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首页> 外文期刊>The journals of gerontology.Series A. Biological sciences and medical sciences >Predictors of short-term functional decline in survivors of nursing home-acquired lower respiratory tract infection.
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Predictors of short-term functional decline in survivors of nursing home-acquired lower respiratory tract infection.

机译：养老院获得性下呼吸道感染幸存者的短期功能下降的预测因素。

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BACKGROUND: Scant information exists about the risk of functional decline following treatment of acute illness in the nursing home (NH) setting. The aim of this study was to determine the incidence of short-term (30-day) functional decline among survivors of NH-acquired lower respiratory tract infection (LRI) and the factors that predict such decline, including the role of initial hospitalization. METHODS: We used a prospective cohort design to study 781 episodes of LRI in 1044 NH residents in 36 NHs in central Missouri and the St. Louis metropolitan area. Functional decline was defined as a 3-point increase on the Minimum Data Set (MDS) activities of daily living (ADL) long form scale. RESULTS: Of 781 LRI cases who survived to 30 days, the incidence of ADL decline was 28.8%. In a logistic regression model that used generalized estimating equations to adjust for clustering, variables associated with ADL decline included the following: chronic feeding tube use (AOR = 4.54, 95% confidence interval, or CI, 1.61, 12.80), decubitus ulcer (adjusted odds ratio [AOR] = 2.29, 95% CI 1.35, 3.90), shortness of breath (AOR = 2.18, 95% CI 1.44, 3.30), short-term memory problems (AOR = 2.07, 95% CI 1.33, 3.23), decline in self-performance of toilet use in the 24 hours prior to evaluation (AOR = 1.65, 95% CI 1.29, 2.12), age (AOR = 1.02, 95% CI 1.00, 1.05), and baseline ADL score. Addition of treatment variables to the model showed that initial hospitalization was also associated with ADL decline (AOR = 1.90, 95% CI 1.20, 3.00). Residents with ADL decline at 30 days were less likely to recover to their baseline ADL status at 90 days. CONCLUSIONS: Many NH residents who survive to 30 days following LRI develop new functional limitations, and such individuals are at risk for ADL decline at 90 days. A limited number of clinical variables may predict short-term functional decline. Initial hospitalization for acute treatment of LRI may increase the risk of subsequent ADL decline among individuals who survive to 30 days.
机译：背景：关于在疗养院（NH）急性疾病治疗后功能下降风险的信息很少。这项研究的目的是确定NH获得性下呼吸道感染（LRI）幸存者中短期（30天）功能下降的发生率以及预测这种下降的因素，包括初始住院的作用。方法：我们采用前瞻性队列研究设计了密苏里州中部和圣路易斯市区的36个NH中的1044个NH居民中781次LRI发作。功能下降被定义为日常生活的最小数据集（MDS）长格式量表的三点增加。结果：781例存活至30天的LRI患者中，ADL下降的发生率为28.8％。在使用广义估计方程调整聚类的对数回归模型中，与ADL下降相关的变量包括：长期饲管使用（AOR = 4.54，95％置信区间，或CI，1.61，12.80），褥疮性溃疡（调整后）比值比[AOR] = 2.29，95％CI 1.35，3.90），呼吸急促（AOR = 2.18，95％CI 1.44，3.30），短期记忆问题（AOR = 2.07，95％CI 1.33，3.23），评估前24小时内厕所使用的自我表现下降（AOR = 1.65，95％CI 1.29，2.12），年龄（AOR = 1.02，95％CI 1.00，1.05）和基线ADL得分。在模型中增加治疗变量后发现，初始住院也与ADL下降有关（AOR = 1.90，95％CI 1.20，3.00）。在30天时ADL下降的居民在90天时恢复其基线ADL状态的可能性较小。结论：许多在LRI后存活30天的NH居民出现了新的功能限制，这些人在90天时有ADL下降的风险。数量有限的临床变量可能会预测短期功能下降。最初接受LRI急性治疗的住院治疗可能会增加存活30天的患者随后ADL下降的风险。

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