老年功能障碍和残疾：心血管健康研究。
Geriatric impairments and disability: the cardiovascular health study.
机构信息
Section of General Medicine, Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut, USA.
出版信息
J Am Geriatr Soc. 2010 Sep;58(9):1686-92. doi: 10.1111/j.1532-5415.2010.03022.x.
OBJECTIVES
To determine the relative importance of geriatric impairments (in muscle strength, physical capacity, cognition, vision, hearing, and psychological status) and chronic diseases in predicting subsequent functional disability in longitudinal analyses.
DESIGN
Longitudinal data from the Cardiovascular Health Study were analyzed. Multivariable Cox hazards regression modeling was used to analyze associations between time-dependent predictors and onset of disability in activities of daily living (ADLs) and mobility.
SETTING
Four communities across the United States (Sacramento County, CA; Washington County, MD; Forsyth County, NC; and Allegheny County, PA).
PARTICIPANTS
Five thousand eight hundred eighty-eight elderly persons.
MEASUREMENTS
Data were collected annually through in-person examinations.
RESULTS
ADL disability developed in 15% of participants and mobility disability in 30%. A single multivariable model was developed that included demographics, marital status, body mass index, and number of impairments and diseases. The hazard ratios (HRs) of having one, two, and three or more geriatric impairments (vs none) for the outcome of ADL disability were 2.12 (95% confidence interval (CI)=1.63-2.75), 4.25 (95% CI=3.30-5.48), and 7.87 (95% CI=6.10-10.17), respectively, and for having one, two, and three or more chronic diseases were 1.75 (95% CI=1.41-2.19), 2.45 (95% CI=1.95-3.07), and 3.26 (95% CI=2.53-4.19), respectively. Similarly, the HRs of having one, two, and three or more impairments for the outcome of mobility disability were 1.48 (95% CI=1.27-1.73), 2.08 (95% CI=1.77-2.45), and 3.70 (95% CI=3.09-4.42), respectively, and for having one, two, and three or more diseases were 2.06 (95% CI=1.76-2.40), 2.80 (95% CI=2.36-3.31), and 4.20 (95% CI=3.44-5.14), respectively.
CONCLUSION
Number of geriatric impairments was more strongly associated than number of chronic diseases with subsequent ADL disability and nearly as strongly associated with the subsequent mobility disability.
目的
在纵向分析中，确定老年损伤（肌肉力量、身体能力、认知、视力、听力和心理状况）和慢性病对随后功能障碍的相对重要性。
设计
分析来自心血管健康研究的纵向数据。多变量 Cox 风险回归模型用于分析随时间变化的预测因子与日常生活活动（ADL）和移动能力障碍发病之间的关系。
地点
美国四个社区（加利福尼亚州萨克拉门托县、马里兰州华盛顿县、北卡罗来纳州福赛斯县和宾夕法尼亚州阿勒格尼县）。
参与者
5888 名老年人。
测量
通过面对面检查每年收集数据。
结果
15%的参与者出现 ADL 残疾，30%的参与者出现移动能力残疾。建立了一个单一的多变量模型，其中包括人口统计学、婚姻状况、体重指数以及损伤和疾病的数量。有一个、两个和三个或更多老年损伤（与没有损伤相比）的 ADL 残疾结局的风险比（HR）分别为 2.12（95%置信区间[CI]=1.63-2.75）、4.25（95% CI=3.30-5.48）和 7.87（95% CI=6.10-10.17），有一个、两个和三个或更多慢性疾病的 HR 分别为 1.75（95% CI=1.41-2.19）、2.45（95% CI=1.95-3.07）和 3.26（95% CI=2.53-4.19）。同样，有一个、两个和三个或更多损伤的 HR 分别为 1.48（95% CI=1.27-1.73）、2.08（95% CI=1.77-2.45）和 3.70（95% CI=3.09-4.42），有一个、两个和三个或更多疾病的 HR 分别为 2.06（95% CI=1.76-2.40）、2.80（95% CI=2.36-3.31）和 4.20（95% CI=3.44-5.14）。
结论
与慢性疾病数量相比，老年损伤数量与随后的 ADL 残疾相关性更强，与随后的移动能力残疾相关性几乎一样强。
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