Staging Activity Limitation

描述（由申请人提供）：21世纪世纪最大的挑战之一是减少残疾，这些残疾往往在长寿的最后几十年演变，以及与之相关的不良后果。残疾的严重程度通常在人口监测研究中通过计算日常生活活动（ADL）和工具性ADL（IADL）限制的数量来报告，这些限制无法表达受限制的活动类型。 因此，我们建议开发几种方法来分期活动限制，并测试每种方法的预测有效性，作为聚合ADL和IADL限制人群监测的替代方法。分期是创新的，因为它传达了除了限制的总体严重性之外，哪些活动受到限制的信息。因此，它改进了仅捕获总体严重性的简单计数方法。 基线信息将从2005年、2006年、2007年和2008年正在进行的医疗保险当前受益人调查（MCBS）（估计N= 16 000）的新进入者那里获得。将通过合并成本和使用文件获得不良结局，并将包括住院、专业护理机构（SNF）、长期护理（LTC）机构使用和全因死亡，随访时间为3年。 目标1将确立界定基线数据阶段的替代方法，这些基线数据将根据困难或所需援助来表达个人的限制类型及其严重程度。目标2将确定在调整年龄、性别和种族后，哪种分期方法最能解释每种不良结局的发生。目标3是理论驱动的，将探索ADL和IADL阶段如何结合独立的领域解释不良事件的风险，这些领域包括描述个人社会生活环境和资源的相关变量集;健康状况;主观身体和心理健康;以及功能期望。目标4是数据驱动的，最终将开发和内部验证简约指数，以预测每种不良结局，编制目标3中确定的每个领域中最具预测性的变量。所有的分析都将解释MCBS的复杂设计。 如果成功的话，分期可以预期作为一种人口监测和患者筛查的工具，可以帮助刺激未来的努力，以减少美国人口的疾病和残疾的负担，通过使疾病和残疾管理和跟踪经济，社会和卫生政策，以减少ADL和IADL限制人群的不良后果。了解哪些ADL和IADL是有限的（由阶段阈值定义）将对评估生活质量和理解所经历的困难的定性性质或确定所需的帮助类型具有重要意义。目前ADL或IADL限制计数中缺少此定性信息。

DESCRIPTION (provided by applicant): Among the greatest challenges of the 21st century is the reduction of disabilities that often evolve in the last decades of a long life and the adverse consequences associated with them. Severity of disability is often conventionally reported in population surveillance studies by counting the numbers of activity of daily living (ADL) and instrumental ADL (IADL) limitations which fail to express the types of activities that are limited. Thus, we propose to develop several approaches to staging activity limitation and test the predictive validity of each approach as alternative ways of aggregating ADL and IADL limitation for population surveillance. Staging is innovative because it conveys information about which activities are limited in addition to the overall severity of limitation. It therefore improves on he simple counts methodology which only captures overall severity. Baseline information will be obtained from new entrants into the 2005, 2006, 2007, and 2008 panels of the ongoing Medicare Current Beneficiary Survey (MCBS) (estimated N=16,000) Access to Care files. Adverse outcomes will be obtained by merging the Cost and Use files and will include inpatient hospitalization(s), skilled nursing facility (SNF), long-term care (LTC) facility use, and all-caus mortality with a follow-up time of 3 years. Aim 1 will establish alternative ways of defining stages in the baseline data that express both individuals' types of limitation and their severity based on difficulty or assistance needed. Aim 2 will determine which staging approaches best explain occurrences of each adverse outcome after adjusting for age, gender, and race. Aim 3 is theory driven and will explore how well ADL and IADL stages explain risks of adverse events in combination with separate domains consisting of sets of related variables describing individuals' social living circumstances and resources; health status; subjective physical and psychological well being; and functional expectations, respectively. Aim 4 is data driven and will culminate in the development and internal validation of parsimonious indices to predict each adverse outcome compiling the most predictive variables in each domain as identified in Aim 3. All analyses will account for the complex design of the MCBS. If successful, staging can be expected to serve as a tool for population surveillance and patient screening that can help stimulate future efforts to reduce the burdens of illness and disability in the US population by enabling disease and disability management and the tracking of economic, social, and health policies targeted to reduce adverse outcomes among people with ADL and IADL limitation. Knowledge of which ADLs and IADLs are limited (defined by stage thresholds) will have important implications for assessing quality of life and to the understanding of either the qualitative nature of difficulty experienced or ascertaining the types of assistance needed. This qualitative information is currently missing from ADL or IADL limitation counts.