMSE测试以及一份健康服务调查问卷评估。如果年龄超过75岁或MMSE测试得分较低，那么这些受试者在次年更有可能住院。严重认知障碍比轻度认知障碍更易增加住院风险。在对人口统计学变量进行控制的多变量分析中，MMSE测试结果是白人群体以及高学历和低学历人群随后是否住院（内科或精神科）的重要预测指标。这种影响并不仅仅由精神科住院率的上升来解释。我们还确定，MMSE得分在一年之内下降与住院风险增加、住院天数增多、平均住院时长变长以及住院时间延长（超过20天）相关。我们得出结论，MMSE测试初始表现不佳以及测试结果恶化都会增加住院几率，并导致住院时间延长。然而，即便MMSE测试表现不佳，大多数老年人仍未住院，而且大多数住院患者的住院时间也未延长；因此，仅凭MMSE得分不足以预测即将发生的住院情况。还需要进一步研究，以纳入其他住院及延长住院时间的风险衡量指标。
