DISABLEMENT PROCESS OF HIP FRACTURE SURVIVORS

本研究的长期目标是了解社区居住的老年髋部骨折患者的失能过程和医疗保健利用情况。该建议的具体目的是：(1)研究髋部骨折幸存者的功能变化的纵向模式，以确定生理功能（如膝关节力量）、功能限制（如步行速度）和功能残疾（如ADL）随时间的变化，以及髋部骨折和非髋部骨折研究对象之间的变化率，以及长期预后；(2)研究年龄、抑郁、合并症和社会支持对髋部骨折组和非髋部骨折组的生理功能、功能限制和功能残疾的协同效应；(3)探讨影响髋部骨折患者功能独立性的相关因素；(4)描述和比较髋部骨折和非髋部骨折受试者使用的正规护理资源（如家庭健康）。髋部骨折在老年人中引起显著的死亡率、发病率和致残率。研究表明，大多数髋部骨折患者在术后一年不能恢复骨折前的功能水平。功能独立性的丧失给个人、照顾者和整个社会带来了沉重的负担。术后1年的日常生活活动（ADLs）和辅助日常生活活动（IADLs）的身体功能恢复已经得到了很好的证实，然而，对于老年髋部骨折患者的生理功能、功能限制和功能残疾的变化是如何导致残疾过程的，以及如何利用医疗资源来弥补他们的功能缺陷以留在社区，我们知之甚少。拟议的研究将利用妇女健康和老龄化研究（1992-1998年）和医疗保险现行受益人调查（1992-1995年）的3年纵向数据。本研究结果将提供髋部骨折患者失能过程的自然历史，并为预测髋部骨折后患者随失能进展的长期医疗保健需求提供依据。这一发现将有助于指导未来的干预计划，通过减缓残疾过程来促进功能独立。

The broad long-term objectives of this proposal are to understand the disablement process and health care utilization among community- dwelling elderly hip fracture subjects. The specific aims of this proposal are: (1) To examine longitudinal patterns of functional change among hip fracture survivors to determine change in physiological function (e.g., knee strength), functional limitation (e.g., walking speed), and functional disability (e.g., ADL) over time and rate of change between hip fracture and non-hip fracture study subjects, and long-term prognosis; (2) To examine the synergistic effects of age, depression, comorbidity, and social support on physiological function, functional limitation, and functional disability over time between hip fracture and nonhip fracture groups; (3) To examine factors associated with functional independence among hip fracture patients; and (4) To describe and compare formal care resources (e.g., home health) utilized by hip fracture and non-hip fracture subjects. Hip fracture causes significant mortality, morbidity, and disability among older adults. It has been demonstrated that the majority of hip fracture patients do not regain their prefracture level of functioning at one-year post surgery. The loss of functional independence imposes heavy burden on individuals, caregivers, and society as a whole. Physical function recovery in activities of daily living (ADLs)and instrumental activities of daily living (IADLs) one year postsurgery is well established, however, little is known about how changes in physiological function, functional limitation, and functional disability contribute to the disablement process among older adult hip fracture patients, and how health care resources are used to compensate for their deficit in function in order to remain in the community. The proposed research will utilize a 3-year longitudinal data from the Women's Health and Aging Study (1992-1998) and the Medicare Current Beneficiaries Survey (1992-1995). The results of this study will provide a natural history of disablement process among hip fracture patients and a basis for predicting long-term health care needs by post-hip fracture patients as their disability progresses. Finding will be useful to guide future intervention programs ,through which to foster functional independence by slowing down the disablement process.