中国老年住院患者功能残疾的潜在相关因素：一项多中心横断面研究。
Potential associated factors of functional disability in Chinese older inpatients: a multicenter cross-sectional study.
机构信息
Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital (Dongdan campus), No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China.
Department of Geriatrics, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital (Dongdan campus), No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China.
出版信息
BMC Geriatr. 2020 Sep 3;20(1):319. doi: 10.1186/s12877-020-01738-x.
BACKGROUND
There is still controversy about the relationship between aging and changes in functional ability. This study aims to describe the level of basic activities of daily living (ADL) and higher-level instrumental activities of daily living (IADL) in different age groups and explore the factors associated with functional disability in Chinese older inpatients.
METHODS
This cross-sectional study surveyed 9996 older inpatients aged 65 years and older from six tertiary hospitals in China from October 2018 to February 2019. The levels of ADL and IADL were measured by scores of the Barthel index and Instrumental Activities of Daily Living Scale. A mixed-effect generalized linear model was used to examine the association between functional disability and covariates.
RESULTS
The average ADL score was 89.51 ± 19.29 and the mean IADL score 6.76 ± 2.01 for all participants. There was a trend of decreasing scores along with aging, and significant differences between age groups were also observed (P < 0.001). The most affected ADL and IADL was stair climbing and shopping, respectively. Sociodemographic characteristics (such as age), physical health variables (frailty, emaciation, hearing dysfunction, urinary dysfunction, defecation dysfunction, falling accidents in the past 12 months), and mental health variables (cognitive dysfunction, depression) were associated with functional disability. Patients from the emergency department or transferred from other hospitals and former alcohol drinkers are at risk of ADL disability. Former smoking is a risk factor for IADL disability, whereas current drinking, higher-level education, and residing in a building without elevators were likely to maintain a better IADL performance.
CONCLUSIONS
Functional ability declines with aging, older inpatients are low dependency upon ADL and IADL. There are several associated factors among the participants derived from this investigation of a large-scale, multicenter, nationally representative Chinese older inpatient population. These findings potentially have major importance for the planning of hospital services, discharge planning, and post-discharge care.
TRIAL REGISTRATION
Chinese Clinical Trial Registry, ChiCTR1800017682 , registered August 9, 2018.
背景
衰老与功能能力变化之间的关系仍存在争议。本研究旨在描述不同年龄组老年人基本日常生活活动（ADL）和较高水平的工具性日常生活活动（IADL）的水平，并探讨与中国老年住院患者功能障碍相关的因素。
方法
本横断面研究于 2018 年 10 月至 2019 年 2 月期间调查了来自中国六家三级医院的 9996 名 65 岁及以上的老年住院患者。ADL 和 IADL 水平通过巴氏指数和工具性日常生活活动量表的得分来衡量。采用混合效应广义线性模型来检验功能障碍与协变量之间的关系。
结果
所有参与者的平均 ADL 得分为 89.51±19.29，平均 IADL 得分为 6.76±2.01。随着年龄的增长，评分呈下降趋势，不同年龄组之间也存在显著差异（P<0.001）。最受影响的 ADL 和 IADL 分别是爬楼梯和购物。社会人口统计学特征（如年龄）、身体健康变量（虚弱、消瘦、听力障碍、尿功能障碍、排便功能障碍、过去 12 个月内跌倒事故）和心理健康变量（认知障碍、抑郁）与功能障碍相关。来自急诊科或转院的患者以及曾经饮酒者有发生 ADL 残疾的风险。曾经吸烟是发生 IADL 残疾的危险因素，而目前饮酒、较高水平的教育和居住在没有电梯的建筑物中可能更有利于保持较好的 IADL 表现。
结论
功能能力随年龄增长而下降，老年住院患者对 ADL 和 IADL 的依赖程度较低。从这项对中国大规模、多中心、全国代表性老年住院患者人群的调查中得出了一些与参与者相关的因素。这些发现可能对医院服务规划、出院计划和出院后护理具有重要意义。
试验注册
中国临床试验注册中心，ChiCTR1800017682，注册于 2018 年 8 月 9 日。
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