住院相关的步态速度变化与老年人功能受限的风险。
Hospitalization-Associated Change in Gait Speed and Risk of Functional Limitations for Older Adults.
机构信息
Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minnesota.
Department of Medicine, Division of General Internal Medicine, University of Minnesota Medical School, Twin Cities.
出版信息
J Gerontol A Biol Sci Med Sci. 2019 Sep 15;74(10):1657-1663. doi: 10.1093/gerona/glz027.
BACKGROUND
Hospitalization-associated functional decline is a common problem for older adults, but it is unclear how hospitalizations affect physical performance measures such as gait speed. We sought to determine hospitalization-associated change in gait speed and likelihood of new limitations in mobility and activities of daily living (ADLs).
METHODS
We used longitudinal data over 5 years from the Health, Aging and Body Composition Study, a prospective cohort of black and white community-dwelling men and women, aged 70-79 years, who had no limitations in mobility (difficulty walking 1/4 mile or climbing 10 steps) or ADLs (transferring, bathing, dressing, and eating) at baseline. Gait speed, and new self-reported limitations in mobility and ADLs were assessed annually. Selected participants (n = 2,963) had no limitations at the beginning of each 1-year interval. Hospitalizations were self-reported every 6 months and verified with medical record data. Generalized estimating equations were used to examine hospitalization-associated change in gait speed and odds of new limitations over each 1-year interval. Fully adjusted models included demographics, hospitalization within the past year, health conditions, symptoms, body mass index, and health-related behaviors.
RESULTS
In fully adjusted models, any hospitalization was associated with decrease in gait speed (-0.04 m/s; 95% confidence interval [CI]: -0.05 to -0.03) and higher odds of new limitations in mobility or ADLs (odds ratio = 1.97, 95% CI: 1.70-2.28), and separately with increased odds of new mobility limitation (odds ratio = 2.22, 95% CI: 1.90-2.60) and new ADL limitations (odds ratio = 1.84, 95% CI: 1.53-2.21). Multiple hospitalizations within a year were associated with gait speed decline (-0.06 m/s; 95% CI: -0.08 to -0.04) and greater odds of new limitations in mobility or ADLs (odds ratio = 2.96, 95% CI: 2.23-3.95).
CONCLUSIONS
Functionally independent older adults experienced hospitalization-associated declines in gait speed and new limitations in mobility and ADLs.
背景
住院相关的功能下降是老年人常见的问题，但住院如何影响步态速度等身体表现测量指标尚不清楚。我们旨在确定与住院相关的步态速度变化以及移动和日常生活活动（ADL）新受限的可能性。
方法
我们使用来自健康、衰老和身体成分研究的 5 年纵向数据，这是一项针对黑人社区和白人社区的、年龄在 70-79 岁之间的、无移动能力受限（行走 1/4 英里或爬 10 级台阶有困难）或日常生活活动受限（转移、洗澡、穿衣和进食）的前瞻性队列。每年评估步态速度以及新报告的移动能力和日常生活活动受限情况。选择参与者（n=2963）在每个 1 年间隔的开始时没有任何限制。每 6 个月自我报告一次住院情况，并用医疗记录数据进行核实。使用广义估计方程来检查每个 1 年间隔内与住院相关的步态速度变化和新限制的几率。完全调整后的模型包括人口统计学数据、过去 1 年内的住院情况、健康状况、症状、体重指数和与健康相关的行为。
结果
在完全调整后的模型中，任何住院治疗都与步态速度下降（-0.04 m/s；95%置信区间[CI]：-0.05 至 -0.03）和新的移动能力或日常生活活动受限的几率增加（比值比=1.97，95%CI：1.70-2.28）相关，分别与新的移动能力受限（比值比=2.22，95%CI：1.90-2.60）和新的日常生活活动受限（比值比=1.84，95%CI：1.53-2.21）的几率增加相关。一年内多次住院与步态速度下降（-0.06 m/s；95%CI：-0.08 至 -0.04）和新的移动能力或日常生活活动受限的几率增加（比值比=2.96，95%CI：2.23-3.95）相关。
结论
功能独立的老年人经历了与住院相关的步态速度下降以及新的移动能力和日常生活活动受限。
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