Mangione C M, Marcantonio E R, Goldman L, Cook E F, Donaldson M C, Sugarbaker D J, Poss R, Lee T H
Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115.
J Am Geriatr Soc. 1993 Apr;41(4):377-83. doi: 10.1111/j.1532-5415.1993.tb06944.x.
To assess the influence of age on the relationships between global measures of health and specific health dimensions.
Cross-sectional cohort study.
University tertiary care hospital.
Patients older than 50 years admitted for major elective non-cardiac surgery.
Consenting patients underwent preoperative evaluations including a medical history, physical examination, and administration of health status assessment instruments. Global health status was measured with the Medical Outcomes Study Short Form (SF-36) and with a 0 to 100 verbal measure of global health. Specific health dimensions (physical function, role function, social function, mental health, energy and fatigue, and pain) were measured using the SF-36. Subjects also completed a second validated measure of physical functioning, the Specific Activity Scale (SAS).
Although patients aged > 70 years (n = 276) had poorer role function, energy, and fatigue scores and poorer physical function on both the SF-36 and SAS than younger patients (n = 469) (P < 0.05), they had similar overall health perception. In the entire population, global health status as measured with the SF-36 health perception scale had the greatest correlation with the energy and fatigue scale (r = .45), correlated moderately with mental health (r = .35), social function (r = .32), and physical function (r = .33), and correlated less well with the surgically remediable dimension of pain (r = .23). However, correlations of global health perception with pain and global health perception with role functioning were significantly (P < or = 0.05) lower in older patients when compared with subjects 70 years or younger (r = .13 vs .28 and r = .19 vs .33, respectively).
Despite poorer role function, poorer energy and fatigue scores, and poorer physical function, elderly persons have similar global health perception when compared with younger individuals. These data indicate that global health perception may be determined by different factors in the elderly or that the elderly have fundamentally different expectations of what their global health status should be. Our findings emphasize the importance of multidimensional scales when evaluating quality of life because, particularly in the elderly, the use of global measures alone may not reflect critically important dimension-specific impairments in health.
评估年龄对整体健康指标与特定健康维度之间关系的影响。
横断面队列研究。
大学三级护理医院。
因择期非心脏大手术入院的50岁以上患者。
同意参与的患者接受术前评估，包括病史采集、体格检查以及健康状况评估工具的使用。整体健康状况通过医学结局研究简表（SF - 36）以及0至100的整体健康口头评分来衡量。特定健康维度（身体功能、角色功能、社会功能、心理健康、精力与疲劳、疼痛）通过SF - 36进行测量。受试者还完成了另一项经过验证的身体功能测量指标，即特定活动量表（SAS）。
尽管70岁以上患者（n = 276）在角色功能、精力和疲劳评分方面以及在SF - 36和SAS上的身体功能评分均低于年轻患者（n = 469）（P < 0.05），但他们的整体健康感知相似。在整个人口中，用SF - 36健康感知量表测量的整体健康状况与精力和疲劳量表的相关性最强（r = 0.45），与心理健康（r = 0.35）、社会功能（r = 0.32）和身体功能（r = 0.33）中度相关，与手术可缓解的疼痛维度相关性较差（r = 0.23）。然而，与70岁及以下受试者相比，老年患者中整体健康感知与疼痛的相关性以及整体健康感知与角色功能的相关性显著更低（P ≤ 0.05）（分别为r = 0.13对0.28以及r = 0.19对0.33）。
尽管老年患者的角色功能较差、精力和疲劳评分较低以及身体功能较差，但与年轻个体相比，他们的整体健康感知相似。这些数据表明，整体健康感知在老年人中可能由不同因素决定，或者老年人对其整体健康状况的期望存在根本差异。我们的研究结果强调了在评估生活质量时多维量表的重要性，因为特别是在老年人中，仅使用整体测量指标可能无法反映健康中至关重要的特定维度损伤。
