Henchoz Yves, Büla Christophe, Guessous Idris, Rodondi Nicolas, Goy René, Demont Maurice, Santos-Eggimann Brigitte
Institute of Social and Preventive Medicine, University of Lausanne Hospital Centre, Lausanne, Switzerland.
Service of Geriatric Medicine and Geriatric Rehabilitation, Lausanne University Hospital, Lausanne, Switzerland.
BMJ Open. 2017 Jan 17;7(1):e014485. doi: 10.1136/bmjopen-2016-014485.
The burden of multiple diagnoses is well documented in older people, but less is known about chronic symptoms, many of which are even not brought to medical attention. This study aimed to determine the prevalence of chronic symptoms, their relationships with disability in basic activities of daily living (BADL) and quality of life (QoL), and their public health impact.
A large cross-sectional population-based study.
Community in 2 regions of French-speaking Switzerland.
Community-dwelling older adults aged 68 years and older in 2011 (N=5300).
Disability in BADL defined as difficulty or help needed with any of dressing, bathing, eating, getting in/out of bed or an arm chair, and using the toilet. Overall QoL dichotomised as favourable (ie, excellent or very good) or unfavourable (ie, good, fair or poor). Disturbance by any of the following 14 chronic symptoms for at least 6 months: joint pain, back pain, chest pain, dyspnoea, persistent cough, swollen legs, memory gaps, difficulty concentrating, difficulty making decisions, dizziness/vertigo, skin problems, stomach/intestine problems, urinary incontinence and impaired sexual life.
Only 17.1% of participants did not report being disturbed by any of these chronic symptoms. Weighted prevalence ranged from 3.1% (chest pain) to 47.7% (joint pain). Most chronic symptoms were significantly associated with disability in BADL or unfavourable QoL, with substantial gender differences. The number of chronic symptoms was significantly associated with disability in BADL and unfavourable QoL, with gradients suggesting dose-response relationships. Joint pain and back pain had the highest population attributable fractions.
Chronic symptoms are highly prevalent in older people, and are associated with disability in BADL and unfavourable QoL, particularly when multiple chronic symptoms co-occur. Owing to their high public health impact, musculoskeletal chronic symptoms represent good targets for preventive interventions.
多重诊断给老年人带来的负担已有充分记录，但对于慢性症状了解较少，其中许多慢性症状甚至未引起医疗关注。本研究旨在确定慢性症状的患病率、它们与日常生活基本活动（BADL）中的残疾以及生活质量（QoL）的关系，及其对公共卫生的影响。
一项基于人群的大型横断面研究。
瑞士法语区两个地区的社区。
2011年年龄在68岁及以上的社区居住老年人（N = 5300）。
BADL中的残疾定义为在穿衣、洗澡、进食、上下床或扶手椅、使用厕所中的任何一项存在困难或需要帮助。总体生活质量分为良好（即优秀或非常好）或不佳（即良好、一般或差）。以下14种慢性症状中的任何一种持续至少6个月：关节疼痛、背痛、胸痛、呼吸困难、持续咳嗽、腿部肿胀、记忆缺失、注意力不集中、决策困难、头晕/眩晕、皮肤问题、胃肠问题、尿失禁和性生活受损。
只有17.1%的参与者报告未受到这些慢性症状中的任何一种困扰。加权患病率从3.1%（胸痛）到47.7%（关节疼痛）不等。大多数慢性症状与BADL中的残疾或不佳的生活质量显著相关，存在明显的性别差异。慢性症状的数量与BADL中的残疾和不佳的生活质量显著相关，梯度表明存在剂量反应关系。关节疼痛和背痛的人群归因分数最高。
慢性症状在老年人中非常普遍，并且与BADL中的残疾和不佳的生活质量相关，尤其是当多种慢性症状同时出现时。由于其对公共卫生的重大影响，肌肉骨骼慢性症状是预防性干预的良好目标。
