Housing conditions and limitations in physical function among older adults
Housing conditions and limitations in physical function among older adults
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DOI：
10.1136/jech-2016-207183
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发表时间：
2016-10-01
影响因子：
6.3
通讯作者：
Rodriguez-Artalejo, Fernando
中科院分区：
文献类型：
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作者：
Garcia-Esquinas, Esther;Perez-Hernandez, Bibiana;Rodriguez-Artalejo, Fernando
住房条件是健康的一个重要社会决定因素。然而，据我们所知，以前没有研究系统地评估住房条件与老年人身体功能限制之间的关系；此外，这种关联是否独立于生命早期所取得的社会经济地位仍不确定。方法采用横断面分析方法，对2012例60岁高龄的老年人进行分析。参与者报告了以下恶劣的住房条件：住在无电梯的建筑里，没有暖气，或者经常感到寒冷。我们使用短物理性能测试（SPPB）评估下肢性能，使用标准化问题评估移动性或敏捷性限制，根据Fried标准评估虚弱，使用Lawton和Brody问卷评估日常生活工具活动（IADL）障碍。结果在调整人口统计学、行为和合并症变量的分析中，与居住在没有恶劣住房条件的家庭相比，居住条件差的家庭在SPPB中表现出更差的得分（-1.06;95% CI -1.46至-0.65），灵敏性限制（OR 1.62; 95% CI 1.00至2.61）和虚弱（OR 8.78; 95% CI 3.00至25.60）的频率更高。在调整了教育和职业水平后，这些联系仍然存在。住在无电梯的建筑里，身体虚弱的频率更高，而没有暖气，在3个SPPB测试中得分较低，以及身体虚弱的频率增加及其4个组成部分（疲惫、步行速度慢、体力活动少和虚弱）。感觉寒冷与疲劳增加有关。住房条件与IADL残疾之间没有关联。结论恶劣的居住条件，特别是居住在无电梯建筑和缺乏供暖，是老年人身体功能限制的独立相关因素。这就造成了职能地位的严重不平等，应该坚决加以解决。
Introduction Housing conditions are an important social determinant of health. However, to the best of our knowledge, no previous study has systematically assessed the association between housing conditions and physical function limitations in older adults; moreover, whether this association is independent of the socioeconomic status achieved earlier in life is still uncertain.Methods Cross-sectional analysis conducted among 2012 non-institutionalised individuals aged 60years, who participated in the Seniors-ENRICA cohort. Participants reported the following poor housing conditions: living in a walk-up building, lacking heating, or feeling cold frequently. We assessed lower extremity performance with the Short Physical Performance Battery (SPPB), mobility or agility limitations with standardised questions, frailty according to the Fried criteria, and disability in instrumental activities of daily living (IADL) with the Lawton and Brody questionnaire.Results In analyses adjusting for demographic, behavioural and comorbidity variables, when compared with those living in homes without poor housing conditions, those with 2 poor conditions showed worse scores in the SPPB ( -1.06; 95% CI -1.46 to -0.65) and a higher frequency of agility limitation (OR 1.62; 95% CI 1.00 to 2.61) and frailty (OR 8.78; 95% CI 3.00 to 25.60). These associations held after adjustment for educational and occupational levels. Living in a walk-up building was associated with a higher frequency of frailty, while lacking heating was linked to lower scores in the 3 SPPB tests, as well as with an increased frequency of frailty and 4 of its components (exhaustion, slow walking speed, low physical activity and weakness). Feeling cold was linked to increased exhaustion. No association was found between housing conditions and IADL disability.Conclusions Poor housing conditions, particularly living in a walk-up building and lacking heating, are independently associated with limitations in physical function in older adults. This entails serious inequalities in functional status, which should be firmly addressed.