Center for Education and Research on Geriatrics and Gerontology and Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.
Disabil Rehabil. 2012;34(15):1271-6. doi: 10.3109/09638288.2011.641657. Epub 2011 Dec 28.
Understanding the hierarchy of higher-level physical functions to infer disability level (mild, moderate or severe) is essential for the precise targeting of preventive interventions and has been examined previously in a cross-sectional study. Based on longitudinal data, this study evaluated the hierarchy of higher-level physical functions.
Data from a cohort of 2729 community-dwelling persons aged over 50 with no initial disability were drawn from the "Survey of Health and Living Status of the Elderly in Taiwan" from 1996 through 2007. The three-level hierarchy of eight chosen activities was examined by the median ages to disability onset with survival analyses and by Cox regressions, which examined the effects of sex and age on the development of this hierarchy.
The progression of incident disability was as follows: mild level-running, carrying weight, and squatting; moderate level-climbing stairs, walking, and standing; and severe level-grasping and raising arms up. Women and older persons were at greater risk of developing more severe levels of disability. Another Cox regression with one index activity from each hierarchical level revealed similar results.
The three-level hierarchy of higher-level physical functions has been validated longitudinally, suggesting rich research and clinical implications.
理解更高层次生理功能的层次结构，以推断残疾程度（轻度、中度或重度），对于精确瞄准预防干预措施至关重要，此前已有横断面研究对此进行了检验。本研究基于纵向数据，评估了更高层次生理功能的层次结构。
本研究的数据来自于台湾“老年人健康与生活状况调查”的一个队列，该队列由 1996 年至 2007 年间无初始残疾的 2729 名 50 岁以上的社区居民组成。通过生存分析和 Cox 回归，以残疾发病的中位年龄检验了 8 项选定活动的三级层次结构，并检验了性别和年龄对这一层次结构发展的影响。
新发残疾的进展情况如下：轻度水平-跑步、搬运重物和深蹲；中度水平-爬楼梯、行走和站立；严重水平-抓握和抬起手臂。女性和老年人发生更严重残疾程度的风险更高。另一项 Cox 回归，每一级层次结构采用一个指标活动，得出了类似的结果。
更高层次生理功能的三级层次结构已得到纵向验证，提示具有丰富的研究和临床意义。
