Observation on survival of the elderly by the severity of impaired activity of daily life and causes of death

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Life expectancy of the elderly for the Japanese is growing year by year, and in consequence Japan runs up to the top ranking of longevity in the world. Geriatric society estimated only by life expectancy, however, is not necessarily mature, and one of factors to inhibit the completeness of fully ripe geriatric society is impaired activity of daily life (ADL) of the elderly.The Japanese Association for Cerebro-cardiovascular Disease Control (JACCDC) has studied actual figures of impaired ADL including 6,000 〜 13,000 subjects aged 65 or over extracted from 10 to 12 areas throughout Japan from 1996 to 1997. Based on the data we estimated quantitatively the severity of impaired ADL of the elderly by Barthel index in 1998. In this study we have followed up 1,492 elderly subjects (11.5 % of JACCDC cohort) with impaired ADL for three years from 1998 to 2001, and obtained data on survival aimed at elucidating an influence of impaired ADL on victim's outcome. During three years of follow-up 130 elderly died (9 %). We classified the severity of impaired ADL into three groups, namely, severe (A group, A・G), moderate (B group, B・G) and slight (C group, C・G), and compared survived rates (Kaplan-Miere) among three groups. Survival most decreased in A・G followed by order of B・G and C・G. We have corrected survived rates by the state of medical treatment and aid-assistance during the follow-up using Cox's proportional hazard model. The impaired ADL most affected survival even though these parameters were taken into account.After adjustment relative risk of dead for A・G and B・G to C・G was 2.6 and 1.9 in each (p<0.01).In conclusion, the severe impaired ADL was, the poorer prognosis of life of the elderly was observed without any relation to medical treatment and aid-care.Since cerebral stroke mostly gave an influence on the severity of impaired ADL for the elderly, preventive strategy of cerebral stroke seems to be most effective on making healthy geriatric society.