Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK.
NHS 24, NHS Scotland, Glasgow, G51 4EB, Scotland.
BMC Geriatr. 2024 Apr 4;24(1):316. doi: 10.1186/s12877-024-04866-w.
Restricted activity is a potential early marker of declining health in older adults. Previous studies of this association with patient outcomes have been inconclusive. This review aimed to evaluate the extent to which restricted activity is associated with decline in health.
A search was conducted for studies including people over 65 years old which investigated the association between measures of restricted activity and hospitalisation, cognitive decline, and mortality. Following data extraction by two reviewers, eligible studies were summarised using Inverse Variance Heterogeneity meta-analysis.
The search identified 8,434 unique publications, with 11 eligible studies. Three measures of restricted activity were identified: bed rest, restricted movement, and dependency for activities of daily living (ADL). Three studies looked at hospitalisations, with two finding a significant association with bed rest or restricted movement and one showing no evidence of an association. Restricted activity was associated with a significant increase in mortality across all three measures (bed rest odds ratio [OR] 6.34, 95%CI 2.51-16.02, I2 = 76%; restricted movement OR 5.38 95%CI 2.60-11.13, I2 = 69%; general ADL dependency OR 4.65 95%CI 2.25-9.26, I2 = 84%). The significant heterogeneity observed could not be explained by restricting the analysis by length of follow-up, or measure of restricted activity. No meta-analysis was conducted on the limited evidence for cognitive decline outcomes.
Limited studies have considered the prognostic value of restricted activity in terms of predicting future declining health. Current evidence suggests restricted activity is associated with hospitalisation and mortality, and therefore could identify a group for whom early intervention might be possible.
活动受限是老年人健康状况下降的一个潜在早期标志。此前关于这一关联与患者预后的研究结果并不一致。本综述旨在评估活动受限与健康状况下降之间的关联程度。
检索了包括 65 岁以上人群在内的研究，这些研究调查了限制活动与住院、认知能力下降和死亡率之间的关系。两名评审员进行数据提取后，使用Inverse Variance Heterogeneity 荟萃分析对符合条件的研究进行了总结。
搜索共确定了 8434 篇独特的出版物，其中有 11 篇符合条件。确定了三种限制活动的测量方法：卧床休息、限制运动和日常生活活动（ADL）依赖。有三项研究着眼于住院治疗，其中两项发现卧床休息或限制运动与住院治疗有显著关联，一项则没有证据表明两者之间存在关联。所有三种限制活动的测量方法都与死亡率显著增加相关（卧床休息比值比[OR]6.34，95%CI 2.51-16.02，I2=76%；限制运动 OR 5.38，95%CI 2.60-11.13，I2=69%；一般 ADL 依赖 OR 4.65，95%CI 2.25-9.26，I2=84%）。观察到的显著异质性不能通过限制分析的随访时间或限制活动的测量方法来解释。关于认知能力下降结果的有限证据没有进行荟萃分析。
有限的研究考虑了限制活动在预测未来健康状况下降方面的预后价值。目前的证据表明，限制活动与住院和死亡率有关，因此可以确定一个可能需要早期干预的群体。
