University of Pittsburgh School of Medicine, 3471 Fifth Avenue, Suite 500, Pittsburgh, PA 15213, USA.
J Gen Intern Med. 2011 Feb;26(2):130-5. doi: 10.1007/s11606-010-1543-2.
Mobility, such as walking 1/4 mile, is a valuable but underutilized health indicator among older adults. For mobility to be successfully integrated into clinical practice and health policy, an easily assessed marker that predicts subsequent health outcomes is required.
To determine the association between mobility, defined as self-reported ability to walk 1/4 mile, and mortality, functional decline, and health care utilization and costs during the subsequent year.
Analysis of longitudinal data from the 2003-2004 Medicare Current Beneficiary Survey, a nationally representative sample of Medicare beneficiaries.
Participants comprised 5895 community-dwelling adults aged 65 years or older enrolled in Medicare.
Mobility (self-reported ability to walk 1/4 mile), mortality, incident difficulty with activities of daily living (ADLs), total annual health care costs, and hospitalization rates.
Among older adults, 28% reported difficulty and 17% inability to walk 1/4 mile at baseline. Compared to those without difficulty and adjusting for demographics, socioeconomic status, chronic conditions, and health behaviors, mortality was greater in those with difficulty [AOR (95% CI): 1.57 (1.10-2.24)] and inability [AOR (CI): 2.73 (1.79-4.15)]. New functional disability also occurred more frequently as self-reported ability to walk 1/4 mile declined (subsequent incident disability among those with no difficulty, difficulty, or inability to walk 1/4 mile at baseline was 11%, 29%, and 47% for instrumental ADLs, and 4%, 14%, and 23% for basic ADLs). Total annual health care costs were $2773 higher (95% CI $1443-4102) in persons with difficulty and $3919 higher (CI $1948-5890) in those who were unable. For each 100 persons, older adults reporting difficulty walking 1/4 mile at baseline experienced an additional 14 hospitalizations (95% CI 8-20), and those who were unable experienced an additional 22 hospitalizations (CI 14-30) during the follow-up period, compared to persons without walking difficulty.
Mobility disability, a simple self-report measure, is a powerful predictor of future health, function, and utilization independent of usual health and demographic indicators. Mobility disability may be used to target high-risk patients for care management and preventive interventions.
行动能力，如行走四分之一英里，是老年人中一项有价值但未得到充分利用的健康指标。为了使行动能力成功地融入临床实践和卫生政策，需要有一种易于评估的标志物来预测随后的健康结果。
确定行动能力（自我报告的行走四分之一英里的能力）与死亡率、功能下降以及随后一年内的医疗保健利用和成本之间的关联。
对 2003-2004 年医疗保险当前受益人调查的纵向数据进行分析，这是医疗保险受益人的全国代表性样本。
参与者包括 5895 名居住在社区的 65 岁或以上的老年人，他们参加了医疗保险。
行动能力（自我报告的行走四分之一英里的能力）、死亡率、新发日常生活活动（ADL）困难、总年度医疗保健费用和住院率。
在老年人中，28%的人报告在基线时有行走四分之一英里的困难，17%的人无法行走四分之一英里。与没有困难的人相比，并调整了人口统计学、社会经济状况、慢性疾病和健康行为因素，有困难的人（AOR（95%CI）：1.57（1.10-2.24））和无能力的人（AOR（CI）：2.73（1.79-4.15））的死亡率更高。随着自我报告的行走四分之一英里的能力下降，新的功能障碍也更频繁地发生（在基线时没有行走困难、有行走困难或无法行走四分之一英里的人随后出现的工具性 ADL 残疾分别为 11%、29%和 47%，基本 ADL 残疾分别为 4%、14%和 23%）。有行走困难的人每年的医疗保健费用增加了 2773 美元（95%CI 1443-4102），无法行走的人增加了 3919 美元（CI 1948-5890）。与没有行走困难的人相比，在基线时报告行走四分之一英里有困难的 100 人中，有 14 人（95%CI 8-20）额外住院，而无法行走的人有 22 人（CI 14-30）额外住院。
行动能力障碍，一种简单的自我报告测量，是未来健康、功能和利用的有力预测指标，独立于常用的健康和人口统计学指标。行动能力障碍可用于确定高危患者进行护理管理和预防干预的对象。
