Hefflin B J
Food and Drug Administration, Center for Devices and Radiological Health, Office of Surveillance and Biometrics, Rockville, Maryland 20850, USA.
J Am Geriatr Soc. 1998 Nov;46(11):1396-400. doi: 10.1111/j.1532-5415.1998.tb06006.x.
Older persons who have initial cardiac pacemakers implanted during their final year of life have not been characterized as a group, which makes it difficult to evaluate the suitability of some of their health services utilizations.
To help determine how prudently pacemakers are used in this group, we assessed its pacemaker candidates from the perspective of health and ability to perform physical activities of daily living.
A retrospective, population-based, cross-sectional study.
The 1993 National Mortality Followback Survey.
An estimated 1,647,955 persons aged 65 years or older who died in the US in 1993.
Demographic and cause-of-death frequencies obtained by analyzing age, sex, race, and underlying cause-of-death variables in the survey. For persons who had initial pacemakers implanted during their last year of life, we determined the percent of persons, within 10-year age groups, who had no difficulty at any time during their final year of life performing 11 specific physical activities of daily living (e.g., climbing stairs, preparing meals, bathing). These data were obtained from negative responses to questions that asked if the decedents, at any time during their last year of life, had difficulty performing the specific activities.
Of the estimated 78,941 persons aged 65 years or older with a pacemaker who died in the US in 1993, 14,158 (18%) had their first pacemaker implanted during their last year of life. Estimated median survival of the final-year-of-life recipients of pacemakers after pacemaker implantation was 5 months. Compared with the general older population that died in 1993, the final-year-of-life recipients of pacemakers group had higher percentages of persons who died of acute disorders (49% vs 19%) and who lived alone in a private home (47% vs 20%), and a lower percentage of persons with Alzheimer's disease (1% vs 7%). The age-stratified means of the percentages of final-year-of-life recipients of pacemakers who had no difficulty performing each physical activity of daily living were all greater than 50.
Our results suggest that older persons who had initial pacemakers implanted during their final year of life and who died in 1993 were not terminally ill, inactive pacemaker candidates, in general, but relatively independent, physically functional candidates who frequently died abruptly. The physical, mental, and life expectancy factors recommended for consideration by expert guidelines for the implantation of cardiac pacemakers were generally applied to persons in this subgroup.
在生命最后一年植入初始心脏起搏器的老年人尚未作为一个群体进行特征描述，这使得评估他们某些医疗服务利用的适宜性变得困难。
为了帮助确定起搏器在该群体中的使用是否审慎，我们从健康状况和日常生活身体活动能力的角度评估了该群体中起搏器植入候选人的情况。
一项基于人群的回顾性横断面研究。
1993年全国死亡率随访调查。
估计有1,647,955名年龄在65岁及以上于1993年在美国死亡的人。
通过分析调查中的年龄、性别、种族和潜在死因变量获得人口统计学和死因频率。对于在生命最后一年植入初始起搏器的人，我们确定了在10岁年龄组内，在生命最后一年任何时候进行11项特定日常生活身体活动（如爬楼梯、做饭、洗澡）都没有困难的人的百分比。这些数据来自对询问死者在生命最后一年任何时候进行特定活动是否有困难的问题的否定回答。
在估计的1993年在美国死亡的65岁及以上有起搏器的78,941人中，14,158人（18%）在生命最后一年植入了首个起搏器。起搏器植入后生命最后一年接受起搏器者的估计中位生存期为5个月。与1993年死亡的一般老年人群相比，生命最后一年接受起搏器者组中死于急性疾病的人（49%对19%）和独自居住在私人住宅中的人（47%对20%）的比例更高，而患有阿尔茨海默病的人比例更低（1%对7%）。按年龄分层的生命最后一年接受起搏器者在进行每项日常生活身体活动时没有困难的百分比的均值均大于50。
我们的结果表明，1993年在生命最后一年植入初始起搏器并死亡的老年人一般不是晚期疾病、不活动的起搏器候选人，而是相对独立、身体功能良好的候选人，他们经常突然死亡。心脏起搏器植入专家指南建议考虑的身体、心理和预期寿命因素通常适用于该亚组中的人。
