评估老年人报告的病史的可靠性。
Assessing the Reliability of Reported Medical History in Older Adults.
机构信息
Hendrix College, Conway, AR, USA.
The Charles F. and Joanne Knight Alzheimer Disease Research Center, St. Louis, MO, USA.
出版信息
J Alzheimers Dis. 2020;78(2):643-652. doi: 10.3233/JAD-200842.
BACKGROUND
Age-associated increases in medical complexity, frailty, and cognitive impairment may compromise reliable reporting of medical history.
OBJECTIVE
To evaluate the influence of increasing age and cognitive impairment on concordance between reported history of stroke and cerebral infarction, and reported history of diabetes and elevated hemoglobinA1c in community-dwelling older adults.
METHODS
The association between participant-specific factors and accurate reporting of stroke or diabetes was evaluated using multivariable logistic regression in 1,401 participants enrolled in longitudinal studies of memory and aging, including 425 participants with dementia (30.3%). Stroke and diabetes were selected as index variables as gold standard measures of both were obtained in all participants: magnetic resonance neuroimaging for cerebral infarcts and hemoglobinA1c (≥6.5%) for diabetes.
RESULTS
Concordance between reported history of stroke and imaging-confirmed cerebral infarction was low (sensitivity: 17.4%, 8/46; specificity: 97.9%, 799/816). Small infarcts were strongly associated with inaccurate reporting (OR = 265.8; 95% CI: 86.2, 819.4), suggesting that occult/silent infarcts contributed to discordant reporting. Reporting accuracy was higher concerning diabetes (sensitivity: 83.5%, 147/176; specificity: 96.2%, 1100/1143). A history of hypertension (OR = 2.3; 95% CI: 1.3, 4.2), higher hemoglobinA1c (OR = 1.9; 95% CI: 1.5, 2.4), and hemoglobinA1c compatible with impaired glucose tolerance (OR = 3.1; 95% CI 1.8, 5.3) associated with increased odds of discordant reporting. Cognitive impairment and increased age were not independently associated with reliable reporting.
CONCLUSION
Factors beyond advancing age and cognitive impairment appear to drive discordance in reported medical history in older participants. Objective testing for cerebral infarcts or diabetes should be performed when relevant to diagnostic or therapeutic decisions in clinical and research settings.
背景
随着年龄的增长，医疗复杂性、脆弱性和认知障碍的增加可能会影响对既往病史的可靠报告。
目的
评估年龄增长和认知障碍对社区居住的老年人中风和脑梗死、糖尿病和糖化血红蛋白升高既往史报告一致性的影响。
方法
在记忆和衰老纵向研究中纳入的 1401 名参与者中，使用多变量逻辑回归评估参与者特定因素与中风或糖尿病准确报告之间的关联，其中包括 425 名痴呆症患者（30.3%）。选择中风和糖尿病作为指标变量，因为所有参与者都获得了这两种疾病的金标准测量值：磁共振神经影像学用于脑梗死和糖化血红蛋白（≥6.5%）用于糖尿病。
结果
中风和影像学确诊脑梗死的报告病史之间的一致性较低（灵敏度：17.4%，8/46；特异性：97.9%，799/816）。小梗死与不准确报告强烈相关（OR=265.8；95%CI：86.2，819.4），表明隐匿性/沉默性梗死导致报告不一致。糖尿病的报告准确性更高（灵敏度：83.5%，147/176；特异性：96.2%，1100/1143）。高血压病史（OR=2.3；95%CI：1.3，4.2）、较高的糖化血红蛋白（OR=1.9；95%CI：1.5，2.4）和糖化血红蛋白提示糖耐量受损（OR=3.1；95%CI 1.8，5.3）与不一致报告的可能性增加相关。认知障碍和年龄增长与可靠报告无关。
结论
除了年龄增长和认知障碍之外，其他因素似乎会导致老年参与者报告的医疗史不一致。在临床和研究环境中，当与诊断或治疗决策相关时，应进行脑梗死或糖尿病的客观检查。
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