Kasper J D, Shapiro S, Guralnik J M, Bandeen-Roche K J, Fried L P
Department of Health Policy and Management, The Johns Hopkins School of Hygiene and Public Health, Baltimore, MD 21205-1901, USA.
Ann Epidemiol. 1999 Nov;9(8):498-507. doi: 10.1016/s1047-2797(99)00026-5.
This paper reports on the design of a community-based study focusing on the effects of prevalent and incident disease and other modifying influences, on changes in functioning among moderately and severely disabled elderly women over a 3-year period [the Women's Health and Aging Study (WHAS)].
An approach to conceptualizing and assessing disability which captured functional difficulty across a broad range of activities and tasks was developed, tested on existing national data, and used, in the form of a brief screening instrument, to identify moderately to severely disabled elderly women in a large community sample representative of women 65 and older. Women meeting study criteria were recruited for a baseline interview, a 3-hour in-home clinical exam, as well as follow-up interviews and physical performance tests at 6-month intervals for three years.
Prevalence of moderate to severe disability among the screened population proved similar to that expected from analysis of national data (about one-third). The screening interview response rate was 78%, and 71% of women eligible by disability criteria participated. Only women completing both the baseline interview and clinical exam were counted as respondents. Analysis of characteristics of participants and nonparticipants indicated no selection bias related to levels of disability. However, education, race, and age were associated with participation. Women with some college education, black women, and younger women were more likely to participate.
The approach used to identify and recruit moderately to severely disabled elderly women in the WHAS is both feasible and applicable to other community-based research where inclusion of elderly people with moderate to severe disability across several areas of functioning is an objective. Other aspects of study design, such as use of proxy respondents, will also affect recruitment of individuals with impaired functioning into epidemiologic studies.
本文报告了一项基于社区的研究设计，该研究聚焦于现患疾病和新发疾病以及其他调节因素对中度和重度残疾老年女性在3年期间功能变化的影响[妇女健康与衰老研究（WHAS）]。
开发了一种概念化和评估残疾的方法，该方法涵盖了广泛活动和任务中的功能困难，并在现有的国家数据上进行了测试，然后以简短筛查工具的形式用于在一个代表65岁及以上女性的大型社区样本中识别中度至重度残疾老年女性。符合研究标准的女性被招募参加基线访谈、为期3小时的家庭临床检查，以及在三年时间里每6个月进行一次的随访访谈和身体机能测试。
筛查人群中中度至重度残疾的患病率与对国家数据的分析预期相似（约三分之一）。筛查访谈的应答率为78%，符合残疾标准的女性中有71%参与了研究。只有同时完成基线访谈和临床检查的女性才被计为受访者。对参与者和非参与者特征的分析表明，不存在与残疾水平相关的选择偏倚。然而，教育程度、种族和年龄与参与情况有关。受过一些大学教育的女性、黑人女性和年轻女性更有可能参与。
在妇女健康与衰老研究中用于识别和招募中度至重度残疾老年女性的方法既可行，也适用于其他基于社区的研究，这些研究的目标是纳入在多个功能领域存在中度至重度残疾的老年人。研究设计的其他方面，如使用代理受访者，也会影响将功能受损个体纳入流行病学研究。
