Veterans Affairs Medical Center, Birmingham, AL, USA.
Eur J Heart Fail. 2012 Jun;14(6):581-7. doi: 10.1093/eurjhf/hfs034. Epub 2012 Apr 4.
Instrumental activities of daily living (IADLs) are tasks that are necessary for independent community living. These tasks often require intact physical and cognitive function, the impairment of which may adversely affect health in older adults. In the current study, we examined the association between IADL impairment and incident heart failure (HF) in community-dwelling older adults.
Of the 5795 community-dwelling adults, aged ≥65 years, in the Cardiovascular Health Study, 5511 had data on baseline IADL and were free of prevalent HF. Of these, 1333 (24%) had baseline IADL impairment, defined as self-reported difficulty with one or more of the following tasks: using the telephone, preparing food, performing light and heavy housework, managing finances, and shopping. Propensity scores for IADL impairment, estimated for each of the 5511 participants, were used to assemble a cohort of 1038 pairs of participants with and without IADL impairment who were balanced on 42 baseline characteristics. Centrally adjudicated incident HF occurred in 26% and 21% of matched participants with and without IADL impairment, respectively, during >12 years of follow-up [matched hazard ratio (HR) 1.33; 95% confidence interval (CI) 1.11-1.59; P = 0.002]. Unadjusted and multivariable-adjusted HRs for incident HF before matching were 1.77 (95% CI 1.56-2.01; P < 0.001) and 1.33 (95% CI 1.15-1.54; P < 0.001), respectively. IADL impairment was also associated with all-cause mortality (matched HR 1.19; 95% CI 1.06-1.34; P = 0.004).
Among community-dwelling older adults free of baseline HF, IADL impairment is a strong and independent predictor of incident HF and mortality.
日常生活活动能力（IADL）是独立社区生活所必需的任务。这些任务通常需要完整的身体和认知功能，其受损可能会对老年人的健康产生不利影响。在本研究中，我们研究了 IADL 受损与社区居住的老年人发生心力衰竭（HF）之间的关联。
在心血管健康研究中，共有 5795 名年龄≥65 岁的社区居住成年人，有基线 IADL 数据且无现患 HF。其中，有 5511 人（24%）基线 IADL 受损，定义为自我报告在以下一项或多项任务中存在困难：使用电话、准备食物、进行轻、重家务劳动、管理财务和购物。为 5511 名参与者中的每一位估计 IADL 受损的倾向评分，以汇集一组 1038 对有和没有 IADL 受损的参与者，这些参与者在 42 项基线特征上平衡。在超过 12 年的随访期间，中心裁定的 HF 发生率分别为 IADL 受损和无 IADL 受损的匹配参与者中的 26%和 21%[匹配的危险比（HR）为 1.33；95%置信区间（CI）为 1.11-1.59；P=0.002]。在匹配前，HF 的未调整和多变量调整 HR 分别为 1.77（95%CI 1.56-2.01；P<0.001）和 1.33（95%CI 1.15-1.54；P<0.001）。IADL 受损也与全因死亡率相关（匹配 HR 为 1.19；95%CI 1.06-1.34；P=0.004）。
在无基线 HF 的社区居住老年人中，IADL 受损是 HF 事件和死亡率的一个强有力且独立的预测因素。
