DISABLEMENT IN AN AGING BI-ETHNIC COHORT

今天，65岁以上的美国人可能会在一个依赖的州度过10-50%的余生。因此，延长积极预期寿命（即，随着人们活到老年而减少依赖的绝对年数）是一个紧迫的目标。这对于墨西哥裔美国人（MA）来说尤其重要，他们是美国老年人口中增长最快的一部分，并且似乎比欧洲裔美国人（EA）的依赖率明显更高。延长积极预期寿命需要系统和详细的信息，了解从特定疾病到最终依赖的进展阶段，以及改变这些阶段的因素，以便确定有效干预的最佳目标，以减缓或防止MA和EA老年人的这种进展。因此，我们收集了一个独特的、老龄化的、双种族的社区居住MA和EA老年人，他们具有低、中、高的社会经济地位。该队列的流行病学分析表明，损伤、功能限制和残疾的种族差异可能主要是由于糖尿病在MA老年人中较高的患病率。进一步的多变量、分层分析，使用位移过程模型（DPM）作为框架，使我们能够确定1)社会心理和生活方式对主要途径中变量的调节。这些横断面结果表明，这些关系可能表明有希望的干预目标，但在这些目标中区分有效目标将需要纵向研究，以估计DPM内这些关系的时间过程。本研究旨在：1)确定糖尿病和关节炎主要疾病-致残途径的最佳干预靶点；2)确定社会心理和生活方式因素是否改变这些疾病的主要途径，以及无论疾病如何，社会心理和生活方式因素是否影响DPM主要途径的连续阶段，这表明这些因素本身是功能增强干预的有希望的目标。为了估计DPM中关系的时间过程，我们将每隔18个月对队列进行三次随访评估。纵向增长曲线模型将用于拟合这些纵向数据的个人特定曲线，并估计队列中与时间相关的变化的一般形状。这项新研究将提供关键信息，确定残疾过程中的关键点，在这些关键点上，有针对性的医疗和/或行为干预可能最有效地改变残疾的进程。因此，科学和公共卫生的好处将是巨大的。

Today, Americans over 65 can expect to spend 10-50% of their remaining lives in a dependent state. Prolong active life expectancy (i.e., decreasing the absolute years of dependency as people survive to older ages) is thus an urgent goal. This is particularly critical for Mexican Americans (MA), who compris3e the most rapidly growing segment of the U.S. elderly population and appear to have markedly higher rates of dependence than European Americans (EA). Prolonging active life expectancy will require systematic and detailed information about stages in the progression from specific diseases to ultimate dependence, and about factors which modify these stages, in order to identify optimal targets for effective interventions to slow or prevent this progression in MA as well as EA elderly. We therefore assembled a unique, aging, bi-ethnic cohort of community- dwelling MA and EA elderly of low, middle, and high socioeconomic status. An epidemiological analysis of this cohort indicated that ethnic differences in impairments, functional limitations, and disability may result primarily from the higher prevalence of diabetes among MA elderly. Further multi-variable, hierarchical analyses, using the Displacement Process Model (DPM) as a framework, enabled us to identify 1) a psychosocial, and lifestyle modifiers to variables within that main pathway. These cross-sectional results suggest relationships that might indicate promising targets for intervention, but distinguishing the valid targets among these will require a longitudinal study to estimate the time course of these relationships within the DPM. This proposed further study is designed: 1) to define optimal targets for intervention in the main disease-to-disability pathways of diabetes and arthritis; and 2) to determine whether psychosocial and lifestyle factors alter the main pathways of these diseases and regardless of disease, whether psychosocial and lifestyle factors influence successive stages in the main DPM pathway, suggesting that these factors themselves are promising targets for function-enhanced intervention. To estimate the time course of relationships in the DPM, we will carry out three follow-up assessments of the cohort at 18-month intervals. Longitudinal growth curve models will be used to fit person-specific curves to these longitudinal data, and estimate the general shapes of time- related changes among the cohort. This new study will provide critical information identifying key points in the disablement process where targeted medical and/or behavioral interventions may be most effective in altering the course of disability. Thus, scientific and public health benefits will be substantial.