PubMed · 2156758
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S S Travis. Personalizing self-care.. https://doi.org/10.1016/s0197-4572(05)80247-2
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BACKGROUND: Functional disability is a common condition among elderly patients. However, to our knowledge, its effect on outcome of myocardial infarction (MI) has not been assessed. Our objectives were to determine whether disability in the activities of daily living measured before MI is a predictor of MI severity and mortality. METHODS: Disability in activities of daily living was measured prospectively in a cohort of 222 patients who were hospitalized with acute MI. Outcome measures were severity characteristics on admission to the hospital (higher Killip class, presence of new Q waves in the first electrocardiogram, and lower systolic blood pressure), and 6-month mortality. RESULTS: Patients with disability before hospitalization were older and had more comorbidity. After adjusting for these factors and for delay in hospital arrival, disability was still significantly associated with clinical severity on admission to the hospital and with mortality (adjusted relative risk of death for patients with disability vs patients without disability, 2.01; 95% confidence interval, 1.23-3.28). Clinical severity and hospital treatment explained the higher mortality of patients with disability. When these factors were added to the previous model, the relative risk of mortality for patients with disability vs patients without disability was 1.24, and the 95% confidence interval was 0.73 to 2.12. CONCLUSIONS: Functional disability in activities of daily living before MI is an important predictor of clinical severity and mortality in elderly patients with MI. This effect is only minimally explained by the older age and higher comorbidity of patients with disability. However, higher clinical severity and lower use of treatment interventions are major determinants of their higher mortality compared with patients without disability.
OBJECTIVE: To examine prognostic factors and outcomes after hip fracture in men aged 60 years and older. DESIGN AND SETTING: Cohort study of all men presenting to St George Hospital (a 650-bed tertiary care centre) with hip fractures in 1995, recruited retrospectively from medical records and evaluated prospectively at six and 12 months after fracture. PATIENTS: 51 men aged 60 years or more (and, for comparison, 51 age-matched women) who presented with hip fracture not caused by high impact injuries or local bone disease. MAIN OUTCOME MEASURES: Prognostic factors (such as pre-existing illness and osteoporotic risk factors) and outcome data (such as fracture-related complications, mortality, and level of function as measured by the Barthel index of activities of daily living at six and 12 months postfracture). RESULTS: Median age of the 51 men was 80 years (interquartile range, 74-86 years); four were aged under 70 years. Outcome assessment was possible for 41 men (80%). Similar proportions of men and women came from institutions (32% v. 28%), and similar additional proportions required institutionalisation after discharge (18% v. 14%). Fracture-related complications affected similar proportions of men and women (30% v. 32%), and mean length of hospital stay was similar. Fourteen per cent of men died in hospital compared with only 6% of women (P = 0.06). Men had more risk factors for osteoporosis (P < 0.01). Physical functioning (measured by the Barthel index) deteriorated significantly in men from 14.9 at baseline to 13.4 at six months (P < 0.05) and 12.4 at 12 months (P < 0.05) after fracture. CONCLUSION: Compared with women, elderly men presenting with hip fracture have higher mortality and have more risk factors for osteoporosis. Like women with hip fracture, men are usually fragile, with pre-existing medical illness and fracture-related complications contributing to their overall poor outcomes.
OBJECTIVE: To test the reliability, validity and utility of an "up-timer", an automated device to measure time spent standing and walking. DESIGN: Repeat measurement of mobility one week apart in a convenience sample. SETTING: Hostel and nursing homes in Melbourne. PARTICIPANTS: 26 hostel and 24 nursing home residents (aged 70-99 years) participated. They were mobile, with or without the use of walking aids or personal assistance. OUTCOME MEASURES: "Up-time" (measured with the up-timer); functional activity (measured with the Barthel Index, Functional Independence Measure, Timed Up & Go, and Human Activity Profile); and disability (measured by the Rapid Disability Rating Scale). RESULTS: The test-retest reliability of the up-timer was high (Pearson's r = 0.84; P < 0.001). Pearson's correlation between the up-timer results and results of functional and disability measures ranged from r = 0.47 to r = 0.55. The functional measures correlated more highly among themselves (r = 0.79 to r = 0.92). The performance-based Timed Up & Go test had moderate levels of correlation with both the up-timer and the functional measures. Use of the device was well accepted by both participants and staff. CONCLUSIONS: The up-timer is a practical, objective and reliable means of measuring mobility. The useful information it provides is different from, but overlaps with, that obtained from subjective observation or self report. It will complement existing subjective and performance-based measures of activity and mobility.