Department of Geriatrics, Bispebjerg Hospital, Denmark; Institute of Sports Medicine Copenhagen, Bispebjerg Hospital, University of Copenhagen, Denmark; Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Physical Activity and Human Performance Group, SMI, Department of Health Science and Technology, Aalborg University, Denmark.
Department of Gerontology, Free University of Brussels (VUB), Laarbeeklaan 103, B-1090 Brussels, Belgium; Department of Frailty in Ageing Research, Free University of Brussels (VUB), Laarbeeklaan 103, B-1090 Brussels, Belgium.
Exp Gerontol. 2017 Dec 1;99:115-119. doi: 10.1016/j.exger.2017.10.006. Epub 2017 Oct 5.
Hospital-associated deconditioning due to a combination of illness and inactivity is a serious problem for elderly adults. Here we investigate whether persistence in inflammatory status affects changes in physical function during short-term hospitalization.
This was a prospective observational study in elderly medical patients at a geriatric department. Measurements were obtained at admission and one week after admission and included de Morton Mobility Index (DEMMI) test, 30-second chair stand test (30-s CST), 4-m gait speed (4-m GST) test, handgrip strength, activity levels determined with ActivPALs, and concentrations of circulating C-reactive protein (CRP) from blood samples. Only patients with inflammation (C-reactive protein levels ≥10mg·L) at admission were included in this study. They were divided into those with continued inflammation (CI: CRP remained ≥10mg·L) and those that became non-inflammatory (BN: CRP decreased to <10mg·L) after one week of admission.
On admission 214 patients (67% female) with a median (IQR) age of 86 (81-91) years were categorized as inflammatory. There were no baseline differences in physical function between CI (n=138, 67% female) and BN (n=76, 68% female). DEMMI-score increased similarly in both groups (P<0.05). When normalized to days between tests, only changes in handgrip strength were significantly different between the CI- and BN-group (-0.05 [-0.27-0.28] vs. 0.16 [-0.10-0.41] kg·day, respectively, P<0.01). There was a positive association between changes in CRP and length of hospital stay (r=0.30, P<0.001).
Hospitalized geriatric patients admitted with inflammation showed only moderate improvement of general mobility during hospital stay, regardless of changes in their inflammatory status. However, handgrip strength increased only in those patients who became non-inflammatory during hospitalization.
由于疾病和不活动的综合作用，医院相关的功能下降是老年人面临的严重问题。本研究旨在探讨短期住院期间持续性炎症状态是否会影响身体功能的变化。
这是一项在老年医学病房进行的老年患者前瞻性观察性研究。在入院时和入院后一周进行测量，包括德莫顿活动能力指数（DEMMI）测试、30 秒椅站测试（30-s CST）、4 米步行速度（4-m GST）测试、握力、使用 ActivPALs 测定的活动水平以及血液样本中循环 C 反应蛋白（CRP）浓度。仅纳入入院时存在炎症（C 反应蛋白水平≥10mg·L）的患者进行本研究。将其分为持续性炎症组（CI：CRP 持续≥10mg·L）和入院后一周内非炎症组（BN：CRP 降低至<10mg·L）。
入院时 214 名患者（67%为女性），中位（IQR）年龄为 86（81-91）岁，分类为炎症。在 CI 组（n=138，67%为女性）和 BN 组（n=76，68%为女性）之间，入院时的身体功能无基线差异。两组的 DEMMI 评分均有相似的增加（P<0.05）。当以测试天数归一化后，仅 CI 组和 BN 组之间的握力变化有显著差异（分别为-0.05[-0.27-0.28]kg·天和 0.16[-0.10-0.41]kg·天，P<0.01）。CRP 变化与住院时间之间存在正相关（r=0.30，P<0.001）。
因炎症入院的老年住院患者在住院期间仅表现出一般活动能力的适度改善，而与炎症状态的变化无关。然而，只有在住院期间炎症状态变为非炎症的患者，握力才会增加。
