Junius-Walker Ulrike, Wiese Birgitt, Klaaßen-Mielke Renate, Theile Gudrun, Müller Christiane Annette, Hummers-Pradier Eva
Institute of General Practice, Hannover Medical School, Hannover, Germany.
Department of Medical Informatics, Biometry and Epidemiology, Ruhr-University, Bochum, Germany.
Patient Prefer Adherence. 2015 Jun 18;9:811-20. doi: 10.2147/PPA.S81348. eCollection 2015.
Older patients often experience the burden of multiple health problems. Physicians need to consider them to arrive at a holistic treatment plan. Yet, it has not been systematically investigated as to which personal burdens ensue from certain health conditions.
The objective of this study is to examine older patients' perceived burden of their health problems.
The study presents a cross-sectional analysis in 74 German general practices; 836 patients, 72 years and older (mean 79±4.4), rated the burden of each health problem disclosed by a comprehensive geriatric assessment. Patients rated each burden using three components: importance, emotional impact, and impact on daily activities. Cluster analyses were performed to define patterns in the rating of these components of burden. In a multilevel logistic regression analysis, independent factors that predict high and low burden were explored.
Patients had a median of eleven health problems and rated the burden of altogether 8,900 health problems. Four clusters provided a good clustering structure. Two clusters describe a high burden, and a further two, a low burden. Patients attributed a high burden to social and psychological health problems (especially being a caregiver: odds ratio [OR] 10.4, 95% confidence interval [CI] 4.4-24.4), to specific symptoms (eg, claudication: OR 2.3, 95% CI 1.3-4.0; pain: OR 2.3, 95% CI 1.6-3.1), and physical disabilities. Patients rated a comparatively low burden for most of their medical findings, for cognitive impairment, and lifestyle issues (eg, hypertension: OR 0.2, 95% CI 0.2-0.3).
The patients experienced a relatively greater burden for physical disabilities, mood, or social issues than for diseases themselves. Physicians should interpret these burdens in the individual context and consider them in their treatment planning.
老年患者常常承受多种健康问题带来的负担。医生需要考虑这些问题，以制定全面的治疗方案。然而，关于某些健康状况会导致哪些个人负担，尚未进行系统研究。
本研究的目的是调查老年患者对自身健康问题的感知负担。
本研究对74家德国普通诊所进行了横断面分析；836名72岁及以上（平均79±4.4岁）的患者对综合老年评估中披露的每个健康问题的负担进行了评分。患者使用重要性、情感影响和对日常活动的影响这三个方面对每个负担进行评分。进行聚类分析以确定这些负担方面评分的模式。在多水平逻辑回归分析中，探索预测高负担和低负担的独立因素。
患者平均有11个健康问题，并对总共8900个健康问题的负担进行了评分。四个聚类提供了良好的聚类结构。两个聚类描述了高负担，另外两个描述了低负担。患者将高负担归因于社会和心理健康问题（尤其是作为照顾者：比值比[OR]10.4，95%置信区间[CI]4.4 - 24.4）、特定症状（如间歇性跛行：OR 2.3，95%CI 1.3 - 至4.0；疼痛：OR 2.3，95%CI 1.6 - 3.1）以及身体残疾。患者对大多数医学检查结果、认知障碍和生活方式问题（如高血压：OR 0.2，95%CI 0.2 - 0.3）的负担评分相对较低。
患者在身体残疾、情绪或社会问题上感受到的负担相对大于疾病本身。医生应在个体背景下解读这些负担，并在治疗规划中予以考虑。
