Guralnik J M, Ferrucci L, Penninx B W, Kasper J D, Leveille S G, Bandeen-Roche K, Fried L P
Epidemiology, Demography, and Biometry Program, National Institute on Aging, Bethesda, Maryland 20892-9205, USA.
J Gerontol A Biol Sci Med Sci. 1999 Aug;54(8):M410-22. doi: 10.1093/gerona/54.8.m410.
Despite the large burden of chronic disease in older persons, especially those with disability, little research has documented changes in symptomatology over short periods of time. Additionally, although it has been demonstrated that medical conditions strongly affect functional level, short-term worsening in condition status has not been investigated for its impact on functional change.
In a substudy of the Women's Health and Aging Study, 102 women with mild to severe disability received weekly home visits over a 6-month period. Each week they were queried as to the onset of 14 acute, generally self-limited conditions and the worsening or new diagnosis of 12 chronic conditions (condition reporting). They also received a battery of physical and cognitive performance tests.
There was a high rate of condition reporting over 24 weekly interviews. Nearly all women reported acute and episodic conditions; the average number of weeks of reporting one or more conditions was 11.8 per woman. For chronic conditions, the average number of weeks of reporting worsening of one or more conditions was 5.2 per woman. Multiple reports of onset or worsening of specific conditions were common, especially for arthritis of the hands, hips, knees, or feet; urinary problems; dizziness or unsteadiness on feet; and back pain. The total number of condition reports and number of weeks of condition reporting were generally not associated with an individual's slope of change in performance tests. For specific conditions, there were generally small and nonsignificant changes in performance in those who reported onset or worsening after 3 or more weeks of not reporting this.
Older disabled women frequently report the onset or worsening of acute and chronic conditions. In weekly observations, these conditions are not related to changes in physical and cognitive performance measures. Possible reasons for this are that (a) condition reporting may not be valid, (b) changes or severity of conditions were of insufficient magnitude to affect functioning, or (c) performance measures are not sensitive to the kinds of changes in chronic and acute conditions that affect people from week to week. We concluded that performance measures are not useful in monitoring modest, short-term changes in health status, but may still be valuable for assessing more major changes in health and functioning over time.
尽管老年人，尤其是残疾老年人面临着巨大的慢性病负担，但很少有研究记录短期症状变化。此外，虽然已经证明健康状况会强烈影响功能水平，但尚未对健康状况的短期恶化对功能变化的影响进行研究。
在妇女健康与衰老研究的一项子研究中，102名轻度至重度残疾的女性在6个月的时间里每周接受一次家访。每周询问她们14种急性、通常为自限性疾病的发病情况以及12种慢性病的恶化或新诊断情况（疾病报告）。她们还接受了一系列身体和认知功能测试。
在24次每周访谈中，疾病报告率很高。几乎所有女性都报告了急性和偶发性疾病；每位女性报告一种或多种疾病的平均周数为11.8周。对于慢性病，每位女性报告一种或多种疾病恶化的平均周数为5.2周。特定疾病发病或恶化的多次报告很常见，尤其是手部、髋部、膝盖或足部的关节炎；泌尿系统问题；头晕或行走不稳；以及背痛。疾病报告的总数和疾病报告的周数通常与个体在功能测试中的变化斜率无关。对于特定疾病，在报告发病或恶化前3周或更长时间未报告的人群中，功能通常只有微小且无显著意义的变化。
老年残疾女性经常报告急性和慢性疾病的发病或恶化。在每周的观察中，这些疾病与身体和认知功能测量的变化无关。可能的原因是：（a）疾病报告可能无效；（b）疾病的变化或严重程度不足以影响功能；或（c）功能测量对影响人们每周的急慢性疾病变化类型不敏感。我们得出结论，功能测量在监测健康状况的适度短期变化方面没有用处，但对于评估随着时间推移健康和功能的更重大变化可能仍然有价值。
