Preclinical mobility disability predicts incident mobility disability in older women.
Preclinical mobility disability predicts incident mobility disability in older women.
复制标题
DOI：
10.1093/gerona/55.1.m43
复制
发表时间：
2000
期刊：
影响因子：
--
通讯作者：
L. Fried;K. Bandeen-Roche;P. Chaves;Brent A. Johnson
中科院分区：
文献类型：
--
作者：
L. Fried;K. Bandeen-Roche;P. Chaves;Brent A. Johnson
身体残疾和依赖是严重的，频繁的，与衰老相关的不良健康结果，由慢性疾病引起。推理表明，可能有一个临床前，中间阶段的残疾，可能发展与基础疾病的进展平行，并提前和预测残疾。这一阶段的定义可以为筛查和早期干预提供基础，以预防残疾。本研究的目的是确定意外移动困难的临床前功能预测因子，并为残疾的临床前阶段提供证据。方法：在马里兰州的巴尔的摩进行了一项前瞻性、基于人群的队列研究，两次评估间隔18个月。参与者是436名社区居住的妇女，基线年龄为70 - 80岁，没有认知障碍，并报告没有身体功能（主要是活动性）方面的困难，或只有一个身体功能方面的困难，他们参加了妇女健康和老龄化研究II。参与者是从基于人口的年龄分层随机样本中招募的。在基线时无此类残疾的亚组中研究了偶发性移动残疾。主要结果测量是自我报告的行走1/2英里或爬上10级台阶困难事件。结果在基线时，69.3%的队列报告没有活动困难。18个月后，分别有16.0%和11.7%的人报告行走1/2英里或爬上10级台阶困难。那些报告基线任务修改由于潜在的健康问题，我们的临床前残疾的措施，在三到四倍的几率进展到困难比那些没有这样的修改。在多变量logistic回归分析中，这种自我报告的措施，任务修改没有困难，客观的性能措施是独立的，并共同预测事件的移动性困难。具体而言，对于行走1/2英里的事件困难，自我报告的任务修改比值比（OR）= 3.67，行走速度（0.5 m/s差异）OR = 2.16;对于爬10级楼梯的事件困难，任务修改的OR = 3.84，爬楼梯速度（1/3步/s差异）= 2.08（95% CI不包括任何1）。协变量，年龄，独居，慢性疾病的数量，抑郁症评分，膝关节力量和功能范围的平衡，在任何一个模型中都不是显着的预测因子。结论：两个指标的功能变化的老年妇女没有移动困难，自我报告的修改方法做一项任务，在没有困难和性能的措施，是独立的和强有力的预测风险的事件移动残疾。自我报告的措施提供了大量的力量在整个性能范围内预测事故残疾的风险，并可能确定一个脆弱的点，在其他风险因素的作用，导致过渡到残疾。这些临床前指标共同确定了一个高功能老年妇女亚组，这些妇女面临行动能力残疾的高风险，并为筛查残疾风险和有针对性的干预措施提供了潜在的基础，以预防行动能力残疾。
BACKGROUND Physical disability and dependency are serious, and frequent, adverse health outcomes associated with aging and resulting from chronic disease. Reasoning has suggested that there might be a preclinical, intermediate phase of disablement which might develop in parallel with progression of underlying disease and precede and predict disability. Definition of this stage could provide a basis for screening and early intervention to prevent disability. The objective of this study was to determine preclinical functional predictors of incident mobility difficulty and provide evidence for a preclinical stage of disability. METHODS A prospective, population-based cohort study was carried out in Baltimore, Maryland, with two evaluations 18 months apart. The participants were 436 community-dwelling women, 70-80 years of age at baseline, not cognitively impaired, and reporting difficulty in no areas, or only one area, of physical function (primarily mobility), who were participating in the Women's Health and Aging Study II. Participants were recruited from a population-based, age-stratified random sample. Incident mobility disability was studied in the subset without such disability at baseline. The main outcome measure was self-reported incident difficulty walking 1/2 mile or climbing up 10 steps. RESULTS At baseline, 69.3% of the cohort reported no difficulty with mobility. After 18 months, 16.0 and 11.7% of this group reported incident difficulty walking 1/2 mile or climbing up 10 steps, respectively. Those reporting baseline task modification due to underlying health problems, our measure of preclinical disability, were at three- to fourfold higher odds of progressing to difficulty than were those without such modification. In multivariate logistic regression analyses, this self-report measure, task modification without difficulty, and objective measures of performance were independently and jointly predictive of incident mobility difficulty. Specifically, for incident difficulty walking 1/2 mile, self-reported task modification odds ratio (OR) = 3.67, walking speed (.5 m/s difference) OR = 2.16; for incident difficulty climbing up 10 stairs, OR for task modification = 3.84, for stair climb speed (1/3 step/s difference) = 2.08 (95% CI did not include 1 for any). Covariates, age, living alone, number of chronic diseases, depression score, knee strength, and balance by functional reach, were not significant predictors in either model. CONCLUSIONS Two indicators of functional changes in older women without mobility difficulty, self-report of modification of method of doing a task in the absence of difficulty and performance measures, are independent and strong predictors of risk of incident mobility disability. The self-report measure provides substantial strength in predicting risk of incident disability across the full range of performance, and may identify a vulnerable point at which other risk factors act to cause transitions to disability. Together, the preclinical indicators identify a subset of high-functioning older women who are at high risk of mobility disability, and provide a potential basis for screening for disability risk and targeting interventions to prevent mobility disability.