Cho C Y, Alessi C A, Cho M, Aronow H U, Stuck A E, Rubenstein L Z, Beck J C
Soonchunhyang University Department of Family Medicine, Seoul, Korea.
J Am Geriatr Soc. 1998 Jun;46(6):677-82. doi: 10.1111/j.1532-5415.1998.tb03800.x.
To examine the association between chronic illness and functional status change during a 3-year period in older people enrolled in an in-home comprehensive geriatric assessment (CGA) and preventive care program.
Secondary analysis of data from a longitudinal cohort study.
Santa Monica, California.
Two hundred two community-dwelling older persons (mean age at baseline was 81 years, 70% were women, and 72% reported good health) randomized to the intervention group in a trial of in-home comprehensive geriatric assessment and preventive care.
We studied 13 common chronic illnesses/conditions determined clinically from an annual comprehensive evaluation by gerontologic nurse practitioners (GNPs) in consultation with study geriatricians. These target conditions included hypertension, osteoarthritis, coronary artery disease, obesity, undernutrition, urinary incontinence, sleep disorders, falls, gait/balance disorders, hearing and vision deficits, depression, and unsafe home environment. The dependent variable was functional change as measured by instrumental activities of daily living (IADL) and basic activities of daily living (BADL) assessed at baseline and annually for 3 years by independent research personnel. Potential confounding variables, including comorbid conditions and other subject characteristics, were controlled for in the analyses.
Although functional status was similar at baseline, the presence of certain target conditions in this sample was associated significantly with functional decline in IADL and BADL during the 3-year period. Four conditions (gait/balance disorders, depression, unsafe home environment, and coronary artery disease) were associated with significant declines in IADL, and four conditions (gait/balance disorders, depression, hypertension, and urinary incontinence) were associated with significant declines in BADL. Conversely, subjects with obesity had no significant change in IADL or BADL throughout the study period and had less decline in IADL compared with nonobese subjects.
Certain chronic conditions, particularly gait/balance disorders and depression, are associated with significant decline in functional status in older persons who receive CGA. These findings may help identify older persons at risk for greatest functional decline despite participation in CGA and may also suggest the need for more effective intervention strategies in these individuals.
在一项居家综合老年评估（CGA）和预防保健项目中，研究老年人在3年期间慢性病与功能状态变化之间的关联。
对一项纵向队列研究的数据进行二次分析。
加利福尼亚州圣莫尼卡。
202名社区居住的老年人（基线时平均年龄为81岁，70%为女性，72%报告健康状况良好），他们在一项居家综合老年评估和预防保健试验中被随机分配到干预组。
我们研究了由老年病护理从业者（GNP）在与研究老年病专家协商后，通过年度综合评估临床确定的13种常见慢性病/状况。这些目标状况包括高血压、骨关节炎、冠状动脉疾病、肥胖、营养不良、尿失禁、睡眠障碍、跌倒、步态/平衡障碍、听力和视力缺陷、抑郁症以及不安全的家庭环境。因变量是功能变化，由独立研究人员在基线时以及之后3年每年通过日常生活活动能力（IADL）和基本日常生活活动（BADL）进行评估。分析中控制了潜在的混杂变量，包括共病状况和其他受试者特征。
尽管基线时功能状态相似，但该样本中某些目标状况的存在与3年期间IADL和BADL的功能下降显著相关。四种状况（步态/平衡障碍、抑郁症、不安全的家庭环境和冠状动脉疾病）与IADL的显著下降相关，四种状况（步态/平衡障碍、抑郁症、高血压和尿失禁）与BADL的显著下降相关。相反，肥胖受试者在整个研究期间IADL或BADL没有显著变化，并且与非肥胖受试者相比，IADL下降较少。
某些慢性病，特别是步态/平衡障碍和抑郁症，与接受CGA的老年人功能状态的显著下降相关。这些发现可能有助于识别尽管参与CGA但功能下降风险最大的老年人，也可能表明需要对这些个体采取更有效的干预策略。
