Disutility of Functional Limitations in the Elderly

描述（由申请人提供）：本项目的首要目标是 评估医疗保健干预措施的成本效益， 防止老年人健康相关生活质量的恶化。的 缺乏公认的、有效的方法来衡量改进的 生活质量往往意味着这些好处要么被低估， 完全被忽略了。我们正在开发各种方法， 测量预防或治疗引起的生活质量变化， 缓解功能限制。这一步可能有助于确保健康 政策适当重视卫生干预措施， 美国老年人的独立功能。 我们计划使用多媒体偏好评估（实用）软件（帕尔斯）， 专为目前没有电脑经验的老年人开发的 项目，ROl AG 15110，以评估功能的健康状态的效用， 对个人的损害，包括有或没有功能限制。我们将 从按年龄分层的随机抽样中采访了大约600名老年人 分为两组：65至74岁和75岁或以上。我们会重新采访 大约300人在一年和两年后， 初次面试。 我们将估计个人在以下活动中的依赖性的影响： 日常生活（ADL）对他或她的功能性健康状态的效用评级 依赖在纵向研究中，我们将定义 随着时间的推移，健康状况的效用，比较那些 在这段时间里，他们自己并没有发展出依赖性。我们将评估 情绪和总体幸福感对效用的影响，包括群体之间和 随着时间的推移，使用年龄、性别、人种/种族的协变量， 和健康状况，以及个人的ADL状态和情绪 幸福，我们将估计一个预测模型的效用为健康状态 功能依赖。最后，通过成本效益评价 老年评估和管理（GEM）干预，我们将说明 使用每种方法可以看到的成本效益估计值的差异 作为公用事业数据的来源。 我们正在开发的偏好评估方法将有可能 对以康复为主要目标的治疗进行正式评估 或者是功能的保留而不是寿命的延长。纵向 来自发展ADL依赖性的个人的数据将加深我们的 了解功能障碍对老年人的影响。

DESCRIPTION (provided by applicant): The overriding goal of this project is to assess the cost-effectiveness of health care interventions that improve or prevent deterioration in health related quality of life of the elderly. The absence of well-accepted, validated methods to measure the benefits of improved quality of life often means that such benefits are either undervalued or ignored altogether. We are developing methods to greatly improve the measurement of quality of life changes resulting from the prevention or mitigation of functional limitations. This step may help ensure that health policies place proper value on health interventions that improve the independent functioning of elderly Americans. We plan to use the multimedia preference assessment (utility) software (PALS), developed specifically for computer-inexperienced elders in the current project, ROl AG15110, to estimate the utility for health states of functional impairment of individuals, both with and without functional limitation. We will interview approximately 600 older adults from a random sample stratified by age into two groups: 65 to 74 years, and 75 years or older. We will re-interview approximately 300 of the individuals at one year and two years after their initial interview. We will estimate the impact of an individual's own dependency in Activities of Daily Living (ADLs) on his or her utility rating for heath states of functional dependency. In the longitudinal study, we will define the stability of utilities for health states over time, comparing individuals who do with those who do not themselves develop dependencies during that time. We will assess the impact of emotional and general well-being on utility, both between groups and within individuals over time. Using covariates of age, gender, race/ethnicity, and health status, in addition to the individual's ADL status and emotional well-being, we will estimate a prediction model for utility for health states of functional dependency. Finally, by performing cost-effectiveness evaluation of a geriatric evaluation and management (GEM) intervention, we will illustrate the differences in estimates of cost-effectiveness that can be seen using each of several groups as sources of utility data. The preference assessment methods we are developing will make it possible to conduct formal evaluations of treatments whose primary goal is rehabilitation or preservation of function rather than life prolongation. The longitudinal data from individuals who develop ADL dependencies will deepen our understanding of the impact of functional impairments on older adults.