Department of Geriatrics, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Environmental Sciences, Wageningen University, Wageningen, the Netherlands.
Department of Geriatrics, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.
J Am Med Dir Assoc. 2020 Apr;21(4):525-530.e4. doi: 10.1016/j.jamda.2019.10.011. Epub 2019 Dec 11.
Acute illnesses and subsequent hospital admissions present large health stressors to older adults, after which their recovery is variable. The concept of physical resilience offers opportunities to develop dynamical tools to predict an individual's recovery potential. This study aimed to investigate if dynamical resilience indicators based on repeated physical and mental measurements in acutely hospitalized geriatric patients have added value over single baseline measurements in predicting favorable recovery.
Intensive longitudinal study.
121 patients (aged 84.3 ± 6.2 years, 60% female) admitted to the geriatric ward for acute illness.
In addition to preadmission characteristics (frailty, multimorbidity), in-hospital heart rate and physical activity were continuously monitored with a wearable sensor. Momentary well-being (life satisfaction, anxiety, discomfort) was measured by experience sampling 4 times per day. The added value of dynamical indicators of resilience was investigated for predicting recovery at hospital discharge and 3 months later.
31% of participants satisfied the criteria of good recovery at hospital discharge and 50% after 3 months. A combination of a frailty index, multimorbidity, Clinical Frailty Scale, and or gait speed predicted good recovery reasonably well on the short term [area under the receiver operating characteristic curve (AUC) = 0.79], but only moderately after 3 months (AUC = 0.70). On addition of dynamical resilience indicators, the AUC for predicting good 3-month recovery increased to 0.79 (P = .03). Variability in life satisfaction and anxiety during the hospital stay were independent predictors of good 3-month recovery [odds ratio (OR) = 0.24, P = .01, and OR = 0.54, P = .04, respectively].
These results highlight that measurements capturing the dynamic functioning of multiple physiological systems have added value in assessing physical resilience in clinical practice, especially those monitoring mental responses. Improved monitoring and prediction of physical resilience could help target intensive treatment options and subsequent geriatric rehabilitation to patients who will most likely benefit from them.
急性疾病和随后的住院会给老年人带来巨大的健康压力，之后他们的康复情况各不相同。身体恢复力的概念为开发预测个体康复潜力的动态工具提供了机会。本研究旨在探讨基于急性住院老年患者反复进行的身体和心理测量的动态恢复力指标，在预测良好康复方面是否比单一基线测量具有额外价值。
强化纵向研究。
121 名（年龄 84.3 ± 6.2 岁，60%为女性）因急性疾病入住老年病房的患者。
除入院前特征（虚弱、多种合并症）外，还使用可穿戴传感器连续监测住院期间的心率和身体活动。通过体验采样每天 4 次测量瞬间幸福感（生活满意度、焦虑、不适）。研究了恢复力动态指标的附加价值，以预测出院时和 3 个月后的康复情况。
31%的参与者出院时符合康复良好的标准，3 个月后符合该标准的比例为 50%。虚弱指数、多种合并症、临床虚弱量表和/或步速的组合对短期的良好康复预测效果较好（受试者工作特征曲线下面积 [AUC] = 0.79），但 3 个月后的预测效果则适中（AUC = 0.70）。在添加动态恢复力指标后，预测 3 个月良好康复的 AUC 增加到 0.79（P =.03）。住院期间生活满意度和焦虑的变异性是 3 个月良好康复的独立预测因素[比值比（OR）= 0.24，P =.01，OR = 0.54，P =.04]。
这些结果表明，捕捉多个生理系统动态功能的测量具有临床实践中评估身体恢复力的附加价值，特别是监测心理反应的测量。改善对身体恢复力的监测和预测，可能有助于针对最有可能从中受益的患者，选择强化治疗方案和后续老年康复。
