Although functional impairment is common among older adults with chronic kidney disease (CKD), functional reserve before an acute health event and physical resilience after the event have not been characterized in this population. The purpose of this study was to identify distinct patterns of physical function before and after an acute health event among older veterans with stage 4 CKD. Prospective cohort study. National sample of veterans≥70 years of age with an estimated glomerular filtration rate (eGFR) of<30mL/min/1.73m who had an acute care encounter (emergency department visit or hospitalization) during the follow-up period (n = 272). Demographic characteristics, eGFR, basic and instrumental activities of daily living (ADL/IADL) difficulty, symptom burden, cognition, depressive symptoms, social support. Function measured using the life-space mobility assessment obtained by telephone survey before and after an acute care encounter. General growth mixture models to identify classes of functional trajectories. Calculation of percentages for demographic characteristics and means for eGFR, ADL/IADL difficulty, symptom burden, cognition, depressive symptoms, and social support by trajectory class. Four trajectory classes were identified and characterized by different levels of life-space mobility before (reserve) and change in life-space mobility after (resilience) an acute care encounter: (1) low reserve, low resilience (n=91), (2) high reserve, high resilience (n=23), (3) moderate reserve, moderate resilience (n=89), and (4) high reserve, low resilience (n=69). Mean levels of ADL/IADL difficulty, symptom burden, cognition, and depressive symptoms, but not demographic characteristics, eGFR, or social support, differed by trajectory class. Veteran cohort was primarily male. Among older adults with stage 4 CKD, physical function trajectories before and after an acute health event vary. Integrating reserve and resilience into care for this population may be useful for anticipating changes in function and developing tailored treatment plans.

中文翻译：

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患有 4 期 CKD 的老年退伍军人的身体复原力轨迹

尽管功能障碍在患有慢性肾病 (CKD) 的老年人中很常见，但该人群在急性健康事件之前的功能储备和事件之后的身体恢复能力尚未得到表征。本研究的目的是确定患有 4 期 CKD 的老年退伍军人在发生急性健康事件之前和之后身体功能的不同模式。前瞻性队列研究。全国退伍军人样本，年龄≥70岁，估计肾小球滤过率（eGFR）<30mL/min/1.73m，在随访期间经历过急性护理（急诊科就诊或住院）（n = 272） 。人口统计特征、eGFR、基本和工具性日常生活活动 (ADL/IADL) 难度、症状负担、认知、抑郁症状、社会支持。使用在紧急护理遭遇之前和之后通过电话调查获得的生命空间流动性评估来测量功能。用于识别功能轨迹类别的一般生长混合模型。按轨迹类别计算人口特征的百分比以及 eGFR、ADL/IADL 难度、症状负担、认知、抑郁症状和社会支持的平均值。确定了四种轨迹类别，并以不同水平的生命空间流动性（保留）和急性护理遭遇后（弹性）后的生活空间流动性变化为特征：（1）低保留，低弹性（n = 91），（ 2）高储备，高复原力（n=23），（3）中等储备，中等复原力（n=89），（4）高储备，低复原力（n=69）。 ADL/IADL 难度、症状负担、认知和抑郁症状的平均水平（但不包括人口特征、eGFR 或社会支持）因轨迹类别而异。退伍军人群体主要是男性。在患有 CKD 4 期的老年人中，急性健康事件前后的身体功能轨迹有所不同。将储备和恢复力纳入对这一人群的护理可能有助于预测功能变化和制定量身定制的治疗计划。