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首页> 外文期刊>The journals of gerontology.Series A. Biological sciences and medical sciences >Relationship between functional loss before hospital admission and mortality in elderly persons with medical illness.
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Relationship between functional loss before hospital admission and mortality in elderly persons with medical illness.

机译：老年住院患者的住院前功能丧失与死亡率之间的关系。

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OBJECTIVE: This hospital-based prospective study tests the hypothesis that, in a large group of hospitalized elderly patients, those who report functional decline between pre-illness baseline and hospital admission have a higher risk of death. METHODS: Nine hundred fifty elderly ambulant patients (F = 69.3%; mean age 78.3 +/- 8.5 years) were consecutively admitted to a geriatric ward (Poliambulanza Hospital, Brescia, Italy) during a 15-month period. Number and severity of somatic diseases, Charlson Index score, APACHE II score, level of serum albumin, cognitive status (by Mini-Mental State Examination), and depression score (by Geriatric Depression Scale), were assessed on admission and evaluated as potential prognostic factors. Functional status (by Barthel Index) was assessed by self-report on admission. Preadmission function was also assessed by self-report at the time of admission. Impairment of function due to an acute event is measured as the difference between performances on admission and 2 weeks before the acute event. Six-month survival was the main outcome variable. RESULTS: Factors related to mortality in bivariate analysis were: male sex, age over 80, cancer, congestive heart failure, pulmonary diseases, elevated Charlson Index score, and (independently) dementia (Mini-Mental State Examination < 18), APACHE-Acute Physiology Score , albumin level <3.5 g/dL, and anemia. After controlling for these variables and for Barthel Index score 2 weeks before the acute event, change in function due to the acute disease is independently related to 6-month mortality (minor functional change [<30 Barthel Index Point] relative risk: 1.3, 95% confidence interval, 0.6-3.0 and major functional change [major functional decrement] relative risk: 2.8, 95% confidence interval, 1.3-5.7). CONCLUSIONS: Disease-induced disability may reflect a condition of biological inability to react to acute diseases (i.e., frailty), and should be assessed as a relevant prognostic indicator.
机译：目的：这项基于医院的前瞻性研究检验了以下假设：在许多住院的老年患者中，那些报告病前基线和入院之间功能下降的患者死亡风险更高。方法：在15个月的期间内，连续收治了950名老年流动病患者（F = 69.3％;平均年龄78.3 +/- 8.5岁），该病患者被送往老年病房（意大利布雷西亚的Poliambulanza医院）。在入院时评估躯体疾病的数量和严重程度，查尔森指数评分，APACHE II评分，血清白蛋白水平，认知状态（通过小精神状态检查）和抑郁评分（通过老年抑郁量表），并将其作为潜在的预后指标因素。入院时通过自我报告评估功能状态（通过Barthel Index）。入院时还通过自我报告评估了入院功能。急性事件导致的功能障碍可通过入院时与急性事件发生前2周之间的差异来衡量。六个月生存是主要的结果变量。结果：双变量分析中与死亡率相关的因素是：男性，80岁以上的癌症，充血性心力衰竭，肺部疾病，查尔森指数评分升高和（独立地）痴呆（迷你精神状态检查<18），APACHE-急性生理评分，白蛋白水平<3.5 g / dL和贫血。在控制了这些变量和急性事件发生前2周的Barthel Index评分后，由急性疾病引起的功能变化与6个月死亡率独立相关（较小的功能变化[<30 Barthel Index Point]相对风险：1.3，95 ％置信区间0.6-3.0和主要功能变化[主要功能减少]相对危险度：2.8，95％置信区间1.3-5.7）。结论：由疾病引起的残疾可能反映了对急性疾病（即脆弱）无生物学反应的状况，应将其评估为相关的预后指标。

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