Department of Community Healthcare & Geriatrics, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.
Department of Family Medicine, E-Da Hospital, No.1, Yida Road, Jiaosu Village, Yanchao District, Kaohsiung City, 82445, Taiwan, Republic of China.
BMC Geriatr. 2019 Jan 24;19(1):21. doi: 10.1186/s12877-019-1040-3.
The trajectories for health-related quality of life of patients receiving home-based primary care are not well identified. Our objective was to investigate changes in the quality of life (QOL) and factors that affected the QOL of patients receiving home-based primary care.
Our prospective cohort study, the Observational study of Nagoya Elderly with HOme MEdical (ONE HOME) study, recruited 184 patients undergoing home-based primary care with a 5-year follow-up period. Patients' demographic data, socioeconomic status, physical diseases, medication use, feeding intake status, nutritional status, and functional status were measured annually. The 4-item quality of life index (QOL-HC [home care]) including self-perceived and family-reported QOL ratings that had been developed and previously validated in home care settings was used. Linear regression models were used for cross-sectional and longitudinal analyses.
The participants' mean age was 78.8 ± 10.8 years, and 55.9% of the sample was male. Most patients were frail, disabled, and/or malnourished. Self-perceived and family-reported QOL scores dropped sequentially on annual follow-ups. In the multivariate longitudinal analysis, patients who were divorced (β = 1.74) had high baseline QOL scores (β = 0.75) and reported higher QOL ratings. In addition, high functional dependency was associated with a low self-perceived QOL rating, with a β-value of - 1.24 in the pre-bedridden group and - 1.39 in the bedridden group. Given the family-reported QOL rating, the baseline QOL scores (β = 0.50) and Mini-Nutritional Assessment-Short-Form scores (β = 0.37) were found to have positive associations with the QOL rating.
For the disabled receiving home-based primary care, independent functional status and divorce were positively associated with better self-perceived QOL, whereas nutritional status was correlated with better family-reported QOL.
接受家庭初级保健的患者的健康相关生活质量轨迹尚不清楚。我们的目的是调查家庭初级保健患者生活质量（QOL）的变化以及影响其 QOL 的因素。
我们的前瞻性队列研究，名古屋老年家庭医疗观察研究（ONE HOME 研究），招募了 184 名接受家庭初级保健的患者，随访时间为 5 年。每年测量患者的人口统计学数据、社会经济状况、身体疾病、药物使用、喂养摄入情况、营养状况和功能状态。使用已在家庭护理环境中开发和验证的 4 项生活质量指数（QOL-HC[家庭护理]），包括自我感知和家庭报告的 QOL 评分。使用线性回归模型进行横断面和纵向分析。
参与者的平均年龄为 78.8±10.8 岁，55.9%的样本为男性。大多数患者身体虚弱、残疾和/或营养不良。自我感知和家庭报告的 QOL 评分在每年的随访中依次下降。在多变量纵向分析中，离婚的患者（β=1.74）基线 QOL 评分较高（β=0.75），报告的 QOL 评分较高。此外，高度的功能依赖性与较低的自我感知 QOL 评分相关，在预卧床组中为-1.24，在卧床组中为-1.39。就家庭报告的 QOL 评分而言，基线 QOL 评分（β=0.50）和迷你营养评估-短表评分（β=0.37）与 QOL 评分呈正相关。
对于接受家庭初级保健的残疾患者，独立的功能状态和离婚与更好的自我感知 QOL 相关，而营养状况与更好的家庭报告 QOL 相关。
