He Shuang, Craig Bruce A, Xu Huiping, Covinsky Kenneth E, Stallard Eric, Thomas Joseph, Hass Zach, Sands Laura P
Department of Statistics, Purdue University, West Lafayette, Indiana.
School of Medicine, Indiana University, Indianapolis.
J Gerontol A Biol Sci Med Sci. 2015 Sep;70(9):1128-32. doi: 10.1093/gerona/glv028. Epub 2015 Apr 1.
Unmet need for assistance with activities of daily living (ADLs) disability is associated with increased risk for future hospitalization. To further explore the association between unmet ADL need and future health outcomes, we examined the association between unmet need for ADL assistance and 1-year mortality.
A prospective study of 6,730 community-living Medicare recipients was conducted among respondents to the 1994, 1999, and/or 2004 National Long Term Care Survey. Only those who reported having one or more ADL disabilities were included. Time to death within 1 year after the community survey was determined from Centers for Medicare and Medicaid Services vital statistics records. The community interviews provided demographic, health, and ADL information.
Unadjusted 1-year death rates were 8.7%, 10.6%, 11.4%, 19.2%, and 27.3%, respectively, for respondents with disabilities in 1, 2, 3, 4, and 5 ADLs. Overall, 21.3% reported unmet need for assistance for one or more ADL disabilities. After controlling for demographic and health characteristics, we found a significant interaction between unmet ADL need and level of ADL disability (p = .018). Post hoc analyses revealed that unmet ADL need was associated with increased risk for mortality only for those with one (hazard ratio = 1.96; 95% CI = 1.29-2.87) or two ADL disabilities (hazard ratio = 1.37; 95% CI = 1.07-1.75), but not for those with three or more ADL disabilities.
Future studies are needed to determine whether these findings are replicable and, if so, whether physiologic or process of care variables explain why ADL is associated with mortality only for those with mild disability.
日常生活活动（ADL）残疾方面的未满足的援助需求与未来住院风险增加相关。为了进一步探讨未满足的ADL需求与未来健康结果之间的关联，我们研究了ADL援助的未满足需求与1年死亡率之间的关联。
对1994年、1999年和/或2004年全国长期护理调查的受访者中6730名社区居住的医疗保险受益人群进行了一项前瞻性研究。仅纳入报告有一项或多项ADL残疾的人群。根据医疗保险和医疗补助服务中心的生命统计记录确定社区调查后1年内的死亡时间。社区访谈提供了人口统计学、健康和ADL信息。
1、2、3、4和5项ADL残疾的受访者未经调整的1年死亡率分别为8.7%、10.6%、11.4%、19.2%和27.3%。总体而言，21.3%的人报告一项或多项ADL残疾的援助需求未得到满足。在控制了人口统计学和健康特征后，我们发现ADL需求未得到满足与ADL残疾水平之间存在显著交互作用（p = 0.018）。事后分析显示，ADL需求未得到满足仅与一项ADL残疾（风险比 = 1.96；95%置信区间 = 1.29 - 2.87）或两项ADL残疾（风险比 = 1.37；95%置信区间 = 1.07 - 1.75）的人群死亡率增加风险相关，而与三项或更多ADL残疾的人群无关。
需要进一步的研究来确定这些发现是否可重复，如果是，生理或护理过程变量是否能解释为什么ADL仅与轻度残疾人群的死亡率相关。
