老年人生命最后一年中足以限制活动的呼吸困难：患病率、模式及相关因素。
Breathlessness in Elderly Adults During the Last Year of Life Sufficient to Restrict Activity: Prevalence, Pattern, and Associated Factors.
作者信息
Johnson Miriam J, Bland J Martin, Gahbauer Evelyne A, Ekström Magnus, Sinnarajah Aynharan, Gill Thomas M, Currow David C
机构信息
Hull York Medical School, University of Hull, Hull, UK.
University of York, York, UK.
出版信息
J Am Geriatr Soc. 2016 Jan;64(1):73-80. doi: 10.1111/jgs.13865.
OBJECTIVES
To investigate relationships between age, clinical characteristics, and breathlessness sufficient to have people spend at least half a day a month in bed or to cut down on their usual activities (restricting breathlessness) during the last year of life.
DESIGN
Secondary data analysis.
SETTING
General community.
PARTICIPANTS
Nondisabled persons aged 70 and older (N=754).
MEASUREMENTS
Monthly telephone interviews were conducted to determine the occurrence of restricting breathlessness. The primary outcome was percentage of months with restricting breathlessness reported during the last year of life.
RESULTS
Data regarding breathlessness were available for 548 of 589 (93.0%) participants who died (mean age 86.7, range 71-106; 38.8% male) between enrollment (March 1998 to October 1999) and June 2013; 311 of these (56.8%) reported restricting breathlessness at some point during the last year of life, but none reported it every month. Frequency increased in the months closer to death, irrespective of cause. Restricting breathlessness was associated with anxiety (0.25 percentage points greater in months with breathlessness per percentage point months reported anxiety, 95% confidence interval (CI)=0.16-0.34, P<.001), depression (0.14, 95% CI=0.05-0.24, P=.003), and mobility problems (0.07, 0.03-0.1, P<.001). Percentage months of restricting breathlessness was greater if chronic lung disease was noted at the most-recent comprehensive assessment (6.62 percentage points, 95% CI=4.31-8.94, P<.001), heart failure (3.34 percentage points, 95% CI=0.71-5.97, P=.01), and ex-smoker status (3.01 percentage points, 95% CI=0.94-5.07, P=.004) but decreased with older age (-0.19 percentage points, 95% CI=-0.37 to -0.02, P=.03).
CONCLUSION
Restricting breathlessness increased in this elderly population in the months preceding death from any cause. Breathlessness should be assessed and managed in the context of poor prognosis.
目的
研究年龄、临床特征与呼吸困难之间的关系，这些呼吸困难足以让人们在生命的最后一年每月至少有半天卧床或减少日常活动（限制呼吸困难）。
设计
二次数据分析。
地点
普通社区。
参与者
70岁及以上的非残疾人士（N = 754）。
测量
每月进行电话访谈以确定限制呼吸困难的发生情况。主要结局是生命最后一年报告的有呼吸困难限制的月份百分比。
结果
在入组（1998年3月至1999年10月）至2013年6月期间死亡的589名参与者（平均年龄86.7岁，范围71 - 106岁；男性占38.8%）中，有548名（93.0%）的呼吸困难数据可用；其中311名（56.8%）报告在生命的最后一年的某个时候有呼吸困难限制，但无人报告每月都有。无论病因如何，在临近死亡的月份中，频率都会增加。限制呼吸困难与焦虑相关（报告焦虑的月份每增加一个百分点，有呼吸困难的月份增加0.25个百分点，95%置信区间（CI）= 0.16 - 0.34，P <.001）、抑郁（0.14，95% CI = 0.05 - 0.24，P =.003）和行动不便（0.07，0.03 - 0.1，P <.001）。如果在最近的综合评估中发现有慢性肺病（6.62个百分点，95% CI = 4.31 - 8.94，P <.001）、心力衰竭（3.34个百分点，95% CI = 0.71 - 5.97，P =.01）和曾经吸烟状态（3.01个百分点，95% CI = 0.94 - 5.07，P =.004），则有呼吸困难限制的月份百分比会更高，但随着年龄增长而降低（-0.19个百分点，95% CI = -0.37至 -0.02，P =.03）。
结论
在该老年人群中，无论何种病因导致的死亡，在临近死亡的月份中，限制呼吸困难的情况都会增加。对于预后不良的情况，应评估和处理呼吸困难。
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