Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia.
Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia; Department of Human Movement Sciences, @AgeAmsterdam, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands; Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Centre for Healthy Longevity, @AgeSingapore, National University Health System, Singapore.
J Am Med Dir Assoc. 2022 Nov;23(11):1800-1806. doi: 10.1016/j.jamda.2022.05.019. Epub 2022 Jun 24.
To investigate the associations of morbidity burden and frailty with the transitions between functional decline, institutionalization, and mortality.
REStORing health of acutely unwell adulTs (RESORT) is an ongoing observational, longitudinal inception cohort and commenced on October 15, 2017. Consented patients were followed for 3 months postdischarge.
Consecutive geriatric rehabilitation inpatients admitted to geriatric rehabilitation wards.
Patients' morbidity burden was assessed at admission using the Charlson Comorbidity Index (CCI) and Cumulative Illness Rating Scale (CIRS). Frailty was assessed using the Clinical Frailty Scale (CFS) and modified Frailty Index based on laboratory tests (mFI-lab). A multistate model was applied at 4 time points: 2 weeks preadmission, admission, and discharge from geriatric rehabilitation and 3 months postdischarge, with the following outcomes: functional decline, institutionalization, and mortality. Cox proportional hazards regression was applied to investigate the associations of morbidity burden and frailty with the transitions between outcomes.
The 1890 included inpatients had a median age of 83.4 (77.6-88.4) years, and 56.3% were female. A higher CCI score was associated with a greater risk of transitions from preadmission and declined functional performance to mortality [hazard ratio (HR) 1.28, 95% CI 1.03-1.59; HR 1.32, 95% CI 1.04-1.67]. A higher CIRS score was associated with a higher risk of not recovering from functional decline (HR 0.80, 95% CI 0.69-0.93). A higher CFS score was associated with a greater risk of transitions from preadmission and declined functional performance to institutionalization (HR 1.28, 95% CI 1.10-1.49; HR 1.23, 95% CI 1.04-1.44) and mortality (HR 1.12, 95% CI 1.01-1.33; HR 1.11, 95% CI 1.003-1.31). The mFI-lab was not associated with any of the transitions. None of the morbidity measures or frailty assessment tools were associated with the transitions from institutionalization to other outcomes.
This study demonstrates that greater frailty severity, assessed using the CFS, is a significant risk factor for poor clinical outcomes and demonstrates the importance of implementing it in the geriatric rehabilitation setting.
探讨发病率负担和脆弱性与功能下降、住院和死亡之间的转变的关系。
REStORing health of acutely unwell adulTs（RESORT）是一项正在进行的观察性、纵向发病队列研究，于 2017 年 10 月 15 日开始。同意参与的患者在出院后随访 3 个月。
连续入住老年康复病房的老年康复住院患者。
在入院时使用 Charlson 合并症指数（CCI）和累积疾病评分量表（CIRS）评估患者的发病率负担。使用临床虚弱量表（CFS）和基于实验室检查的改良虚弱指数（mFI-lab）评估脆弱性。在四个时间点应用多状态模型：入院前 2 周、入院时、出院时和出院后 3 个月，结果为：功能下降、住院和死亡。应用 Cox 比例风险回归分析发病率负担和脆弱性与结局之间的转变关系。
1890 名住院患者的中位年龄为 83.4（77.6-88.4）岁，56.3%为女性。CCI 评分较高与从入院前和功能下降到死亡的转变风险增加相关[风险比（HR）1.28，95%置信区间（CI）1.03-1.59；HR 1.32，95% CI 1.04-1.67]。CIRS 评分较高与从功能下降到无法恢复的风险增加相关（HR 0.80，95% CI 0.69-0.93）。CFS 评分较高与从入院前和功能下降到住院和死亡的转变风险增加相关（HR 1.28，95% CI 1.10-1.49；HR 1.23，95% CI 1.04-1.44）。mFI-lab 与任何转变均无关。发病前和功能下降的发病率负担和脆弱性评估工具均与从住院到其他结局的转变无关。
本研究表明，使用 CFS 评估的脆弱性严重程度增加是不良临床结局的重要危险因素，并表明在老年康复环境中实施该评估的重要性。
