Functional Decline and Recovery of Activities of Daily Living among Elderly Patients Hospitalized with Colorectal Cancer Undergoing Colectomy

高齡患者住院接受大腸直腸癌切除手術的日常生活活動功能衰退和恢復

林承賦(Cheng-Fu Lin) ； 邱語蘋(Yu-Ping Chiou) ； 周吟怡(Yin-Yi Chou) ； 林時逸(Shih-Yi Lin) ； 陳周斌(Chou-Pin Chen) ； 林鉅勝(Chu-Sheng Lin) ； 李毓珊(Yu-Shan Lee) ； 翁碩駿(Shuo-Chun Weng)

《台灣老年醫學暨老年學雜誌》 12卷2期 (2017/05) Pp. 118-132

https://doi.org/10.29461/TGG.201705_12(2).0004

摘要

Objectives: Old individuals are known to be at an increased risk of postoperative functional decline after major surgery that will lead to reduced quality of life and autonomy. The purpose of this study was to assess factors related to postoperative functional change using comprehensive geriatric assessment (CGA) in patients with colorectal cancer undergoing colectomy. Methods: 30 patients older than 65 years undergoing colectomy for colorectal cancer in a medical center in central Taiwan were enrolled. A CGA was done at two time points, postoperative day 3 and discharge, respectively, to examine factors associated with the regaining of mobility upon discharge after colon cancer surgery. Results: Of the 30 patients (43.3% women), the median age was 72.5 years (inter-quartile range [IQR], 67.8-77.0 years), and all lived independently with the median baseline Activities of Daily Living (ADL) of 100 points (IQR, 100-100 points) before admission. After surgery, the median ADL score was significantly decreased to 55 points (IQR, 45-70 points), and then significantly improved to 83 points (IQR, 70-90 points) at discharge. The median length of stay (LOS) was 10.0 days (IQR, 8.8-14.0 days). It was shown that age, gender, hand grip strength, walking speed, timed up and go test, cognitive impairment and nutritional status at day 3 postoperatively were associated with the ADL at discharge. In addition, the study also found that postoperative day 3 mood and nutritional status were related to the LOS. Conclusion: Using CGA, we identified predictive factors for functional decline after colectomy in elderly patients with colorectal cancer. It may be helpful for identifying patients at high risk of functional decline after colorectal surgery and for developing methods to improve performance status before and after surgery.

關鍵字

geriatric assessment ； surgical outcome ； elderly patients ； colorectal cancer ； hospitalization

並列摘要

背景：年邁是已知造成手術後日常生活活動功能衰退的風險因子，如此將導致生活品質下降與自主性喪失。此研究想要探討周全性老人評估各項目與其他臨床相關因子等對高齡大腸直腸癌手術患者的預後關聯性。方法：此實驗在2016年的台灣中部某一醫學中心進行，納入30名65歲以上高齡患者接受大腸直腸癌切除術。分別於手術後3天內和出院時，使用周全性老人評估測量患者的身體、心理社會和功能狀態，藉以了解各項目與其他臨床相關因子的變化，是否與預後如功能恢復的狀況、住院天數有相關。結果：本研究共納入30患者(43.3%為女性)，中位數年齡為72.5 歲(四分位距，67.8及77.0歲)，住院前的日常生活活動皆可獨立自主，中位數為100分(四分位距，100及100分)。手術後的日常生活活動功能降至55分(四分位距，45及70分)，出院時則顯著改善至83分(四分位距，70及90分)。住院天數為10.0天(四分位距，8.8至14.0天)。本研究發現年齡、性別、以及術後3天內評量的周全性老人評估包含握力、行走速度及起立行走測試、心智和營養狀況與出院時的日常生活活動功能狀況有關。另術後3天內評量的情緒和營養狀況則與住院天數相關。結論：藉由周全性老人評估，我們發現了高齡大腸直腸癌患者經手術後造成功能衰退的預測因子，如此可能有助於及早發現這類高風險患者，並因此開發改善手術前後功能狀態的方法。

並列關鍵字

老年評估 ； 手術預後 ； 高齡病患 ； 大腸直腸癌 ； 住院治療