Wenzhou Medical University, Facutly of Nursing, North near the intersection of Zhongxin North Road and Qiuzhen Road, Ouhai District, Wenzhou, 325000, Zhejiang province, China.
BMC Geriatr. 2020 Mar 4;20(1):86. doi: 10.1186/s12877-020-1481-8.
Among the previous studies about the ADL recovery and its predictors, the researches and resources used to study and protect the baseline-independent older patients from being permanently ADL-dependent was few. We aimed to describe the level of activities of daily living (ADL) at discharge and ADL change within 6 months after discharge in older patients who were ADL-independent before admission but became dependent because of acute illness, and to identify the predictors of early rehabilitation,so as to provide the basis to early intervention.
Stratified cluster sampling was used to recruit 520 hospitalised older patients who were ADL-independent from departments of internal medicine at two tertiary hospitals from August 2017 to May 2018. Demographics, clinical data, and ADL status at 1, 3, and 6 months after discharge were collected. Data were analysed using descriptive statistics, Student's t-test, Pearson's chi-square test,Spearman's correlation analysis, binary logistic regression analysis, and receiver operating characteristic (ROC) curve analysis.
There were 403 out of 520 patients completing the 6-month follow-up, and 229 (56.8%) regained independence at 6 months after discharge. There was an overall increasing trend in ADL with time. The recovery rate was the highest within the first month after discharge, gradually declined after 1 month, and changed less obviously from 3 to 6 months after discharge (p < 0.001). ADL score at discharge (OR = 1.034, p < 0.001), age (OR = 0.269, p = 0.001), post-discharge residence (OR = 0.390, p < 0.05), and cognition status at discharge (OR = 1.685, p < 0.05) were predictors of ADL recovery. The area under the curve of the four predictors combined was 0.763 (p < 0.001).
Studying ADL recovery rate and its predicting indicators of the baseline independent inpatients at different time points provide a theoretical reference for the formulation of nursing plans and allocation of care resources.
在之前关于日常生活活动（ADL）恢复及其预测因素的研究中，用于研究和保护基线独立的老年患者免受永久性 ADL 依赖的研究和资源较少。我们旨在描述在入院前 ADL 独立但因急性疾病而变得依赖的老年患者出院时的 ADL 水平以及出院后 6 个月内 ADL 的变化，并确定早期康复的预测因素，从而为早期干预提供依据。
采用分层整群抽样的方法，于 2017 年 8 月至 2018 年 5 月，从 2 家三级医院的内科科室招募 520 名入院前 ADL 独立的老年患者。收集人口统计学、临床数据和出院后 1、3 和 6 个月的 ADL 状况。采用描述性统计、学生 t 检验、Pearson χ²检验、Spearman 相关分析、二项逻辑回归分析和受试者工作特征（ROC）曲线分析进行数据分析。
520 例患者中有 403 例完成了 6 个月的随访，有 229 例（56.8%）在出院后 6 个月内恢复独立。ADL 随时间呈总体上升趋势。出院后第一个月内恢复率最高，1 个月后逐渐下降，3 至 6 个月后变化不明显（p<0.001）。出院时的 ADL 评分（OR=1.034，p<0.001）、年龄（OR=0.269，p=0.001）、出院后居住地（OR=0.390，p<0.05）和出院时认知状态（OR=1.685，p<0.05）是 ADL 恢复的预测因素。这四个预测因素结合的曲线下面积为 0.763（p<0.001）。
研究不同时间点基线独立住院患者的 ADL 恢复率及其预测指标，为制定护理计划和分配护理资源提供了理论参考。
