Geriatric Medicine Research, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
Canadian Center for Vaccinology, Halifax, Nova Scotia, Canada.
J Am Geriatr Soc. 2021 Mar;69(3):696-703. doi: 10.1111/jgs.16950. Epub 2020 Dec 8.
BACKGROUND/OBJECTIVES: Influenza is associated with significant morbidity and mortality, particularly for older adults. Persistent functional decline following hospitalization has important impacts on older adults' wellbeing and independence, but has been under-studied in relation to influenza. We aimed to investigate persistent functional change in older adults admitted to hospital with influenza and other acute respiratory illness (ARI).
Protective observational cohort study.
Canadian Immunization Research Network Serious Outcomes Surveillance Network 2011 to 2012 influenza season.
A total of 925 patients aged 65 and older admitted to hospital with influenza and other ARI.
Influenza was laboratory-confirmed. Frailty was measured using a Frailty index (FI). Functional status was measured using the Barthel index (BI); moderate persistent functional decline was defined as a clinically meaningful loss of ≥10 to <20 points on the 100-point BI. Catastrophic disability (CD) was defined as a loss of ≥20 points, equivalent to full loss of independence in two basic activities of daily living.
Five hundred and nineteen (56.1%) were women; mean age was 79.4 (standard deviation=8.4) years. Three hundred and forty-six (37.4%) had laboratory-confirmed influenza. Influenza cases had lower baseline function (BI = 77.0 vs 86.9, P < .001) and higher frailty (FI = 0.23 vs 0.20, P < .001) than those with other ARI. A total of 8.4% died, 8.2% experienced persistent moderate functional decline, and 9.9% experienced CD. Higher baseline frailty was associated with increased odds of experiencing functional decline, CD, and death. The experience of functional decline and CD, and its association with frailty, was the same for influenza and other ARI.
Functional loss in hospital is common among older adults; for some this functional loss is persistent and catastrophic. This highlights the importance of prevention and optimal management of acute declines in health, including influenza, to avoid hospitalization. In the case of influenza, for which vaccines exist, this raises the potential of vaccine preventable disability.
背景/目的：流感可导致较高的发病率和死亡率，尤其是老年人。流感住院后持续的功能下降对老年人的健康和独立性有重要影响，但与流感相关的研究却相对较少。本研究旨在调查流感和其他急性呼吸道感染（ARI）住院老年人的持续性功能变化。
保护观察性队列研究。
加拿大免疫研究网络严重结局监测网络 2011-2012 年流感季节。
共纳入 925 名年龄在 65 岁及以上的因流感和其他 ARI 住院的患者。
流感经实验室确诊。采用衰弱指数（FI）评估衰弱情况。采用巴氏量表（BI）评估功能状态；中度持续性功能下降定义为 BI 下降 10-20 分，具有临床意义。灾难性残疾（CD）定义为 BI 下降≥20 分，相当于日常生活两项基本活动完全丧失独立性。
519 名（56.1%）为女性；平均年龄为 79.4 岁（标准差=8.4 岁）。346 名（37.4%）患者流感经实验室确诊。与其他 ARI 相比，流感患者的基线功能（BI=77.0 分 vs 86.9 分，P<0.001）和衰弱程度（FI=0.23 vs 0.20，P<0.001）均更低。共有 8.4%的患者死亡，8.2%经历持续性中度功能下降，9.9%经历 CD。较高的基线衰弱与发生功能下降、CD 和死亡的风险增加相关。流感和其他 ARI 患者均经历了功能下降和 CD，且其与衰弱的相关性相同。
住院老年人的功能丧失较为常见；对一些人来说，这种功能丧失是持续性和灾难性的。这突出了预防和优化急性健康下降（包括流感）管理的重要性，以避免住院。在流感疫苗存在的情况下，这增加了疫苗可预防残疾的可能性。
