Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan.
Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Hsin-Chu, Taiwan.
Exp Gerontol. 2021 Jul 15;150:111353. doi: 10.1016/j.exger.2021.111353. Epub 2021 Apr 20.
To investigate the prognostic significance of hospitalization-associated muscle weakness for short-term and long-term functional declines among oldest old hospitalized patients.
We conducted a retrospective cohort study in the Geriatric Evaluation and Management Unit (GEMU) of a tertiary medical center in Taiwan. Data from patients admitted to the GEMU were collected, including demographic characteristics, underlying diseases, functional assessments, and nutritional status. Handgrip strength was measured at admission and before discharge, and hospitalization-associated muscle weakness was defined accordingly. Functional status was ascertained by a telephone survey, and functional decline was defined based on a comparison with each patient's functional status before discharge.
Overall, data from 555 patients were retrieved, and 431 patients (mean age: 86.0 ± 6.2 years, 78.5% males) were included in the study, with a mean Barthel Index score of 74.7 ± 20.8, Mini-Mental State Examination (MMSE) score of 19.1 ± 6.8, Geriatric Depression Scale (GDS-5) score of 2.2 ± 1.6, Mini-Nutritional Assessment-Short Form (MNA-SF) score of 8.9 ± 3.0, Cumulative Illness Rating Scale-Geriatric (CIRS-G) score of 2.2 ± 0.9, and the regular use of 6.7 ± 3.5 medications. Patients with a 1-month postdischarge functional decline had significantly lower body weight and body mass index, more severe frailty and more hospitalization-associated muscle weakness. Patients with a 6-month postdischarge functional decline had lower body weight, BMI, MMSE scores, MNA-SF scores, handgrip strength, Barthel Index scores, and Braden Scale scores. BMI (OR: 0.815, 95% CI: 0.691-0.962, P = 0.015) and hospitalization-associated muscle weakness (OR: 1.227, 95% CI: 1.147-1.332, P < 0.001) were significantly associated with a 1-month postdischarge functional decline. Hospitalization-associated muscle weakness (OR: 1.067, 95% CI: 1.035-1.101, P < 0.001), the risk of pressure sores (Braden Scale, OR: 0.767, 95% CI: 0.646-0.910, P = 0.002), and BMI (OR: 0.914, 95% CI: 0.838-0.998, P = 0.045) were independently associated with a 6-month postdischarge functional decline.
Hospitalization-associated muscle weakness significantly predicts functional decline among oldest old patients hospitalized for acute conditions. Further interventional studies are needed to examine the causal relationship between hospitalization-associated muscle weakness and clinical outcomes.
探讨住院相关肌肉无力对老年住院患者短期和长期功能下降的预后意义。
我们在台湾一家三级医学中心的老年评估和管理病房（GEMU）进行了一项回顾性队列研究。收集了入住 GEMU 的患者的数据，包括人口统计学特征、基础疾病、功能评估和营养状况。入院时和出院前测量握力，据此定义住院相关肌肉无力。通过电话调查确定功能状态，根据与每位患者出院前的功能状态比较来定义功能下降。
总体而言，我们检索了 555 名患者的数据，其中 431 名患者（平均年龄：86.0±6.2 岁，78.5%为男性）纳入研究，平均巴氏指数评分为 74.7±20.8，简易精神状态检查（MMSE）评分为 19.1±6.8，老年抑郁量表（GDS-5）评分为 2.2±1.6，迷你营养评估-简短表格（MNA-SF）评分为 8.9±3.0，累积疾病评分-老年（CIRS-G）评分为 2.2±0.9，以及常规使用 6.7±3.5 种药物。出院后 1 个月功能下降的患者体重和体重指数明显较低，衰弱程度更严重，且更易发生住院相关肌肉无力。出院后 6 个月功能下降的患者体重、BMI、MMSE 评分、MNA-SF 评分、握力、巴氏指数评分和布雷登评分均较低。BMI（OR：0.815，95%CI：0.691-0.962，P=0.015）和住院相关肌肉无力（OR：1.227，95%CI：1.147-1.332，P<0.001）与出院后 1 个月功能下降显著相关。住院相关肌肉无力（OR：1.067，95%CI：1.035-1.101，P<0.001）、压疮风险（布雷登评分，OR：0.767，95%CI：0.646-0.910，P=0.002）和 BMI（OR：0.914，95%CI：0.838-0.998，P=0.045）与出院后 6 个月功能下降独立相关。
住院相关肌肉无力显著预测老年急性住院患者的功能下降。需要进一步的干预研究来检验住院相关肌肉无力与临床结局之间的因果关系。
