Reuben David B, Seeman Teresa E, Keeler Emmett, Hayes Risa P, Bowman Lee, Sewall Ase, Hirsch Susan H, Wallace Robert B, Guralnik Jack M
Multicampus Program in Geriatric Medicine and Gerontology, David Geffen School of Medicine at the University of California, Los Angeles 90095-1687, USA.
J Gerontol A Biol Sci Med Sci. 2004 Oct;59(10):1056-61. doi: 10.1093/gerona/59.10.m1056.
When considered individually, self-reported functional status and performance-based functional status predict functional status decline and mortality. However, what additional prognostic information is gained by combining these approaches remains unknown.
The authors used three waves of three sites (5138 participants) of the Established Populations for Epidemiologic Studies of the Elderly to determine the prognostic value of individual and combined approaches. Baseline self-reported (mobility and activities of daily living [ADL] items) and performance-based (Physical Performance Score) functional status information was classified into three and four hierarchical categories, respectively.
Based on self-reported information alone, at 1 year, 73% participants had not changed, 15% declined, 6% improved, and 6% died. At 4 years, 53% had not changed, 24% declined, 2% improved, and 22% died. Based on performance-based assessment alone, at 4 years, 33% of the sample remained stable, 37% declined, 6% improved, and 24% died. In the top two self-reported categories, functioning on the performance-based assessment varied widely. Among those who were independent in all self-reported functioning, approximately 40% scored in each of the top two performance-based categories. Among persons in the top two self-reported categories, poorer performance was associated with progressively higher 1-year and 4-year mortality rates. Among persons with impaired mobility and at least 1 ADL dependency, the mortality rate was high and was not influenced by performance-based score.
Combining self-reported and performance-based measurements can refine prognostic information, particularly among older persons with high self-reported functioning. However, if ADL dependency is present, performance-based measures do not add prognostic value regarding mortality.
单独来看，自我报告的功能状态和基于表现的功能状态可预测功能状态下降和死亡率。然而，将这些方法结合起来能获得哪些额外的预后信息仍不清楚。
作者利用老年流行病学研究既定人群三个地点（5138名参与者）的三轮数据，来确定单独及联合方法的预后价值。基线时，自我报告的（移动性和日常生活活动[ADL]项目）和基于表现的（身体表现评分）功能状态信息分别被分为三个和四个等级类别。
仅基于自我报告信息，1年时，73%的参与者未发生变化，15%下降，6%改善，6%死亡。4年时，53%未发生变化，24%下降，2%改善，22%死亡。仅基于基于表现的评估，4年时，33%的样本保持稳定，37%下降，6%改善，24%死亡。在自我报告的前两个类别中，基于表现的评估功能差异很大。在所有自我报告功能均独立的人群中，约40%在基于表现的前两个类别中得分。在自我报告前两个类别的人群中，表现较差与1年和4年死亡率逐渐升高相关。在行动不便且至少有1项ADL依赖的人群中，死亡率很高，且不受基于表现的评分影响。
结合自我报告和基于表现的测量可以细化预后信息，特别是在自我报告功能良好的老年人中。然而，如果存在ADL依赖，基于表现的测量在死亡率方面不会增加预后价值。
