McGilton Katherine S, Chu Charlene H, Naglie Gary, van Wyk Paula M, Stewart Steven, Davis Aileen M
Department of Research, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario.
Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario.
J Am Geriatr Soc. 2016 Aug;64(8):1601-9. doi: 10.1111/jgs.14297. Epub 2016 Jun 28.
To determine the contribution of cognitive impairment, prefracture functional impairment, and treatment as predictors of functional status and mobility 6 months after discharge from rehabilitation for older adults with hip fracture.
Longitudinal.
Inpatient rehabilitation units of two community hospitals.
Adults with hip fractures aged 65 and older who were discharged from a rehabilitation unit and had been living in the community before the fracture (N = 133).
Mini-Mental State Examination (MMSE) score at discharge from rehabilitation was used to identify the presence and severity of cognitive impairment. Outcomes were measured using questions from two subscales of the Functional Independence Measure (Self-Care Function and Functional Mobility) and the New Mobility Scale (NMS). Measurements were made at discharge from a rehabilitation setting and 3 and 6 months after discharge.
Prefracture functional impairment was associated with worse outcomes throughout the 6 months after discharge and with lower rates of improvement, or in some cases decline, after discharge. Cognitive impairment was associated with worse outcomes throughout the 6 months after discharge but was only weakly associated with lower rates of improvement or decline. The Patient Centered Rehabilitation Model of care targeting persons with cognitive impairment (PCRM-CI) intervention group had higher NMS scores after discharge than a usual care group.
Although cognitive impairment and prefracture functional impairment contribute to poor outcomes, prefracture functional impairment was more strongly associated with poor outcomes than cognitive impairment. There is evidence to show that individuals with cognitive impairment are able to regain their mobility, which suggests a need for postdischarge targeted interventions that include a focus on activities of daily living for older adults with cognitive impairment and functional impairment to stabilize gains from inpatient rehabilitation.
确定认知障碍、骨折前功能障碍以及治疗作为髋部骨折老年患者康复出院后6个月功能状态和活动能力预测指标的作用。
纵向研究。
两家社区医院的住院康复单元。
65岁及以上髋部骨折的成年人，他们从康复单元出院，骨折前居住在社区（N = 133）。
使用康复出院时的简易精神状态检查表（MMSE）评分来确定认知障碍的存在和严重程度。使用功能独立性测量（自我护理功能和功能活动能力）的两个子量表以及新活动量表（NMS）中的问题来测量结果。在康复机构出院时、出院后3个月和6个月进行测量。
骨折前功能障碍与出院后6个月内较差的结果相关，且出院后改善率较低，在某些情况下甚至下降。认知障碍与出院后6个月内较差的结果相关，但与改善或下降率的相关性较弱。以认知障碍患者为目标的以患者为中心的康复护理模式（PCRM-CI）干预组出院后的NMS评分高于常规护理组。
虽然认知障碍和骨折前功能障碍会导致不良后果，但骨折前功能障碍与不良后果的关联比认知障碍更强。有证据表明，认知障碍患者能够恢复其活动能力，这表明需要进行出院后有针对性的干预，包括关注有认知障碍和功能障碍的老年人的日常生活活动，以巩固住院康复所取得的成效。
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