Ostir G V, Volpato S, Kasper J D, Ferrucci L, Guralnik J M
Epidemiology, Demography and Biometry Program, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA.
Aging (Milano). 2001 Dec;13(6):465-72.
Activities of Daily Living (ADLs) rating scales often classify older persons as independent or dependent in self-care activities. However, with this type of classification system little information is available on people who, while not dependent, do report some difficulty in performing self-care activities. This 3-year prospective cohort study presents an ADL summary scale that assesses a gradient of difficulty in ADLs for moderately to severely disabled women aged 65 and older living in the Baltimore, Maryland area. At baseline and for each of six interviews done at 6-month intervals, an ADL summary score measuring ADL difficulty was created. ADL summary score slopes were created for each woman who completed at least the baseline and first three follow-up interviews. The baseline ADL summary score and slope of the ADL summary score were used to predict risk of future hospitalization, nursing home admission and death. Additionally, 6-month ADL summary change scores were calculated in order to assess change in the ADL summary score for women who did and did not report an acute event (MI, stroke or hip fracture) at follow-up. The ADL summary scale showed excellent reliability. Intraclass correlation coefficients ranged from 0.83 to 0.93 for measures made one week apart. The 6-month average correlation coefficient was 0.77. The ADL summary scale also performed well in tests of validity. Poorer scores on the ADL summary scale were significantly and inversely related to an objective physical performance scale. The baseline ADL summary score and slope of the ADL summary score predicted future risk of hospitalization, nursing home admission and death. Each unit increase in the slope of the ADL summary score was associated with a 19% (95% CI 1.10, 1.29) increased risk of hospitalization, a 57% (95% CI 1.37, 1.81) increased risk of nursing home admission and a 41% (95% CI 1.22, 1.64) increased risk of death, adjusting for potential confounders. The mean 6-month ADL change score for women reporting an acute event (2.59) was significantly different from those not reporting an acute event (0.52). The strongest and most significant mean 6-month ADL change score was observed for women who reported a hip fracture (4.52) followed by stroke (2.40) and MI (1.00). These results demonstrate that the ADL summary scale presented has validity, reliability and is sensitive to change. This scale, therefore, offers the opportunity to classify functional problems in a larger proportion of the population than do ADL dependence scales. Additionally, it gives us a way to identify earlier functional changes, and a way to track the natural history of functional problems as well as a response to interventions.
日常生活活动（ADL）评定量表通常将老年人在自我护理活动中分为独立或依赖两类。然而，在这种分类系统下，对于那些虽不依赖他人，但在自我护理活动中确实存在一些困难的人，所提供的信息很少。这项为期3年的前瞻性队列研究提出了一种ADL综合量表，用于评估居住在马里兰州巴尔的摩地区65岁及以上中度至重度残疾女性在ADL方面的困难程度梯度。在基线时以及每隔6个月进行的6次访谈中的每次访谈时，都会创建一个衡量ADL困难程度的ADL综合评分。为每位至少完成了基线和前三次随访访谈的女性创建了ADL综合评分斜率。基线ADL综合评分和ADL综合评分斜率被用于预测未来住院、入住养老院和死亡的风险。此外，还计算了6个月的ADL综合变化评分，以评估在随访时报告了急性事件（心肌梗死、中风或髋部骨折）和未报告急性事件的女性在ADL综合评分方面的变化。ADL综合量表显示出极好的可靠性。相隔一周进行的测量的组内相关系数范围为0.83至0.93。6个月的平均相关系数为0.77。ADL综合量表在效度测试中也表现良好。ADL综合量表得分较低与客观身体表现量表显著负相关。基线ADL综合评分和ADL综合评分斜率预测了未来住院、入住养老院和死亡的风险。在调整了潜在混杂因素后，ADL综合评分斜率每增加一个单位，住院风险增加19%（95%可信区间1.10，1.29），入住养老院风险增加57%（95%可信区间1.37，1.81），死亡风险增加41%（95%可信区间1.22，1.64）。报告急性事件的女性的平均6个月ADL变化评分为（2.59），与未报告急性事件的女性（0.52）有显著差异。报告髋部骨折的女性的6个月ADL平均变化评分最强且最显著（4.52），其次是中风（2.40）和心肌梗死（1.00）。这些结果表明，所提出的ADL综合量表具有效度、可靠性且对变化敏感。因此，与ADL依赖量表相比，该量表为更大比例的人群中的功能问题分类提供了机会。此外，它为我们提供了一种识别早期功能变化的方法，一种追踪功能问题自然史以及对干预措施反应的方法。
