Ayis S, Gooberman-Hill R, Bowling A, Ebrahim S
MRC Health Services Research Collaboration, Department of Social Medicine, University of Bristol, Canynge Hall, Whiteladies Road, Bristol, BS8 2PR, UK.
Age Ageing. 2006 Jul;35(4):382-7. doi: 10.1093/ageing/afl004. Epub 2006 Apr 25.
to investigate the associations between chronic health conditions, psychosocial and environmental factors and catastrophic decline in mobility among older people.
longitudinal cohort.
national sample living in private households.
nine hundred and ninety-nine adults aged > or = 65 years at initial interview, of which 786 agreed to take part in a follow-up survey 12 months later, and 531 responded to the questionnaire.
catastrophic decline in mobility: inability to do any of the three activities of daily living items-walking 400 yards, climbing up and down stairs or steps and getting on a bus-having been capable of independently doing all three one year earlier.
similar annual rates of catastrophic decline were reported for men and women: 4.8 [95% confidence interval (CI) 2.7-8.3] and 4.6% (2.4-8.6), respectively. Strong associations were found between catastrophic decline and age > 70 years, hearing problems and health deterioration, odds ratio (OR) 3.7 (95% CI 1.1-11.8), 2.8 (1.1-7.3) and 4.3 (1.2-14.7), respectively. Poor perceptions of health, loss of control and feeling fearful also appeared to be important: below average summary psychological status, OR 6.5 (1.9-22.3). Inability to do heavy housework, carry heavy shopping or bend to cut own toenails, indicating poor functional reserve capacity, was strongly associated with decline, OR 6.8 (2.2-20.8).
psychosocial factors are as strongly associated with catastrophic decline as deterioration in health status. Interventions to reduce the risk of catastrophic decline may require management of psychosocial problems as well as health condition components.
探讨老年人慢性健康状况、心理社会及环境因素与活动能力灾难性下降之间的关联。
纵向队列研究。
居住在私人家庭中的全国性样本。
首次访谈时年龄≥65岁的999名成年人，其中786人同意在12个月后参加随访调查，531人对问卷做出了回应。
活动能力灾难性下降：无法完成三项日常生活活动中的任何一项——行走400码、上下楼梯或登上公交车，而一年前能够独立完成所有三项活动。
男性和女性报告的灾难性下降年发生率相似：分别为4.8%[95%置信区间（CI）2.7 - 8.3]和4.6%（2.4 - 8.6）。发现灾难性下降与年龄>70岁、听力问题和健康恶化之间存在强关联，比值比（OR）分别为3.7（95%CI 1.1 - 11.8）、2.8（1.1 - 7.3）和4.3（1.2 - 14.7）。对健康的不良认知、失去控制感和感到恐惧似乎也很重要：心理状态综合评分低于平均水平，OR为6.5（1.9 - 22.3）。无法进行繁重家务、搬运重物购物或弯腰剪自己的脚趾甲，表明功能储备能力差，与活动能力下降密切相关，OR为6.8（2.2 - 20.8）。
心理社会因素与灾难性下降的关联程度与健康状况恶化一样强烈。降低灾难性下降风险的干预措施可能需要同时处理心理社会问题和健康状况因素。
