Miller Ram R, Zhang Yuqing, Silliman Rebecca A, Hayes Margaret Kelly, Leveille Suzanne G, Murabito Joanne M, Kiel Douglas, O'Connor George T, Felson David T
Geriatrics Section, Boston University School of Medicine, Boston, Massachusetts, USA.
J Am Geriatr Soc. 2004 Feb;52(2):217-23. doi: 10.1046/j.0002-8614.2004.52057.x.
To evaluate the effect of nine disabling medical conditions upon recovery from functional limitations by elders.
Retrospective analysis of prospective longitudinal cohort.
Community.
Persons aged 65 and older in Framingham Heart Study.
Change in function in elders from biennial Examinations 18 (1983-85; baseline) through 23 (1994-96). At each examination, subjects reported limitations in heavy household work, walking up and down stairs, walking half a mile, bathing, toileting, and continence. They were also directly observed for performance of transferring in and out of a chair, dressing, walking 50 feet, and carrying a 10-pound object 10 feet. The prevalence of functional limitations and the incidence of recovery from functional limitation by the subsequent examination for each task were calculated. The effects of congestive heart failure, cognitive impairment, diabetes mellitus, stroke, depressive symptoms, hip fracture, knee pain, claudication, and chronic obstructive pulmonary disease were evaluated. The relationship between the total number of comorbid conditions present (0, 1, 2, 3 or more), the presence of each individual condition at the start of each examination cycle, and the incidence of recovery from functional limitations were examined using generalized estimating equations.
One thousand eight hundred twenty-five subjects were studied at baseline; 1,026 were available 10 years later. Mean age of subjects at baseline was 73.5 (range 61-95); 60.7% were women. The prevalence of functional limitations ranged from 3.1% to 29.8% at biennial Examination 18 and increased to 15.1% to 32.4% at Examination 23. The incidence of recovery ranged from 3.2% to 78.4% depending upon the task and the examination cycle. Increasing disease burden, as measured by the number of comorbidities, was associated with a decreased likelihood of recovery from functional limitations. Diabetes mellitus, stroke, depressive symptoms, hip fracture, and knee pain had the strongest adverse effect upon recovery from functional limitations.
In these community-dwelling elders, recovery from prevalent functional limitations was frequent. Increasing disease burden was associated with a decreased incidence of recovery. Diabetes mellitus, stroke, depressive symptoms, hip fracture, and knee pain had the strongest adverse effect on recovery from functional limitations.
评估九种致残性疾病对老年人功能受限恢复情况的影响。
对前瞻性纵向队列进行回顾性分析。
社区。
弗雷明汉心脏研究中65岁及以上的人群。
从第18次两年一次的检查（1983 - 1985年；基线）到第23次检查（1994 - 1996年）期间老年人功能的变化。每次检查时，受试者报告在繁重家务、上下楼梯、步行半英里、洗澡、如厕和大小便失禁方面的受限情况。还直接观察他们进出椅子、穿衣、步行50英尺以及搬运10磅重物走10英尺的表现。计算每项任务功能受限的患病率以及后续检查中从功能受限恢复的发生率。评估充血性心力衰竭、认知障碍、糖尿病、中风、抑郁症状、髋部骨折、膝关节疼痛、间歇性跛行和慢性阻塞性肺疾病的影响。使用广义估计方程研究共病情况总数（0、1、2、3种或更多）、每个检查周期开始时每种疾病的存在情况与功能受限恢复发生率之间的关系。
1825名受试者在基线时接受研究；10年后有1026名受试者可用。基线时受试者的平均年龄为73.5岁（范围61 - 95岁）；60.7%为女性。在第18次两年一次的检查中，功能受限的患病率在3.1%至29.8%之间，在第23次检查时增至15.1%至32.4%。恢复的发生率根据任务和检查周期在3.2%至78.4%之间。以共病数量衡量的疾病负担增加与功能受限恢复的可能性降低相关。糖尿病、中风、抑郁症状、髋部骨折和膝关节疼痛对功能受限恢复的不利影响最强。
在这些社区居住的老年人中，从普遍存在的功能受限中恢复的情况很常见。疾病负担增加与恢复发生率降低相关。糖尿病、中风、抑郁症状、髋部骨折和膝关节疼痛对功能受限恢复的不利影响最强。
