功能测量在预测老年住院患者死亡率方面的重要性
S K Inouye1, P N Peduzzi, J T Robison
1Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06504, USA.
JAMA
|April 29, 1998
概括
功能性测量显著预测老年住院患者的死亡率,改进现有的风险评估工具. 结合功能状态可以提高90天和2年生存期的预后准确性.
科学领域:
- 老年医学 老年医学
- 临床流行病学临床流行病学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 身体和认知功能的测量是老年患者的重要预后指标.
- 目前的风险调整指数没有包括这些关键的功能性指标.
- 这限制了对疾病负担和医院结果的准确评估.
研究的目的:
- 评估90天和2年死亡率的功能性措施的预测价值.
- 评估功能性措施对标准疾病负担指数的贡献.
- 在老年住院患者中验证这些贡献.
主要方法:
- 两项前性队列研究涉及老年住院患者 (70岁以上).
- 开发队列 (n=207) 和验证队列 (n=318).
- 功能轴是使用日常生活活动,迷你精神状态检查和老年抑郁量表来开发的.
主要成果:
- 一个功能轴在两个队列中显著预测死亡率 (P<.001).
- 功能性措施大大提高了5个标准疾病负担指数的预测能力.
- 观察到"双梯度现象":死亡率随着疾病负担层中的功能衰退而增加.
结论:
- 功能性测量是入院后短期和长期死亡率的强有力的预测指标.
- 这些措施显著提高了现有的疾病负担指数的预后能力.
- 对于老年住院患者来说,最佳的风险调整需要整合功能状态变量.
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