Fathi Roya, Bacchetti Peter, Haan Mary N, Houston Thomas K, Patel Kanan, Ritchie Christine S
Division of Geriatrics, University of California at San Francisco, San Francisco, California.
Division of Geriatrics, San Francisco Veterans Affairs Medical Center, San Francisco, California.
J Am Geriatr Soc. 2017 May;65(5):1004-1011. doi: 10.1111/jgs.14739. Epub 2017 Feb 2.
To describe the association between restricted life-space and characteristics of community-dwelling adults hospitalized for congestive heart failure (CHF) or chronic obstructive pulmonary disease (COPD), to estimate the effect of hospitalization on postdischarge mobility, and to determine whether baseline restricted life-space predicts hospital readmission.
Observational.
Urban academic hospital that serves as a safety net for urban and rural populations with low resources and serves central and northern Alabama.
Individuals with CHF or COPD hospitalized from home (N = 478).
The Life-Space Assessment (LSA) measures mobility by asking about movement in situations ranging from within one's dwelling to beyond one's town. LSA scores below 60 correspond to "restricted life-space." Baseline LSA scores before admission were measured during an index hospitalization; follow-up LSA scores were determined over the telephone at 90 days. Participant characteristics were examined according to baseline restricted life-space using the chi-square test and Student's t-test. Each characteristic's association with restricted life-space was estimated uisng logistic regression.
Of the participants, 372 (77.8%) were classified as having baseline restricted life-space. Baseline restricted life-space was associated with older age (odds ratio (OR) = 1.29 per decade, 95% confidence interval (CI) = 1.17-1.42, P = .001), female sex (OR = 2.69, 95% CI = 1.69-4.29, P < .001), African-American race (OR = 1.55, 95% CI = 1.00-2.41, P = .05), and having inadequate financial resources (OR = 2.03, 95% CI = 1.22-3.38, P = .006). In the baseline unrestricted life-space group, 49.5% (n = 49) had restricted life-space at 90-day follow-up. Baseline restricted life-space was associated with greater odds of 90-day hospital readmission (unadjusted OR = 1.64, 95% CI = 1.00-2.70, P = .05; adjusted OR = 1.72, 95% CI = 1.04-2.85, P = .03).
Baseline restricted life-space was associated with greater risk of hospital readmission within 90 days after hospital discharge. These findings suggest a need to customize the management of individuals hospitalized with CHF or COPD based on baseline life-space level.
描述居家活动空间受限与因充血性心力衰竭（CHF）或慢性阻塞性肺疾病（COPD）住院的社区成年人特征之间的关联，评估住院对出院后活动能力的影响，并确定基线活动空间受限是否可预测再次入院。
观察性研究。
一所城市学术医院，为资源匮乏的城乡人口提供安全保障服务，服务范围覆盖阿拉巴马州中部和北部。
478名从家中入院的CHF或COPD患者。
生活空间评估（LSA）通过询问从住所内到城镇外等不同场景下的活动情况来衡量活动能力。LSA得分低于60分对应“活动空间受限”。入院前的基线LSA得分在首次住院期间测量；随访LSA得分在90天时通过电话确定。使用卡方检验和学生t检验根据基线活动空间受限情况检查参与者特征。使用逻辑回归估计每个特征与活动空间受限的关联。
参与者中，372人（77.8%）被归类为基线活动空间受限。基线活动空间受限与年龄较大（优势比（OR）=每十年1.29，95%置信区间（CI）=1.17 - 1.42，P = 0.001）、女性（OR = 2.69，95% CI = 1.69 - 4.29，P < 0.001）、非裔美国人种族（OR = 1.55，95% CI = 1.00 - 2.41，P = 0.05）以及经济资源不足（OR = 2.03，95% CI = 1.22 - 3.38，P = 0.006）相关。在基线活动空间未受限组中，49.5%（n = 49）在90天随访时活动空间受限。基线活动空间受限与90天再次入院的可能性更大相关（未调整OR = 1.64，95% CI = 1.00 - 2.70，P = 0.05；调整后OR = 1.
