제주도 노인에서 고관절 주위 골절로 인한 활동성 장애가 사망률에 미치는 영향

Abstract

본 연구에서 제주도 노인에서 고관절 주위 골절로 인한 활동성 장애와 삶의 질(QOL)이 사망률에 많은 영향을 미친다는 사실을 확인하였다. 또한 골절 후에 일상생활동작(ADL)의 현저한 저하로 인하여 사망률이 높게 나타난다는 것을 알았다. 고관절 골절 후 활동성을 증진시킬 수 있는 다양한 활동프로그램을 개발하여 적용시킴으로써 일상생활동작을 향상시키고 나아가 가족과 사회의 간병 부담을 줄이고 삶의 질 향상과 함께 궁극적으로 사망률을 줄일 수 있을 것이라 사료된다.

The purpose of this study was to evaluate the effect on the mortality due to the activity disturbance after hip fracture in the elderly in Jeju-do. We enrolled 254 cases among 318 patients older than 50 years of age with a hip fracture during two years period(2003-2004). We investigated the activity of daily living(ADL) by using modified Barthel index(MBI score), quality of life, and mortality during follow up 3~4 years period until December 31, 2007. The crude incidences of hip fracture the age group≥50 years were 141(11.2/10,000) in 2003, 177(13.6/10,000) in 2004, and 249(17.0/10,000), 69(6.3/10,000) for women and men, respectively. The mean age of them was 78.3 years. Survivor was in the 146(57.5%), death was in the 108(42.5%) among 254 cases period for follow up. The cumulative survival rates were 3 months(0.89), 1 year(0.82), 2 years(0.73), 4 years(0.55) respectively. In the death group, activity was significantly lower at the time of post-fracture 6 and 12 months, and the sex and aged adjusted odds ratio was 2. 948(1.762~4.914), and 2.988(1.757~5.081) respectively. ADL(MBI score) of the death group was significantly lower than the score of survivor group(p<0.05); MBI scores were 26.85, 29.72, 31.63 in the death, 46.77, 59.11, 67.05 in the survivor, at post-fracture 3, 6, 12 months. The death group had significantly bad quality of life, needed more help and had fewer social contacts(visits to friends and participate to outdoor hobbies) than the survivor group at post-fracture 3, 6, 12 months(p<0.05). We evaluated the statistical correlation by using the Cox regression analysis; dependent variables were period for follow up and death at post-fracture, independent variables were ADL(MBI scores) at post-fracture 3, 6, 12 months, and adjusted variables were sex, age, family, marriage, health, economics status and pre-fracture MBI score. In this analysis, MBI scores were OR 0.956(0.942~0.969), OR 0.959(0.949~0.970), OR 0.969(0.960~0.978) at 3, 6, 12 months; the mortality was significantly high among low MBI scores. The decrease of ADL(MBI score) was the most significant factor affecting the mortality after hip fracture in the patients older than 50 years of age in our study. Developing and applying a variety of activity programs that increase activity in post-fracture may improve activities of daily living, reduce burden of family and society, be useful in improving the quality of life and ultimately lower the mortality.