RESUMO
Objective: Latent class analysis was used to identify functional classes among patients hospitalized for pneumonia. Then, we determined predictors of class membership and examined variation in distal outcomes among the functional classes. Design: An observational, cross-sectional study design was used with retrospectively collected data between 2014 and 2018. Setting: The study setting was a single health system including 5 acute care hospitals. Participants: A total of 969 individuals hospitalized with the primary diagnosis of pneumonia and receipt of an occupational and/or physical therapy evaluation were included in the study. Interventions: Not applicable. Main Outcomes: The following 5 distal outcomes were examined: (1) occupational therapy treatment use, (2) physical therapy treatment use, (3) discharge to home with no services, (4) discharge to home with home health, and (5) institutional discharge. Results: Five functional classes were identified and labeled as follows: Globally impaired, Independent with low-level self-care, Independent low-level mobility, Independent self-care, and Independent. Probability of occupational therapy treatment use (χ2[4]=50.26, P<.001) and physical therapy treatment use (χ2[4]=50.86, P<.001) varied significantly across classes. The Independent with low-level self-care class had the greatest probability of occupational therapy treatment use and physical therapy treatment use. Probability of discharging to home without services (yes/no; χ2[4]=88.861, P<.001), home with home health (yes/no; χ2[4]=15.895, P=.003), and an institution (yes/no; χ2[4]=102.013, P<.001) varied significantly across the 5 classes. The Independent class had the greatest probability of discharging to home without services. Conclusions: Five functional classes were identified among individuals hospitalized for pneumonia. Functional classes could be used by the multidisciplinary team in the hospital as a framework to organize the heterogeneity of functional deficits after pneumonia, improve efficiency of care processes, and help deliver targeted rehabilitation treatment.
RESUMO
Objective. To examine the effect of obesity on incidence of disability and mortality among non-disabled older Mexicans at baseline. Materials and methods. The sample included 8 415 Mexicans aged ≥ 50 years from the Mexican Health and Aging Study (2001 -2012), who reported no limitations in activities of daily living (ADLs) at baseline and have complete data on all covariates. Sociodemographics, smoking status, comorbidities, ADL activities, and body mass index (BMI) were collected. Results. The lowest hazard ratio (HR) for disability was at BMI of 25 to < 30 (HR = 0.97;95% confidence interval [CI], 0.85-1.12).The lowest HR for mortality were seen among participants with BMIs 25 to < 30 (HR = 0.85; 95%CI, 075-0.97), 30 to < 35 (HR = 0.86; 95 %CI, 0.72-1.02), and > 35 (HR = 0.92; 95 %CI, 0.70-1.22). Conclusion. Mexican older adults with a BMI of 25 to < 30 were at less risk for both disability and mortality.
Objetivo. Examinar el efecto de la obesidad sobre la incidencia de discapacidad y mortalidad en adultos mayores mexicanos sin discapacidad al inicio del estudio. Material y métodos. La muestra incluyó 8 415 Mexicanos ≥ 50 años de edad del Estudio Nacional de Salud y Envejecimiento en México (2001 -2012), quienes no reportaron discapacidad en las actividades de la vida diaria en la encuesta basal y tenían información completa de todas las covariables. Resultados. La razón de riesgo más baja (HR) para discapacidad se observó con un IMC de 25 a < 30 (HR=0.97;95%CI, 0.85-1.12). La razón de riesgo más baja para mortalidad se observó con IMC de 25 a < 30 (HR = 0.85;95%CI,075-0.97),de 30 a < 35 (HR = 0.86; 95%CI, 0.72-1.02), y > 35 (HR = 0.92; 95%CI, 0.70-1.22). Conclusión. Los adultos mayores mexicanos con un IMC de 25 a < 30 tuvieron menor riesgo de discapacidad y mortalidad.