DISABLEMENT IN AN AGING BI-ETHNIC COHORT

今天，65岁以上的美国人可以预期在他们的余生中有10%-50%的时间是在依赖状态中度过的。因此，延长预期寿命(即随着人们活到高龄而减少绝对依赖年数)是一项紧迫的目标。这对墨西哥裔美国人(MA)尤其重要，他们构成了美国老年人口中增长最快的部分，而且他们的依赖率似乎明显高于欧洲裔美国人(EA)。延长预期寿命将需要关于从特定疾病发展到最终依赖阶段的系统和详细信息，以及关于改变这些阶段的因素的系统和详细信息，以便确定有效干预的最佳目标，以减缓或防止MA和EA老年人的这一进展。因此，我们聚集了一个独特的、老龄化的、由社区居住的MA和EA老年人组成的双种族队列，这些老年人的社会经济地位分别为低、中、高。对这一队列的流行病学分析表明，损害、功能限制和残疾方面的种族差异可能主要是由于MA老年患者中糖尿病患病率较高所致。以置换过程模型(DPM)为框架的进一步多变量、层次化分析，使我们能够识别1)心理社会因素和生活方式对该主要途径中变量的影响。这些横断面研究结果表明，这些关系可能表明有希望的干预目标，但区分这些有效的目标将需要一项纵向研究，以估计这些关系在DPM中的时间进程。这项拟议的进一步研究旨在：1)确定糖尿病和关节炎等主要疾病到残疾途径的最佳干预目标；2)确定心理社会和生活方式因素是否改变这些疾病的主要途径，无论疾病如何，心理社会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中关系的时间进程，我们将每隔18个月对该队列进行三次后续评估。纵向增长曲线模型将用于将特定人的曲线与这些纵向数据进行拟合，并估计队列中与时间相关的变化的一般形状。这项新的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/或行为干预可能是改变残疾进程最有效的。因此，科学和公共卫生方面的好处将是巨大的。

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.