哈密市老年人日常活动能力及健康期望寿命研究

目的 了解哈密市（伊区两县）≥60岁老年人日常活动能力及健康期望寿命,分析ADL的影响因素。方法 通过多阶段抽样抽取调查对象,收集≥60岁老年人的人口学特征、慢病患病情况以及日常活动能力情况。不同人群ADL依赖率的比较采用χ2检验,ADL影响因素筛选采用二分类Logistic回归分析。结果 共抽样调查880人,哈密市60岁及以上老年人ADL依赖率为13.18%。男性60岁及以上老年人ADL依赖率为10.21%,女性为16.59%;不同性别、民族、文化程度、婚姻状况、户籍类型、社会医疗保险,是否患有慢性病、是否吸烟,是否饮酒,是否进行体育锻炼分组的≥60岁老年人ADL依赖率有统计学差异（P＜0.05）;二分类Logistic回归分析显示,民族为哈萨克族、文盲、丧偶、患有慢性病的老年人ADL依赖率更高,参加体育锻炼的老年人ADL依赖率更低。哈密市60～64岁组老年人期望寿命为25.58岁,期望寿命随年龄增加而呈现下降趋势。60～64岁组老年人健康期望寿命为20.17岁,ADL依赖健康期望寿命为5.41岁。结论 在老年人健康问题中,应更加关注易发生ADL损失的高危人群,重点关注独居,丧偶老年人。鼓励老年人多参加体育锻炼或社区活动,增强身体健康。     

Mortality and quality of life after trochanteric hip fracture

The objective was to evaluate the survival and some aspects of the quality of life of patients with trochanteric hip fracture after long-term follow-up in comparison with the age- and sex-matched controls without fracture. Two hundred consecutive patients (mean age at fracture 77 y) with trochanteric hip fractures were compared with the age- and sex-matched controls representing an average population from the same area. After a mean 7 y follow-up period a questionnaire concerning their place of residence, ambulation, causes leading to impairment, need for locomotor aids and management of activities in daily living (ADL) functions was sent to the surviving patients and controls. Mortality increased gradually being 4.5 percent above the control level one month after the fracture, 6.0 percent above at three months, 3.5 percent above at one year, 4.5 percent above at two years, 6.5 percent above at five years and 9.0 percent above at six years. Thirty (48%) of the surviving 62 patients and 83 (90%) of the 92 surviving controls were living in their own homes and 2 (3%) and 4 (4%) in service apartments respectively. Seventeen (27%) of patients alive were institutionalized in a chronic care hospital unit and 13 (21%) in an old people's home as compared with 2 (2%) and 3 (3%) of the controls respectively. Twenty-two (35%) of the patients and 73 (79%) of the controls were able to move about independently. The patients were significantly worse at ADL-management, required more home help and had fewer social contacts and outdoor hobbies than the controls. In conclusion surgically-treated trochanteric hip fractures markedly increase mortality rate, reduce independence and impair walking ability and ADL-functions, and thus seriously affect the health-related quality of life of the patients. This fact should be considered in the planning of the healthcare of elderly people.     

代谢综合征对中国中老年人日常生活活动能力影响的前瞻性队列研究

目的:探讨我国中老年人代谢综合征（MS）与日常生活活动能力（ADL）受损的关联,为提高人口健康预期寿命提供依据。方法:采用前瞻性队列研究设计,利用2011-2018年中国健康与养老追踪调查数据,以2011年数据为基线,分别在2013、2015和2018年随访ADL结局,且以2013年和2015年新进入队列的人群作为基线...     

Quality of life in elderly subjects with pain in the hip or knee

This study examines the quality of life (QOL) of community living elderly people aged 55-74 with chronic, episodic or sporadic pain in the hip or knee and of a reference group without pain (total n=306). Firstly, it was hypothesized that the experienced QOL is lower in people with more chronic pain. Secondly, the potential mediating and moderating roles of disability and of coping with problems in general on the relationship between pain chronicity and QOL were assessed. A Visual Analogue Scale was used to assess global QOL. Physical as well as psychosocial disability was assessed with the Sickness Impact Profile (SIP). Coping with problems in general was assessed with the Utrecht Coping List. As expected, a significantly lower QOL was found in people with more chronic pain (p=0.045). The difference in QOL between the group with chronic pain and a reference group without pain was 10%. A multivariate regression model showed that physical and especially psychosocial disability are mediators in the relationship between pain chronicity and QOL and that seeking social support as a coping style is a more important predictor of the experienced QOL than either pain chronicity or physical disability. No moderating role of the style of coping with problems was found.     

Two-stage revision of implant-associated infections after total hip and knee arthroplasty

Septic loosening of total hip and knee endoprostheses gains an increasing proportion of revision arthroplasties. Operative revisions of infected endoprostheses are mentally and physically wearing for the patient, challenging for the surgeon and a significant economic burden for healthcare systems. In cases of early infection within the first three weeks after implantation a one-stage revision with leaving the implant in place is widely accepted. The recommendations for the management of late infections vary by far. One-stage revisions as well as two-stage or multiple revision schedules have been reported to be successful in over 90% of all cases for certain patient collectives. But implant associated infection still remains a severe complication. Moreover, the management of late endoprosthetic infection requires specific logistics, sufficient and standardized treatment protocol, qualified manpower as well as an efficient quality management. With regard to the literature and experience of specialized orthopaedic surgeons from several university and regional hospitals we modified a commonly used treatment protocol for two-stage revision of infected total hip and knee endoprostheses. In addition to the achievement of maximum survival rate of the revision implants an optimisation of the functional outcome of the affected artificial joint is aimed for.     

Adherence to Dietary Guidelines Positively Affects Quality of Life and Functional Status of Older Adults

BackgroundNutritional parameters could influence self-perceived health and functional status of older adults.ObjectiveWe prospectively determined the association between diet quality and quality of life and activities of daily living.DesignThis was an observational cohort study in which total diet scores, reflecting adherence to dietary guidelines, were determined. Dietary intakes were assessed using a food frequency questionnaire at baseline. Total diet scores were allocated for intake of selected food groups and nutrients for each participant as described in the Australian Guide to Healthy Eating. Higher scores indicated closer adherence to dietary guidelines.Participants/settingIn Sydney, Australia, 1,305 and 895 participants (aged ≥55 years) with complete data were examined over 5 and 10 years, respectively.Main outcome variablesThe 36-Item Short-Form Survey assesses quality of life and has eight subscales representing dimensions of health and well-being; higher scores reflect better quality of life. Functional status was determined once at the 10-year follow-up by the Older Americans Resources and Services activities of daily living scale. This scale has 14 items: seven items assess basic activities of daily living (eg, eating and walking) and seven items assess instrumental activities of daily living (eg, shopping or housework).Statistical analyses performedNormalized 36-Item Short-Form Survey component scores were used in analysis of covariance to calculate multivariable adjusted mean scores. Logistic regression analysis was used to calculate adjusted odds ratios and 95% CIs to demonstrate the association between total diet score with the 5-year incidence of impaired activities of daily living.ResultsParticipants in the highest vs lowest quartile of baseline total diet scores had adjusted mean scores 5.6, 4.0, 5.3, and 2.6 units higher in these 36-Item Short-Form Survey domains 5 years later: physical function (P_trend=0.003), general health (P_trend=0.02), vitality (P_trend=0.001), and physical composite score (P_trend=0.003), respectively. Participants in the highest vs lowest quartile of baseline total diet scores had 50% reduced risk of impaired instrumental activites of daily living at follow-up (multivariable-adjusted P_trend=0.03).ConclusionsHigher diet quality was prospectively associated with better quality of life and functional ability.     

Quality of life: An overview of issues for use in occupational therapy outcome measurement

The concept of quality of life (QOL) has been used as an outcome measure to indicate the global health, functioning and wellbeing of a person following illness, injury or disability, and to evaluate the effectiveness of therapeutic interventions. Whilst QOL has been widely used for these purposes by researchers and practitioners in the health and social sciences, it has had limited application by occupational therapists. This has occurred despite the obvious links to occupational therapy philosophy, with both having a multifaceted, holistic, and client-centred approach to people's lives, and a concern with the roles and functions that give life meaning and value. This paper reviews QOL literature in order to introduce occupational therapists to the issues involved with using this construct, from its conceptualization to its measurement. A guide to the decision-making processes involved in selecting an appropriate QOL outcome measure for use in occupational therapy practice is provided.     

Nutritional status and functional capacity of community-dwelling elderly in southern Laos

Objectives

The aim of this study was to assess the nutritional status and functional capacity of 144 community-dwelling elderly in three rural ethnic groups, namely, the Oy, the Brau and the Lao, of southern Laos.

Methods

The Mini nutritional assessment (MNA) questionnaire and Determine Your Nutritional Health checklist were used to assess nutritional status. The Barthel Activities of Daily Living questionnaire and Lawton and Brody’s Instrumental Activities of Daily Living questionnaire were used to assess the functional capacity of the respondents.

Results

The MNA score results indicated that 92.5 % of Oy respondents, 85.4 % of Brau respondents and 60 % of Lao respondents were malnourished. Analysis of variance tests showed that the MNA scores of the Oy and Lao ethnic groups and of the Brau and Lao ethnic groups were significantly different ( both p < 0.01), but that there was no significant difference between the MNA scores of the Oy and Brau ethnic groups (p > 0.05). In terms of functional capacity, 47.2 % of Oy respondents, 43.9 % of Brau respondents and 20 % of Lao respondents had limitations in their activities of daily living, whereas 98.1 % of Oy respondents, 97.6 % of Brau respondents and 86 % of Lao respondents had limitations in their instrumental activities of daily living. Body mass index, reduced appetite, number of meals consumed daily and presence of common diseases predicted nutritional status in all three ethnic groups; the remaining factors differed by ethnicity. This result implies that ethnic differences and other factors, such as location of the village, services, resources within the village and respondents’ lifestyles, can affect nutritional status.

Conclusions

Because predictors of nutritional status varied by ethnicity, there is a need for area-specific interventions aimed at improving the quality of life of the elderly in these areas.     

A model of subjective quality of life for outpatients with schizophrenia and other psychoses

This study investigated predictors of quality of life among persons with schizophrenia and other psychoses. On the basis of previous research, it was hypothesised that objective life circumstances, self-variables, psychopathology, activity level, satisfaction with daily activities, and satisfaction with medical care would be determinants of quality of life. 134 persons were investigated, and the analysis was based on Structural Equation Modelling (SEM). A model with two quality of life variables, General quality of life and Security, fitted the data best. A self-variable, Sense of self, and Satisfaction with daily activities, Psychopathology, and Satisfaction with medical care served as mediators and explained the variation in the quality of life variables. External to the mediators, and related to these, were Activity level, Educational level, and Independent living. In conclusion, a self-variable showed the strongest association with quality of life, but two aspects that should be feasible to influence in mental health care, daily activity and medical care, contributed to the subjects self-rated quality of life. These results render a somewhat optimistic view on how to accomplish a better self-perceived quality of life among people with severe mental illness.     

Social support and health-related quality of life in hip and knee osteoarthritis

OBJECTIVE: To document the association between social support and health-related quality of life (HRQoL) in hip and knee osteoarthritis (OA). METHODS: A prospective survey including the SF-36 and the Social Support questionnaire (SSQ) was administered to 108 hip and knee OA patients attending an outpatient physical rehabilitation and rheumatology clinic. Multiple regression analysis were performed to study the relation between social support and each dimension of the SF-36, controlling for age, sex, body mass index, number of comorbid conditions, socioeconomic status, site of survey completion and severity of OA which was gauged with the pain dimension of the WOMAC, an OA-specific health status instrument. RESULTS: Greater social companionship transactions were associated with higher physical functioning (standardized regression coefficients: beta = 0.26, p < 0.01), general health (beta = 0.32, p < 0.001), mental health (beta = 0.25, p < 0.01), social functioning (beta = 0.20, p < 0.05) and vitality (beta = 0.25, p < 0.05). Satisfaction with problem-oriented emotional support was related to better physical functioning (beta = 0.22, p < 0.01), mental health (beta = 0.38, p < 0.001), role-emotional (B = 0.23, p < 0.01), social functioning (beta = 0.19, p < 0.05) and vitality (beta = 0.26, p < 0.01). CONCLUSION: Social support components significantly account for HRQoL. Health interventions in OA, primary dedicated to pain and physical disability, could be supplemented with social support component to enhance health outcomes.     

The water exercise improves health-related quality of life of frail elderly people at day service facility

Objective The purpose of this study was to investigate the effects of water exercise at a day service facility and the effects of water exercise frequency on health-related quality of life (HRQL). Methods Participants (n = 30) were randomly separated into three groups: two indicating exercise frequency, at once-weekly or twice-weekly, and a control group. One-hour exercise intervention sessions were carried out once or twice a week, accordingly, for 24 weeks. The water exercise session comprised a warm-up on land, activities of daily living (ADL) exercises, stretching, strength training, and relaxation in water. HRQL was evaluated using the Medical Outcomes Survey Short-Form 36 (SF-36) questionnaire, and ADL disability was assessed using the Functional Independence Measure. Results Significant differences were found between pre- and 6 months in both the once- and twice-weekly groups in HRQL (p < 0.05). No significant difference was found among pre-, 3 months, and 6 months. The effect size between the once and twice groups was moderate in both the physical component summary (0.72) and mental component summary (0.75) at 3 months. ADL disability shows significant correlation with HRQL. Conclusion Water exercise intervention at a day service facility improved participants’ HRQL for 6 months by improving exercise habits and ADL disability. Furthermore, the HRQL change differed according to exercise frequency: twice-weekly exercise showed more rapid improvement than once-weekly.     

老年慢性病患者生活质量指数与日常活动能力的相关性研究

目的了解老年慢性病患者生活质量指数和日常活动能力的关系。方法采用生活质量指数问卷和日常生活活动能力表 (ADL)评定 5 4例老年心身疾病患者的状况 ,与 5 4例老年非心身疾病患者和健康老人对照。结果老年心身疾病患者的生活质量指数和日常活动能力差于非心身疾病老人和普通老人。老年心身疾病患者生活质量指数和日常生活活动能力的典型相关分析发现的日常生活能力与洗澡自理能力成正相关。结论心理干预和健康教育 ,特别是提高老年心身疾病患者洗澡技巧的教育有助于提高他们的生活质量。     

离退休干部日常生活能力评价及影响因素分析

目的 探讨我省军队离退休干部的日常生活能力状况及其影响因素。方法 采用问卷访问和体格检查相结合的方法对我省军队离退休干部767人进行流行病学调查分析。结果 日常生活能力与心理卫生、生活满意度有显著相关性。影响离退休老年人日常生活能力的主要因素是婚姻家庭、膳食营养、娱乐活动、睡眠质量、躯体疾病等。结论 加强老年人躯体疾病的防治，重视心理卫生和健康教育，以不断提高军队离退休干部的生活质量。     

Using patient-reported outcome measures to estimate cost-effectiveness of hip replacements in English hospitals

Objective

To estimate the average cost per quality adjusted life year (QALY) gained from hip surgery, and to examine the variation in that between hospitals.

Design

The transformation of patient-reported outcome measures (EQ-5D data) into QALYs, covering 25,463 NHS patient episodes between April 2009 and August 2010 from hospitals in England, using a model of future health change arising from a hip operation compared to a counterfactual of no operation. Hospital-level costs for hip procedures from the National Reference Costs data-set was used to calculate the hospitals'' cost per QALY.

Setting

English hospitals treating NHS-funded patients undergoing hip replacement.

Participants

NHS-funded patients undergoing primary hip replacement.

Main outcome measure

Cost per QALY.

Results

Assuming some degradation in patients’ health over the lifetime of the hip prosthesis, average health gain arising from a hip operation was 2.77 QALYs. For procedures paid for by the NHS but carried out in the independent sector the average gain was 2.97 QALYs. Average NHS hospital hip procedure costs were estimated to be £5844. The unweighted average cost per QALY for NHS hospitals was £2128. There were significant variations in cost per QALY between hospitals; most of this variation appears to be driven by variations in cost, not QALYs.

Conclusions

Using the new patient-assessed health-related quality of life data combined with routine hospital-level cost data it is possible to estimate a procedure-based measure of efficiency for hospitals. The fact that variations in cost per QALY are strongly driven by variations in cost suggests that further work is needed to investigate the causes of cost variations per se – especially the quality of routine NHS cost data.     

The Association Between Quality of Care and Quality of Life in Long-Stay Nursing Home Residents With Preserved Cognition

ObjectivesTo assess the overall quality of life of long-stay nursing home residents with preserved cognition, to examine whether the Centers for Medicare and Medicaid Service's Nursing Home Compare 5-star quality rating system reflects the overall quality of life of such residents, and to examine whether residents' demographics and clinical characteristics affect their quality of life.Design/measurementsQuality of life was measured using the Participant Outcomes and Status Measures—Nursing Facility survey, which has 10 sections and 63 items. Total scores range from 20 (lowest possible quality of life) to 100 (highest).Setting/participantsLong-stay nursing home residents with preserved cognition (n = 316) were interviewed.ResultsThe average quality- of-life score was 71.4 (SD: 7.6; range: 45.1–93.0). Multilevel regression models revealed that quality of life was associated with physical impairment (parameter estimate = −0.728; P = .04) and depression (parameter estimate = −3.015; P = .01) but not Nursing Home Compare's overall star rating (parameter estimate = 0.683; P = .12) and not pain (parameter estimate = −0.705; P = .47).ConclusionThe 5-star quality rating system did not reflect the quality of life of long-stay nursing home residents with preserved cognition. Notably, pain was not associated with quality of life, but physical impairment and depression were.     

Analysis of regional variation in hip and knee joint replacement rates in England using Hospital Episodes Statistics

OBJECTIVES: Total hip and knee joint replacements are effective interventions for people with severe arthritis, and demand for these operations appears to be increasing as our population ages. This study explores regional variations in health care and inequalities in the provision of these expensive interventions, which are high on the UK Government's health agenda. STUDY DESIGN: The Hospital Episode Statistics (HES) for England were analysed. The HES database holds information on patients who are admitted to National Health Service (NHS) hospitals in England. METHODS: Age-standardized procedure rates were calculated using 5-year age groups with the English mid-year population of 2000 as the reference. Univariate associations between age-standardized operation rates and regional characteristics were assessed using Pearson's correlation coefficient. RESULTS: Age and sex-standardized surgery rates vary by 25-30%. For both hip and knee replacement, rates are highest in the South West and Midlands and lowest in the North West, South East and London regions. In the case of knee replacement, there are also marked differences in the sex ratios between regions. The variable that explained most variation in hip replacement rates was the proportion of older people in the region. In the case of knee replacement, the number of NHS centres offering surgery in the region was the main explanatory variable, with regions with fewer centres having the highest provision rates. CONCLUSION: These data can help to inform planning of services. They suggest that there may be inequities as well as inequalities in the provision of primary joint replacement surgery in England.     

Variability in measuring (instrumental) activities of daily living functioning and functional decline in hospitalized older medical patients: a systematic review

Objective

To study instruments used and definitions applied in order to measure (instrumental) activities of daily living (I [ADL]) functioning and functional decline in hospitalized older medical patients.

Study Design

We systematically searched Medline, Embase, and the Cochrane Database of Systematic Reviews from 1990 to January 2010. Articles were included if they (1) focused on acute hospitalization for medical illness in older patients; (2) described the instrument used to measure functioning; and (3) outlined the clinical definition of functional decline. Two reviewers independently extracted data.

Results

In total, 28 studies were included in this review. Five different instruments were used to measure functioning: the Katz ADL index, the IADL scale of Lawton and Brody, the Barthel index, Functional Independence Measure, and Care Needs Assessment. Item content and scoring between and within the instruments varied widely. The minimal amount for decline, as defined by the authors, referred to a decrease in functioning between 2.4% and 20.0%.

Conclusion

This review shows there is a large variability in measuring (I)ADL functioning of older hospitalized patients and a large range of clinical definitions of functional decline. These conceptual and clinimetric barriers hamper the interpretation and comparison of functional outcome data of epidemiological and clinical studies.