Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham, North Carolina; Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina; Center for the Study of Aging and Human Development (the Aging Center), Duke University, Durham, North Carolina; Department of Medicine, Duke University, Durham, North Carolina.
Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina.
Am J Kidney Dis. 2024 Aug;84(2):154-163. doi: 10.1053/j.ajkd.2024.01.529. Epub 2024 Mar 12.
RATIONALE & OBJECTIVE: Although functional impairment is common among older adults with chronic kidney disease (CKD), functional reserve before an acute health event and physical resilience after the event have not been characterized in this population. The purpose of this study was to identify distinct patterns of physical function before and after an acute health event among older veterans with stage 4 CKD.
Prospective cohort study.
SETTING & PARTICIPANTS: National sample of veterans≥70 years of age with an estimated glomerular filtration rate (eGFR) of<30mL/min/1.73m who had an acute care encounter (emergency department visit or hospitalization) during the follow-up period (n = 272).
Demographic characteristics, eGFR, basic and instrumental activities of daily living (ADL/IADL) difficulty, symptom burden, cognition, depressive symptoms, social support.
Function measured using the life-space mobility assessment obtained by telephone survey before and after an acute care encounter.
General growth mixture models to identify classes of functional trajectories. Calculation of percentages for demographic characteristics and means for eGFR, ADL/IADL difficulty, symptom burden, cognition, depressive symptoms, and social support by trajectory class.
Four trajectory classes were identified and characterized by different levels of life-space mobility before (reserve) and change in life-space mobility after (resilience) an acute care encounter: (1) low reserve, low resilience (n=91), (2) high reserve, high resilience (n=23), (3) moderate reserve, moderate resilience (n=89), and (4) high reserve, low resilience (n=69). Mean levels of ADL/IADL difficulty, symptom burden, cognition, and depressive symptoms, but not demographic characteristics, eGFR, or social support, differed by trajectory class.
Veteran cohort was primarily male.
Among older adults with stage 4 CKD, physical function trajectories before and after an acute health event vary. Integrating reserve and resilience into care for this population may be useful for anticipating changes in function and developing tailored treatment plans.
尽管慢性肾脏病（CKD）老年患者常伴有功能障碍，但在该人群中，急性健康事件前的功能储备和事件后的身体恢复能力尚未得到描述。本研究旨在确定处于 CKD 4 期的老年退伍军人在急性健康事件前后的身体功能的不同模式。
前瞻性队列研究。
该研究纳入了在随访期间（n=272）有急性医疗就诊（急诊就诊或住院）的年龄≥70 岁、估算肾小球滤过率（eGFR）<30mL/min/1.73m2 的退伍军人的全国性样本。
人口统计学特征、eGFR、基本和工具性日常生活活动（ADL/IADL）困难、症状负担、认知、抑郁症状、社会支持。
使用电话调查获得的生活空间移动评估来测量功能，该评估在急性医疗就诊前后进行。
采用广义增长混合模型识别功能轨迹的类别。根据轨迹类别计算人口统计学特征的百分比和 eGFR、ADL/IADL 困难、症状负担、认知、抑郁症状和社会支持的平均值。
确定了 4 种轨迹类别，并根据急性医疗就诊前后的生活空间移动能力（储备）和生活空间移动能力变化（恢复力）水平进行了特征描述：（1）低储备、低恢复力（n=91），（2）高储备、高恢复力（n=23），（3）中储备、中恢复力（n=89），（4）高储备、低恢复力（n=69）。ADL/IADL 困难、症状负担、认知和抑郁症状的平均水平，但不是人口统计学特征、eGFR 或社会支持，因轨迹类别而异。
退伍军人队列主要为男性。
在处于 CKD 4 期的老年患者中，急性健康事件前后的身体功能轨迹不同。将储备和恢复力纳入该人群的护理中，可能有助于预测功能变化并制定针对性的治疗计划。
