Disutility of Functional Limitations in the Elderly

描述(由申请人提供)：本项目的首要目标是 评估卫生保健干预措施的成本效益，改善或 防止老年人与健康相关的生活质量下降。这个 缺乏公认的、经过验证的方法来衡量改进的好处 生活质量通常意味着这样的好处要么被低估，要么 完全被忽视了。我们正在开发方法来极大地改善 生活质量变化的测量，由预防或 缓解功能限制。这一步骤可能有助于确保健康 政策对健康干预给予适当的重视，以改善 美国老年人的独立运作。 我们计划使用多媒体偏好评估(实用程序)软件(PALS)， 专为没有电脑经验的长者而设计 项目，ROL AG15110，以评估功能的健康状态的效用 有功能限制和无功能限制的个体损害。我们会 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岁至74岁，以及75岁或以上。我们将重新采访 大约300个人在他们的一年和两年后 初次面谈。 我们将评估个人在以下活动中的依赖程度的影响 日常生活(ADL)对他或她的功能性健康状态的效用评级 依附性。在纵向研究中，我们将定义 随着时间的推移，健康状态的公用事业，比较那些 他们自己在这段时间内不会产生依赖关系。我们将评估 情绪幸福感和总体幸福感对群体间和群体间效用的影响 随着时间的推移在个人内部。使用年龄、性别、种族/民族的协变量， 和健康状况，除了个人的ADL状况和情绪 幸福，我们将为健康状态的效用估计一个预测模型 函数依赖的。最后，通过进行成本效益评价 关于老年评估和管理(GEM)干预，我们将说明 成本效益估计的差异可以看出使用每种方法 作为公用事业数据来源的几个组。 我们正在开发的偏好评估方法将使我们有可能 对以康复为主要目标的治疗进行正式评估 或保留功能，而不是延长生命。纵向的 来自形成ADL依赖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.