Underestimation of disability in community-living older persons
Underestimation of disability in community-living older persons
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DOI：
10.1046/j.1532-5415.2002.50403.x
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发表时间：
2002-09-01
影响因子：
6.3
通讯作者：
Williams, CS
中科院分区：
文献类型：
--
作者：
Gill, TM;Hardy, SE;Williams, CS
目的：在确定残疾的发生时，评估间隔时间过长可能会造成问题，因为它们没有考虑到康复的可能性或死亡或失访。我们的目的是比较从单次随访评估中获得的残疾率与从间隔长达24个月的每月评估中获得的残疾率。设计：前瞻性队列研究。设置：一般社区。参与者：754名非残疾人，年龄70岁及以上，根据残疾风险分为三组（低、中、高）。测量：参与者每月进行一次电话访谈，以确定四种主要日常生活活动（ADL）中一种或多种的残疾发生率。对于每个风险组，从ADL功能的每月评估（累积残疾）中获得的残疾率大大高于从单次随访评估（普遍残疾）中获得的残疾率。随着评估间隔时间的增加，这些比率差异逐渐增加。例如，中等风险组参与者的残疾累积率和患病率在6个月时分别为0.24和0.11，在12个月时分别为0.36和0.20，在18个月时分别为0.46和0.16，在24个月时分别为0.53和0.20。尽管总体发生率较低，但持续性残疾（定义为至少连续2个月存在的新残疾）的结果相似。虽然这些差异率几乎完全归因于残疾的恢复，在第6个月，他们越来越多的死亡和损失，在未来18个月的后续行动，特别是在参与者中的高危group.CONCLUSIONS：残疾的发生率大大低估了纵向研究与长期评估间隔。更频繁地评估功能状况，可以更好地了解社区生活老年人的残疾进程和总体负担。
OBJECTIVES: When ascertaining the occurrence of disability, long assessment intervals may be problematic because they do not account for the possibility of recovery or for deaths or losses to follow-up. Our objective was to compare the rates of disability obtained from single follow-up assessments with those obtained from monthly assessments for intervals up to 24 months.DESIGN: Prospective cohort study.SETTING: General community.PARTICIPANTS: Seven hundred fifty-four nondisabled persons, aged 70 and older, categorized into three groups according to their risk for disability (low, intermediate, and high).MEASUREMENTS: Participants were followed with monthly telephone interviews to determine the occurrence of disability in one or more of four key activities of daily living (ADLs).RESULTS: For each risk group, the rates of disability obtained from monthly assessments of ADL function (cumulative disability) were considerably greater than those obtained from single follow-up assessments (prevalent disability). These differences in rates increased progressively as the length of the assessment interval increased. For example, the cumulative and prevalence rates of disability in participants in the intermediate risk group were 0.24 and 0.11 at 6 months, 0.36 and 0.20 at 12 months, 0.46 and 0.16 at 18 months, and 0.53 and 0.20 at 24 months, respectively. Although the overall rates were lower, the results for persistent disability, defined as a new disability that was present for at least 2 consecutive months, were similar. Although these differences in rates were attributable almost exclusively to recovery from disability in the first 6 months, they were due increasingly to deaths and losses to follow-up over the next 18 months, particularly in participants in the high-risk group.CONCLUSIONS: The occurrence of disability is substantially underestimated by longitudinal studies with long assessment intervals. More frequent assessments of functional status could lead to an improved understanding of the course and overall burden of disability in community-living older persons.