Atlas Alvin, Grimmer Karen, Kennedy Kate
International Centre for Allied Health Evidence, University of South Australia, Adelaide, SA, Australia.
Clin Interv Aging. 2015 Apr 10;10:703-12. doi: 10.2147/CIA.S74613. eCollection 2015.
Accurately detecting markers of early functional decline (FD) are essential to support older people to successfully age in place; however, these markers are poorly understood. We tested the hypothesis that compromised mental quality of life after a minor health crisis could be an early predictor of FD.
This longitudinal observational cohort study was conducted in the emergency department (ED) of a large Australian hospital and in the community. Data were collected from 148 community-dwelling people aged 65+ years, who provided data at recruitment (baseline), and at 1 month and 3 months post discharge from the ED. Short Form-12 mental quality of life component scores (MCS) were regressed with patient descriptors taken at baseline (age, sex, socioeconomic status, education, Mini-Mental State Examination, and primary language), and over-time estimates of FD taken at baseline, and at 1 and 3 months post discharge (instrumental activities of daily living, frequency of falls and hospitalizations, use of gait aids, receipt of community services, living status, and requiring a carer).
MCS at 1 month (MCS1) post ED discharge was significantly associated with instrumental activities of daily living at 1 (r=0.45, P<0.001) and 3 months (r=0.401, P=0.001) post ED discharge, but not at baseline (r=0.010, P>0.05). Subjects with lower than the population median MCS showed a significant linear decline in total instrumental activities of daily living scores over 3 months (P=0.025). There was no linear trend over time in the relationship between MCS1 with frequency of falls (P=0.20) or hospitalizations (P=0.42); however, there was a significant difference at 3 months post ED discharge for falls (P=0.036) and hospitalizations (P=0.039) between low and high MCS1 groups. There were no significant confounders.
Low MCS scores 1 month after a minor health crisis appear to significantly predict downstream FD. This finding needs to be tested in a larger sample.
准确检测早期功能衰退（FD）的标志物对于支持老年人成功地居家养老至关重要；然而，这些标志物目前还知之甚少。我们检验了这样一个假设，即轻微健康危机后心理生活质量受损可能是FD的早期预测指标。
这项纵向观察性队列研究在一家大型澳大利亚医院的急诊科和社区中进行。数据收集自148名年龄在65岁及以上的社区居民，他们在招募时（基线）以及从急诊科出院后1个月和3个月提供了数据。简明健康调查问卷12项心理生活质量分量表得分（MCS）与基线时采集的患者描述指标（年龄、性别、社会经济地位、教育程度、简易精神状态检查表和主要语言）以及基线时、出院后1个月和3个月时的FD随时间变化的估计值（日常生活工具性活动、跌倒和住院频率、使用助行器、接受社区服务、生活状况以及是否需要护理人员）进行回归分析。
急诊科出院后1个月（MCS1）的MCS与出院后1个月（r = 0.45，P < 0.001）和3个月（r = 0.401，P = 0.001）的日常生活工具性活动显著相关，但与基线时无关（r = 0.010，P > 0.05）。MCS低于人群中位数的受试者在3个月内日常生活工具性活动总分呈显著线性下降（P = 0.025）。MCS1与跌倒频率（P = 0.20）或住院频率（P = 0.42）之间的关系随时间没有线性趋势；然而，在急诊科出院后3个月时，低MCS1组和高MCS1组在跌倒（P = 0.036）和住院（P = 0.039）方面存在显著差异。没有显著的混杂因素。
轻微健康危机后1个月的低MCS得分似乎能显著预测随后的FD。这一发现需要在更大的样本中进行验证。
