Kańtoch Anna, Wójkowska-Mach Jadwiga, Wizner Barbara, Heczko Piotr, Grodzicki Tomasz, Gryglewska Barbara
Department of Internal Medicine and Gerontology, Faculty of Medicine, Jagiellonian University Medical College, University Hospital in Kraków, Kraków, Poland.
Department of Microbiology, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland.
Folia Med Cracov. 2021;61(1):67-79.
B a c k g r o u n d / A i m: Factors influencing the survival of the nursing home population have not yet been clearly defined. The aim of the study was to investigate the impact of nutritional, mental, functional, disease and pharmacological factors on the survival of nursing home residents with severe disabilities. Material and Methods: A retrospective cohort study was conducted with a 9-year follow-up period among nursing home residents with a Barthel score ≤40. The initial assessment included the following scales: Mini Nutritional Assessment Short-Form (MNA-SF), Abbreviated Mental Test Score (AMTS), the Barthel Index, and blood pressure (BP) measurements. Comorbidities, medications and all-cause mortality were extracted from medical records. The analyzed cohort was divided into two groups: Deceased - residents who died ≤3 years and Survivors - those who survived >3 years of observation. R e s u l t s: Survivors (n = 40) and Deceased (n = 48) did not differ significantly in terms of age, sex, systolic and diastolic BP, the Barthel Index, number of diseases and medications used. Survivors had significantly higher scores in MNA-SF (p <0.001) and AMTS (p <0.003) than Deceased. Moreover, Survivors had hypertension significantly more often and took aspirin and ACE inhibitors (p <0.05). The multivariable logistic regression analysis showed that the MNA-SF score significantly affected mortality [OR = 0.62, (95%CI, 0.46-0.84), p <0.001]. C o n c l u s i o n: Higher MNA-SF scores were a factor that significantly affected the survival of nursing home residents, while functional status assessed using the Barthel Index had no effect on survival. MNA-SF was found to be a useful tool for assessing the risk of death in a nursing home.
背景/目的：影响养老院人群生存的因素尚未明确界定。本研究的目的是调查营养、心理、功能、疾病和药物因素对重度残疾养老院居民生存的影响。材料与方法：对Barthel评分≤40的养老院居民进行了一项为期9年随访的回顾性队列研究。初始评估包括以下量表：微型营养评定简表（MNA-SF）、简易精神状态检查表（AMTS）、Barthel指数和血压（BP）测量。从医疗记录中提取合并症、用药情况和全因死亡率。分析的队列分为两组：死亡组——死亡时间≤3年的居民；存活组——观察时间>3年的存活者。结果：存活者（n = 40）和死亡者（n = 48）在年龄、性别、收缩压和舒张压、Barthel指数、疾病数量和用药方面无显著差异。存活者在MNA-SF（p <0.001）和AMTS（p <0.003）方面的得分显著高于死亡者。此外，存活者患高血压的频率明显更高，服用阿司匹林和ACE抑制剂的比例也更高（p <0.05）。多变量逻辑回归分析表明，MNA-SF评分显著影响死亡率[比值比=0.62，（95%置信区间，0.46 - 0.84），p <0.001]。结论：较高的MNA-SF评分是显著影响养老院居民生存的一个因素，而使用Barthel指数评估的功能状态对生存没有影响。发现MNA-SF是评估养老院死亡风险的一个有用工具。
