Nielsen Anni Brit Sternhagen, Siersma Volkert, Waldemar Gunhild, Waldorff Frans Boch
The Research Unit and Section of General Practice, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark.
Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
BMC Geriatr. 2016 Apr 19;16:87. doi: 10.1186/s12877-016-0262-x.
Self-rated health (SRH) has in many population-based studies predicted adverse health outcomes, e.g. morbidity, permanent nursing home (NH) placement, and mortality. However, the predictive value of SRH to NH placement and mortality among elderly people is not consistent. This may be due to cognitive impairment. Since the SRH item is widely used, it is important to know whether SRH has different predictive value among people with cognitive impairments. We aimed to examine SRH and the risk of permanent NH placement and mortality among people with mild Alzheimer's disease (AD).
Data are from The Danish Alzheimer Intervention StudY (DAISY), a large randomized controlled trial of psychosocial intervention for patients with mild dementia and their caregivers with 3-years' follow-up. Five out of 14 Danish counties participated and 321 home-living elderly (mean age: 76.2 years) with mild AD (46.4 % male) were included during 2004 and 2005. Self-rated SRH, cognitive function (MMSE), quality of life (proxy-rated QOL-AD), activities of daily living (ADCS-ADL), insight, and socio-demographics were assessed at baseline. Comorbidities and information about NH placement and mortality was obtained over 3-years' follow-up from registries. With Cox proportional hazard regression we analysed the association between SRH (dichotomised into good vs. poor) and NH placement and mortality adjusted for potential confounders.
At baseline 66 % reported excellent or good, and 34 % fair, poor or very poor SRH. Mean MMSE was 24.0 (range: 20-30). NH placement and mortality totalled 28.1 % and 16.5 % at 3-years' follow-up, respectively. Poor SRH at baseline was not related to increased risk of NH placement or to increased mortality neither in the univariable nor in multivariable analysis: In the fully adjusted models HR was 0.63 (95 % CI 0.38-1.05) and 1.28 (95 % CI 0.67-2.45), respectively.
When poor SRH was present we found no increased risk for NH placement or death among elderly people with mild AD. SRH is a widely used parameter in clinical and epidemiological research but may not be a valid indicator of health in patients with AD due to loss of insight.
在许多基于人群的研究中，自评健康状况（SRH）可预测不良健康结局，如发病率、长期养老院安置情况和死亡率。然而，SRH对老年人养老院安置情况和死亡率的预测价值并不一致。这可能是由于认知障碍。由于SRH项目被广泛使用，了解SRH在认知障碍患者中是否具有不同的预测价值很重要。我们旨在研究轻度阿尔茨海默病（AD）患者的SRH以及长期养老院安置和死亡风险。
数据来自丹麦阿尔茨海默病干预研究（DAISY），这是一项针对轻度痴呆患者及其照顾者的社会心理干预大型随机对照试验，随访期为3年。丹麦14个县中的5个县参与了研究，2004年至2005年期间纳入了321名居家生活的轻度AD老年人（平均年龄：76.2岁），男性占46.4%。在基线时评估了自评SRH、认知功能（MMSE）、生活质量（代理评定的QOL-AD）、日常生活活动能力（ADCS-ADL）、洞察力和社会人口统计学特征。通过登记处获取3年随访期间的合并症以及养老院安置和死亡信息。我们使用Cox比例风险回归分析了SRH（分为良好与不佳）与养老院安置和死亡率之间的关联，并对潜在混杂因素进行了调整。
在基线时，66%的人报告SRH为优秀或良好，34%的人报告为中等、不佳或非常不佳。MMSE平均值为24.0（范围：20 - 30）。3年随访时，养老院安置率和死亡率分别为28.1%和16.5%。在单变量和多变量分析中，基线时SRH不佳与养老院安置风险增加或死亡率增加均无关联：在完全调整模型中，HR分别为0.63（95%CI 0.38 - 1.05）和1.28（95%CI 0.67 - 2.45）。
当存在SRH不佳情况时，我们发现轻度AD老年人的养老院安置风险或死亡风险并未增加。SRH是临床和流行病学研究中广泛使用的参数，但由于洞察力丧失，它可能不是AD患者健康状况的有效指标。
