Ferrucci L, Guralnik J M, Pahor M, Corti M C, Havlik R J
Geriatric Department, I Fraticini, National Research Institute (INRCA), Florence, Italy.
JAMA. 1997 Mar 5;277(9):728-34.
To characterize hospital diagnoses, procedures and charges, and nursing home admissions in the year when older persons become severely disabled, comparing those in whom severe disability develops rapidly with those in whom disability develops gradually.
A prospective, population-based cohort study with at least 6 annual interviews beginning in 1982.
A total of 3 communities: East Boston, Mass, New Haven, Conn, and Iowa and Washington counties in Iowa.
A total of 6070 persons at least 70 years old with at least 1 interview after the fourth annual follow-up and without evidence of previous severe disability, defined as disability in 3 or more activities of daily living (ADLs).
Characteristics associated with development of severe disability after the fourth annual follow-up, in which the disability is classified as catastrophic disability if the individual did not report any ADL disability in the 2 interviews prior to severe disability onset or as progressive disability if the individual had previous disability in 1 or 2 ADLs.
In the year during which severe disability developed, hospitalizations were documented for 72.1% of those developing catastrophic disability and for 48.6% of those developing progressive disability. In the corresponding year, only 14.7% of those who were stable with no disability and 22.3% of those with some disability were hospitalized. The 6 most frequent principal discharge diagnoses included stroke, hip fracture, congestive heart failure, and pneumonia in both severe disability subsets; coronary heart disease and cancer in catastrophic disability; and diabetes and dehydration in progressive disability. These diagnoses occurred in 49% of those with catastrophic disability and 25% of those with progressive disability. In both severe disability subsets, the oldest patients received less intensive hospital care as indicated by charges for surgery, diagnostics, and rehabilitation and by the percentage who received major diagnostic procedures; they were also more often admitted to nursing homes.
In the year when they become severely disabled, a large proportion of older persons are hospitalized for a small group of diseases. Hospital-based interventions aimed at reducing the severity and functional consequences of these diseases could have a large impact on reduction of severe disability.
描述老年人出现严重残疾当年的医院诊断、治疗程序和费用以及养老院入住情况，比较严重残疾迅速发展者与残疾逐渐发展者的上述情况。
一项前瞻性、基于人群的队列研究，从1982年开始至少进行6次年度访谈。
总共3个社区：马萨诸塞州东波士顿、康涅狄格州纽黑文以及爱荷华州的爱荷华县和华盛顿县。
总共6070名至少70岁的老年人，在第四次年度随访后至少接受过1次访谈，且无先前严重残疾的证据，严重残疾定义为日常生活活动（ADL）中有3项或更多项存在残疾。
第四次年度随访后与严重残疾发展相关的特征，若个体在严重残疾发作前的2次访谈中均未报告任何ADL残疾，则将残疾分类为灾难性残疾；若个体先前在1项或2项ADL中有残疾，则分类为进行性残疾。
在出现严重残疾的当年，72.1%的灾难性残疾发展者和48.6%的进行性残疾发展者有住院记录。在相应年份，无残疾且情况稳定者中只有14.7%住院，有一定残疾者中22.3%住院。在两个严重残疾亚组中，最常见的6种主要出院诊断均包括中风、髋部骨折、充血性心力衰竭和肺炎；灾难性残疾中为冠心病和癌症；进行性残疾中为糖尿病和脱水。这些诊断在49%的灾难性残疾者和25%的进行性残疾者中出现。在两个严重残疾亚组中，年龄最大的患者接受的医院护理强度较低，这体现在手术、诊断和康复费用以及接受主要诊断程序的百分比方面；他们也更常入住养老院。
在老年人出现严重残疾的当年，很大一部分人因一小部分疾病而住院。旨在降低这些疾病的严重程度和功能后果的以医院为基础的干预措施，可能对减少严重残疾有很大影响。
