Vicki A. Freedman is with the Institute for Social Research, University of Michigan, Ann Arbor. Judith D. Kasper is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Brenda C. Spillman is with the Health Policy Center, the Urban Institute, Washington, DC. Emily M. Agree is with the Department of Sociology, Johns Hopkins University. Vincent Mor is with the Department of Health Services, Policy and Practice, Brown University, Providence, RI. Robert B. Wallace is with the Department of Epidemiology, University of Iowa, Iowa City. Douglas A. Wolf is with the Department of Public Administration and International Affairs, Syracuse University, Syracuse, NY.
Am J Public Health. 2014 Feb;104(2):e88-94. doi: 10.2105/AJPH.2013.301687. Epub 2013 Dec 12.
To inform public health efforts to promote independent functioning among older adults, we have provided new national estimates of late-life disability that explicitly recognize behavioral adaptations.
We analyzed the 2011 National Health and Aging Trends Study, a study of Medicare enrollees aged 65 years and older (n = 8077). For 7 mobility and self-care activities we identified 5 hierarchical stages--fully able, successful accommodation with devices, activity reduction, difficulty despite accommodations, and receipt of help--and explored disparities and associations with quality of life measures.
Among older adults, 31% were fully able to complete self-care and mobility activities. The remaining groups successfully accommodated with devices (25%), reduced their activities (6%), reported difficulty despite accommodations (18%), or received help (21%). With successive stages, physical and cognitive capacity decreased and symptoms and multimorbidity increased. Successful accommodation was associated with maintaining participation in valued activities and high well-being, but substantial disparities by race, ethnicity, and income existed.
Increased public health attention to behavioral adaptations to functional change can promote independence for older adults and may enhance quality of life.
为了推动老年人独立生活的公共卫生工作，我们提供了新的全国范围内的关于晚年残疾的估计数据，这些数据明确承认了行为适应。
我们分析了 2011 年国家健康老龄化趋势研究，该研究是对 65 岁及以上的医疗保险参保者（n=8077）进行的一项研究。对于 7 项移动性和自我护理活动，我们确定了 5 个层次阶段——完全能够、成功使用设备适应、活动减少、尽管适应仍有困难、以及接受帮助——并探讨了这些阶段与生活质量衡量指标的差异和关联。
在老年人中，有 31%的人完全能够独立完成自我护理和移动性活动。其余的人则成功地使用了设备（25%）、减少了他们的活动（6%）、尽管有适应但仍有困难（18%）或接受了帮助（21%）。随着阶段的推进，身体和认知能力下降，症状和多种疾病增加。成功适应与保持参与有价值的活动和高幸福感相关，但在种族、族裔和收入方面存在着显著的差异。
增加对功能变化的行为适应的公共卫生关注可以促进老年人的独立性，并可能提高生活质量。
