Unmet Need for ADL Assistance Is Associated With Mortality Among Older Adults With Mild Disability
Unmet Need for ADL Assistance Is Associated With Mortality Among Older Adults With Mild Disability
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DOI：
10.1093/gerona/glv028
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发表时间：
2015-09-01
影响因子：
5.1
通讯作者：
Sands, Laura P.
中科院分区：
文献类型：
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作者：
He, Shuang;Craig, Bruce A.;Sands, Laura P.
背景未满足的日常生活活动（ADL）残疾援助需求与未来住院风险增加相关。为了进一步探讨未满足的ADL需求与未来健康结果之间的关系，我们研究了未满足的ADL援助需求与1年死亡率之间的关系。对1994年、1999年和/或2004年国家长期护理调查的6,730名社区生活医疗保险接受者进行了一项前瞻性研究。只有那些报告有一个或多个ADL残疾的人被纳入。根据医疗保险和医疗补助服务中心的生命统计记录确定社区调查后1年内的死亡时间。社区访谈提供人口学、健康和ADL信息。对于1、2、3、4和5项ADL的残疾受访者，未校正的1年死亡率分别为8.7%、10.6%、11.4%、19.2%和27.3%。总体而言，21.3%的人报告了一种或多种ADL残疾的援助需求未得到满足。在控制人口统计学和健康特征后，我们发现未满足的ADL需求和ADL残疾水平之间存在显著的相互作用（p = 0.018）。事后分析显示，未满足的ADL需求仅与有1项（危害比= 1.96; 95%CI = 1.29-2.87）或2项（危害比= 1.37; 95%CI = 1.07-1.75）ADL残疾的患者的死亡风险增加相关，但与有3项或3项以上ADL残疾的患者无关。未来的研究需要确定这些发现是否是可复制的，如果是这样，是否生理或护理过程变量解释了为什么ADL仅与轻度残疾患者的死亡率相关。
Background. Unmet need for assistance with activities of daily living (ADLs) disability is associated with increased risk for future hospitalization. To further explore the association between unmet ADL need and future health outcomes, we examined the association between unmet need for ADL assistance and 1-year mortality.Methods. A prospective study of 6,730 community-living Medicare recipients was conducted among respondents to the 1994, 1999, and/or 2004 National Long Term Care Survey. Only those who reported having one or more ADL disabilities were included. Time to death within 1 year after the community survey was determined from Centers for Medicare and Medicaid Services vital statistics records. The community interviews provided demographic, health, and ADL information.Results. Unadjusted 1-year death rates were 8.7%, 10.6%, 11.4%, 19.2%, and 27.3%, respectively, for respondents with disabilities in 1, 2, 3, 4, and 5 ADLs. Overall, 21.3% reported unmet need for assistance for one or more ADL disabilities. After controlling for demographic and health characteristics, we found a significant interaction between unmet ADL need and level of ADL disability (p =.018). Post hoc analyses revealed that unmet ADL need was associated with increased risk for mortality only for those with one (hazard ratio = 1.96; 95% CI = 1.29-2.87) or two ADL disabilities (hazard ratio = 1.37; 95% CI = 1.07-1.75), but not for those with three or more ADL disabilities.Conclusion. Future studies are needed to determine whether these findings are replicable and, if so, whether physiologic or process of care variables explain why ADL is associated with mortality only for those with mild disability.