Staging Activity Limitation

描述(申请人提供)：21世纪最大的挑战之一是减少通常在长寿的最后几十年中演变的残疾及其相关的不利后果。在人口监测研究中，残疾的严重程度通常是通过计算日常生活活动(ADL)和工具性ADL(IADL)限制的数量来报告的，这些限制不能表示有限的活动类型。 因此，我们建议开发几种分期活动限制的方法，并测试每种方法的预测有效性，作为人口监测中聚合ADL和IADL限制的替代方法。阶段性是创新的，因为它除了传达限制的总体严重性之外，还传达了有关哪些活动受到限制的信息。因此，它改进了仅反映整体严重性的简单计数方法。基准信息将从正在进行的联邦医疗保险当前受益人调查(MCBS)(估计N=16,000)的2005、2006、2007和2008年小组的新参与者那里获得。不良结果将通过合并成本和使用文件获得，将包括住院(S)、熟练护理设施(SNF)、长期护理(LTC)设施使用和全因死亡率，随访时间为3年。目标1将根据需要的困难或援助，确定确定基线数据中各阶段的替代方法，以表达个人的限制类型和严重程度。目标2在对年龄、性别和种族进行调整后，将确定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阶段如何结合不同的领域很好地解释不良事件的风险，这些领域分别由描述个人的社会生活环境和资源、健康状况、主观生理和心理健康以及功能预期的一组相关变量组成。目标4是数据驱动的，最终将开发和内部验证节俭指数，以预测每个不利结果，汇编目标3中确定的每个领域最具预测性的变量。所有分析都将考虑到MCBS的复杂设计。如果成功，STAGE将有望成为人口监测和患者筛查的工具，通过实现疾病和残疾管理以及跟踪旨在减少ADL和IADL受限人群不良后果的经济、社会和卫生政策，有助于刺激未来减轻美国人口疾病和残疾负担的努力。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了解所经历困难的定性性质或确定所需援助的类型具有重要影响。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.