住院ADL依赖老年患者出院后功能恢复的预测因素

目的了解基线水平独立的老年患者住院后日常生活活动能力(ADL)的依赖现状,探索出院后3个月ADL恢复的预测因素。方法采用一般资料调查表、Barthel指数评定量表、工具性日常生活活动功能量表、简易智力测量量表、5项老年抑郁量表对2所三级甲等医院内科233例老年患者进行调查,随访出院后3个月的ADL水平,分析影响出院后ADL恢复的因素。采用ROC曲线评估各项因素对ADL恢复的预测价值。结果 233例老年患者出院后3个月的ADL恢复独立的比例为53.2%。认知得分(OR=1.201,P<0.01)、出院时ADL得分(OR=1.047,P<0.01)是出院后3个月ADL恢复的预测因素。两者单项预测ADL的ROC曲线下面积为0.719、0.792,联合预测的ROC曲线下面积为0.808。结论基线独立、住院后ADL依赖老年患者出院后功能恢复的状况有待改善。认知得分、出院时ADL得分是出院后3个月功能恢复的主要预测因素。

Predictors of recovery of activities of daily living after hospital discharge in older patients who become disabled during hospitalization

Objective To describe the status of activities of daily living(ADL) during hospital stay in older patients who were independent in ADL before admission, and to identify predictors of ADL recovery 3 months after discharge. Methods A total of 233 older patients hospitalized in department of internal medicine were recruited from two tertiary hospitals and were surveyed using a general information questionnaire, the Barthel index, Instrumental Activities of Daily Living(IADL), Abbreviated Mental Test(AMT), and the Geriatric Depression Scale(GDS-5). And their ADL were measured again at three months after discharge. Predictors of ADL recovery after discharge were analyzed and ROC curve was used to evaluate the predictive value of each predictor for ADL recovery. Results More than fifty percent(53.2%) of participants regained independence at three months after discharge. Cognition score(OR=1.201,P<0.01) and ADL score at discharge(OR=1.047,P<0.01) were predictors of recovery of ADL. The area under the ROC curve(AUC) of the above two predictors was 0.719 and 0.792, respectively. The AUC of combination use of the 2 predictors was 0.808. Conclusion Functional recovery of older patients who was nondisabled before admission and developed new disability during hospitalization needs to be improved after discharge. Cognition and ADL score at discharge are predictors of functional recovery at three months after discharge.