Disability among Elderly Survivors of Mechanical Ventilation

被引:122
作者
Barnato, Amber E. [1 ,2 ,3 ]
Albert, Steven M. [4 ]
Angus, Derek C. [1 ,2 ,3 ]
Lave, Judith R. [1 ,3 ]
Degenholtz, Howard B. [1 ,3 ]
机构
[1] Univ Pittsburgh, Ctr Res Hlth Care, Pittsburgh, PA 15213 USA
[2] Univ Pittsburgh, Clin Res Invest & Syst Modeling Acute Illness Lab, Dept Crit Care Med, Pittsburgh, PA 15213 USA
[3] Univ Pittsburgh, Sch Med, Dept Hlth Policy & Management, Grad Sch Publ Hlth, Pittsburgh, PA 15213 USA
[4] Univ Pittsburgh, Grad Sch Publ Hlth, Dept Behav & Community Hlth Sci, Pittsburgh, PA 15213 USA
关键词
Medicare; intensive care; mechanical ventilation; quality of life; functional status; INTENSIVE-CARE-UNIT; QUALITY-OF-LIFE; ACUTE LUNG INJURY; OLDER-ADULTS; MEDICARE BENEFICIARIES; FUNCTIONAL STATUS; CRITICAL ILLNESS; OUTCOMES; HOSPITALIZATION; IMPACT;
D O I
10.1164/rccm.201002-0301OC
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Rationale: Studies of long-term functional outcomes of elderly survivors of mechanical ventilation (MV) are limited to local samples and biased retrospective, proxy-reported preadmission functional status. Objectives: To assess the impact on disability of hospitalization with MV, compared with hospitalization without MV, accounting for prospectively assessed prior functional status. Methods: Retrospective population-based longitudinal cohort study of Medicare beneficiaries age 65 and older enrolled in the Medicare Current Beneficiary Survey, 1996-2003. Measurements and Main Results: Premeasures and postmeasures of disability included mobility difficulty and weighted activities of daily living disability scores ranging from 0 (not disabled) to 100 (completely disabled) based on self-reported health and functional status collected 1 year apart. Among 54,771 person-years (PY) of observation over 7 calendar years of data, 42,890 PY involved no hospitalization, 11,347 PY involved a hospitalization without MV, and 534 PY included a hospitalization with MV. Mortality at 1 year was 8.9%, 23.9%, and 72.5%, respectively. The level of disability at the post-assessment was substantially higher for a prototypical patient who survived after hospitalization with MV (adjusted activities of daily living disability score [95% confidence interval] 14.9 [12.2-17.7]; adjusted mobility difficulty score [95% confidence interval] 25.4 [22.4-28.4]) compared with an otherwise identical patient who survived hospitalization without MV (11.5 [11.1-11.9] and 22.3 [21.8-22.9]) or who was not hospitalized (8.0 [7.9-8.1] and 13.4 [13.3-13.6]). Conclusions: The greater marginal increase in disability among survivors of MV compared with survivors of hospitalization without MV is larger than would be predicted from prior functional status.
引用
收藏
页码:1037 / 1042
页数:6
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