Functional Impairment and Decline in Middle Age: A Cohort Study.
Functional Impairment and Decline in Middle Age: A Cohort Study.
复制标题
DOI：
10.7326/m17-0496
复制
发表时间：
2017-12-05
影响因子：
39.2
通讯作者：
Steinman MA
中科院分区：
文献类型：
--
作者：
Brown RT;Diaz-Ramirez LG;Boscardin WJ;Lee SJ;Steinman MA
日常功能障碍在中年人中很常见。然而，关于这些功能问题的流行病学或临床过程，包括它们与老年人功能损害的共同特征的程度，人们知之甚少。了解中年人群功能损害和功能衰退的流行病学和临床病程。队列研究。健康与退休研究。登记时没有功能障碍的6874名50-56岁的社区居住成年人。日常生活活动障碍(ADL)，定义为自我报告的执行一种或更多ADL的困难，在最长20年的随访期内每两年评估一次，以及仪器性ADL(IADL)，定义类似。使用多状态模型对数据进行分析，这些模型估计不同结果的概率。22%的参与者在50岁到之间出现了日常生活能力障碍。在这些人中，进一步的功能转变是常见的。两年后，4%(95%CI，3%-5%)的参与者死亡，9%(CI，8%-11%)的ADL进一步下降，50%(CI，48%-52%)持续受损，37%(CI，35%-39%)恢复独立。在最初损害后的10年中，16%(CI，14%-18%)有一次或多次功能下降，28%(CI，26%-30%)从最初的损害中恢复并始终保持独立。IADL的发现模式与此类似。功能状态由患者自行报告。在中年，功能受损和功能衰退很常见，从受损到独立再回来的过渡也很常见。由于老年人的功能衰退也有类似的特征，目前用于预防老年人功能衰退的干预措施可能对中年成年人有希望。通过加州大学旧金山分校的国家老龄研究所和国家翻译科学促进中心-临床和翻译科学研究所
Difficulties with daily functioning are common in middle-aged adults. However, little is known about the epidemiology or clinical course of these functional problems, including the extent to which they share common features with functional impairment in older adults. To determine the epidemiology and clinical course of functional impairment and decline in middle age. Cohort study. The Health and Retirement Study. 6874 community-dwelling adults aged 50–56 who did not have functional impairment at enrollment. Impairment in activities of daily living (ADLs), defined as self-reported difficulty performing 1 or more ADLs, assessed every 2 years over a maximum follow-up period of 20 years, and impairment in instrumental ADLs (IADLs), defined similarly. Data were analyzed using multi-state models which estimate probabilities of different outcomes. Twenty-two percent of participants developed ADL impairment between ages 50 and 64. Among these individuals, further functional transitions were common. Two years after the initial impairment, 4% (95% CI, 3%–5%) of participants had died, 9% (CI, 8%–11%) had experienced further ADL decline, 50% (CI, 48%–52%) had persistent impairment, and 37% (CI, 35%–39%) had recovered independence. In the 10 years following the initial impairment, 16% (CI, 14%–18%) had one or more episodes of functional decline, and 28% (CI, 26%–30%) recovered from their initial impairment and remained independent throughout. The pattern of findings was similar for IADLs. Functional status was self-reported. Functional impairment and decline are common in middle age, as are transitions from impairment to independence and back again. Because functional decline in older adults has similar features, interventions currently used to prevent functional decline among older adults may hold promise for adults in middle age. National Institute on Aging and the National Center for Advancing Translational Sciences through the UCSF-Clinical and Translational Sciences Institute