Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, Iowa, USA.
BMC Geriatr. 2011 Aug 16;11:43. doi: 10.1186/1471-2318-11-43.
Most prior studies have focused on short-term (≤ 2 years) functional declines. But those studies cannot address aging effects inasmuch as all participants have aged the same amount. Therefore, the authors studied the extent of long-term functional decline in older Medicare beneficiaries who were followed for varying time lengths, and the authors also identified the risk factors associated with those declines.
The analytic sample included 5,871 self- or proxy-respondents who had complete baseline and follow-up survey data that could be linked to their Medicare claims for 1993-2007. Functional status was assessed using activities of daily living (ADLs), instrumental ADLs (IADLs), and mobility limitations, with declines defined as the development of two of more new difficulties. Multiple logistic regression analysis was used to focus on the associations involving respondent status, health lifestyle, continuity of care, managed care status, health shocks, and terminal drop.
The average amount of time between the first and final interviews was 8.0 years. Declines were observed for 36.6% on ADL abilities, 32.3% on IADL abilities, and 30.9% on mobility abilities. Functional decline was more likely to occur when proxy-reports were used, and the effects of baseline function on decline were reduced when proxy-reports were used. Engaging in vigorous physical activity consistently and substantially protected against functional decline, whereas obesity, cigarette smoking, and alcohol consumption were only associated with mobility declines. Post-baseline hospitalizations were the most robust predictors of functional decline, exhibiting a dose-response effect such that the greater the average annual number of hospital episodes, the greater the likelihood of functional status decline. Participants whose final interview preceded their death by one year or less had substantially greater odds of functional status decline.
Both the additive and interactive (with functional status) effects of respondent status should be taken into consideration whenever proxy-reports are used. Encouraging exercise could broadly reduce the risk of functional decline across all three outcomes, although interventions encouraging weight reduction and smoking cessation would only affect mobility declines. Reducing hospitalization and re-hospitalization rates could also broadly reduce the risk of functional decline across all three outcomes.
大多数先前的研究都集中在短期（≤2 年）的功能下降。但这些研究并不能解决老化的影响，因为所有参与者的年龄都相同。因此，作者研究了在随访时间长短不同的老年医疗保险受益人中，长期功能下降的程度，并确定了与这些下降相关的风险因素。
分析样本包括 5871 名自我或代理受访者，他们有完整的基线和随访调查数据，可以与他们在 1993-2007 年的医疗保险索赔相联系。使用日常生活活动（ADL）、工具性日常生活活动（IADL）和移动能力来评估功能状态，定义为发展两种或更多新的困难。多逻辑回归分析用于关注涉及受访者状况、健康生活方式、护理连续性、管理式医疗状况、健康冲击和终端下降的关联。
第一次和最后一次访谈之间的平均时间为 8.0 年。36.6%的人在日常生活活动能力方面下降，32.3%的人在工具性日常生活活动能力方面下降，30.9%的人在移动能力方面下降。当使用代理报告时，功能下降更有可能发生，而当使用代理报告时，基线功能对下降的影响会降低。持续进行剧烈的身体活动可以有效地预防功能下降，而肥胖、吸烟和饮酒仅与移动能力下降有关。基线后的住院治疗是功能下降的最有力预测因素，表现出剂量反应效应，即平均每年住院次数越多，功能状态下降的可能性就越大。最后一次访谈在一年或更短时间内先于死亡的参与者，其功能状态下降的可能性显著增加。
无论何时使用代理报告，都应考虑受访者状况的累积和交互（与功能状态）效应。鼓励锻炼可以广泛降低所有三种结果的功能下降风险，尽管鼓励减肥和戒烟的干预措施只会影响移动能力下降。降低住院和再住院率也可以广泛降低所有三种结果的功能下降风险。
