Article

OBJECTIVE: To examine how health-related, socioeconomic, and environmental
factors combine to influence the onset of activity of daily living (ADL) limitations or prognosis for death or further functional deterioration or
improvement among elderly people. DESIGN: A national representative sample with
2-year follow-up. SETTING: Community-dwelling people. PARTICIPANTS: Included were
9447 persons (>/=70 years of age) in the United States from the Second
Longitudinal Study of Aging who were interviewed in 1994, 1995, or 1996. METHODS:
Self- or proxy-reported health conditions, ADLs expressed as 5 stages describing
severity and pattern of limitations, and other baseline characteristics were
obtained. A multinomial logistic regression model was used to predict stage
transitions. Because of incomplete follow-up (17.7% of baseline sample), primary
analyses were determined by multiple imputation to address potential bias
associated with loss to follow-up. MAIN OUTCOME MEASUREMENT: ADL stage
transitions in 2 years (death, deteriorated, stable, and improved ADL function).
RESULTS: In the imputed-case analysis, the percentages for those who died,
deteriorated, were stable, and improved were 12.6%, 32.7%, 48.4%, and 6.2%,
respectively. Persons at a mild stage of ADL limitation were most likely to
deteriorate further. Persons at advanced stages were most likely to die. Married
people and high school graduates had a lower likelihood of deterioration. The
risk of mortality and functional deterioration increased with age. Certain
conditions, such as diabetes, were associated both with mortality and functional
deterioration; other conditions, such as cancer, were associated with mortality
only, and arthritis was associated only with functional deterioration.
CONCLUSIONS: Although overlap occurs, different clinical traits are associated
with mortality, functional deterioration, and functional improvement. ADL stages
might aid physical medicine and rehabilitation clinicians and researchers in
developing and monitoring disability management strategies targeted to
maintaining and enhancing self-care among community-dwelling older people.
CI - Copyright (c) 2013 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS