Jain Snigdha, Han Ling, Gahbauer Evelyne A, Leo-Summers Linda, Feder Shelli L, Ferrante Lauren E, Gill Thomas M
Department of Internal Medicine, Yale School of Medicine, New Haven, CT.
Yale School of Nursing and the Pain Research, Informatics, Multiple Morbidities, and Education Center of Excellence at the VA Connecticut Healthcare System, West Haven, CT.
Crit Care Med. 2024 Dec 1;52(12):1816-1827. doi: 10.1097/CCM.0000000000006427. Epub 2024 Sep 18.
Older adults who survive critical illness are at risk for increased disability, limiting their independence and quality of life. We sought to evaluate whether the occurrence of symptoms that restrict activity, that is, restricting symptoms, is associated with increased disability following an ICU hospitalization.
Prospective longitudinal study of community-living adults 70 years old or older who were interviewed monthly between 1998 and 2018.
South Central Connecticut, United States.
Two hundred fifty-one ICU admissions from 202 participants who were discharged alive from the hospital.
None.
Occurrence of 15 restricting symptoms (operationalized as number of symptoms and presence of ≥ 2 symptoms) and disability in activities of daily living, instrumental activities of daily living, and mobility was ascertained during monthly interviews throughout the study period. We constructed multivariable Poisson regression models to evaluate the association between post-ICU restricting symptoms and subsequent disability over the 6 months following ICU hospitalization, adjusting for known risk factors for post-ICU disability including pre-ICU disability, frailty, cognitive impairment, mechanical ventilation, and ICU length of stay. The mean age of participants was 83.5 years ( sd , 5.6 yr); 57% were female. Over the 6 months following ICU hospitalization, each unit increase in the number of restricting symptoms was associated with a 5% increase in the number of disabilities (adjusted rate ratio, 1.05; 95% CI, 1.04-1.06). The presence of greater than or equal to 2 restricting symptoms was associated with a 29% greater number of disabilities over the 6 months following ICU hospitalization as compared with less than 2 symptoms (adjusted rate ratio, 1.29; 95% CI, 1.22-1.36).
In this longitudinal cohort of community-living older adults, symptoms restricting activity were independently associated with increased disability after ICU hospitalization. These findings suggest that management of restricting symptoms may enhance functional recovery among older ICU survivors.
危重病存活的老年人面临残疾增加的风险，这限制了他们的独立性和生活质量。我们试图评估限制活动的症状（即限制性症状）的出现是否与重症监护病房（ICU）住院后的残疾增加有关。
对1998年至2018年期间每月接受访谈的70岁及以上社区居住成年人进行前瞻性纵向研究。
美国康涅狄格州中南部。
202名从医院存活出院的参与者中有251次ICU入院。
无。
在整个研究期间的每月访谈中，确定15种限制性症状的出现情况（以症状数量和≥2种症状的存在来衡量）以及日常生活活动、工具性日常生活活动和移动性方面的残疾情况。我们构建了多变量泊松回归模型，以评估ICU住院后6个月内ICU后限制性症状与随后残疾之间的关联，并对ICU后残疾的已知风险因素进行调整，包括ICU前残疾、虚弱、认知障碍、机械通气和ICU住院时间。参与者的平均年龄为83.5岁（标准差5.6岁）；57%为女性。在ICU住院后的6个月内，限制性症状数量每增加一个单位，残疾数量就增加5%（调整后的率比为1.05；95%置信区间为1.04 - 1.06）。与少于2种症状相比，在ICU住院后的6个月内，存在大于或等于2种限制性症状与残疾数量多29%相关（调整后的率比为1.29；95%置信区间为1.22 - 1.36）。
在这个社区居住的老年人群体的纵向队列中，限制活动的症状与ICU住院后残疾增加独立相关。这些发现表明，管理限制性症状可能会增强老年ICU幸存者的功能恢复。
