Brown Rebecca T, Diaz-Ramirez L Grisell, Boscardin W John, Lee Sei J, Steinman Michael A
From University of California, San Francisco, and San Francisco Veterans Affairs Medical Center, San Francisco, California.
Ann Intern Med. 2017 Dec 5;167(11):761-768. doi: 10.7326/M17-0496. Epub 2017 Oct 31.
Difficulties with daily functioning are common in middle-aged adults. However, little is known about the epidemiology or clinical course of these problems, including the extent to which they share common features with functional impairment in older adults.
To determine the epidemiology and clinical course of functional impairment and decline in middle age.
Cohort study.
The Health and Retirement Study.
6874 community-dwelling adults aged 50 to 56 years who did not have functional impairment at enrollment.
Impairment in activities of daily living (ADLs), defined as self-reported difficulty performing 1 or more ADLs, assessed every 2 years for a maximum follow-up of 20 years, and impairment in instrumental ADLs (IADLs), defined similarly. Data were analyzed by using multistate models that estimate probabilities of different outcomes.
Impairment in ADLs developed in 22% of participants aged 50 to 64 years, in whom further functional transitions were common. Two years after the initial impairment, 4% (95% CI, 3% to 5%) of participants had died, 9% (CI, 8% to 11%) had further ADL decline, 50% (CI, 48% to 52%) had persistent impairment, and 37% (CI, 35% to 39%) had recovered independence. In the 10 years after the initial impairment, 16% (CI, 14% to 18%) had 1 or more episodes of functional decline and 28% (CI, 26% to 30%) recovered from their initial impairment and remained independent throughout this period. The pattern of findings was similar for IADLs.
Functional status was self-reported.
Functional impairment and decline are common in middle age, as are transitions from impairment to independence and back again. Because functional decline in older adults has similar features, current interventions used for prevention in older adults may hold promise for those in middle age.
National Institute on Aging and National Center for Advancing Translational Sciences through the University of California, San Francisco, Clinical and Translational Sciences Institute.
日常功能障碍在中年成年人中很常见。然而，对于这些问题的流行病学或临床病程，包括它们与老年人功能障碍的共同特征程度，人们了解甚少。
确定中年人群功能障碍和衰退的流行病学及临床病程。
队列研究。
健康与退休研究。
6874名年龄在50至56岁之间、入组时无功能障碍的社区居住成年人。
日常生活活动（ADL）障碍，定义为自我报告在进行1项或多项ADL时存在困难，每2年评估一次，最长随访20年；工具性日常生活活动（IADL）障碍，定义类似。使用多状态模型分析数据，该模型可估计不同结果的概率。
50至64岁的参与者中有22%出现ADL障碍，其中进一步的功能转变很常见。在首次出现障碍后的两年里，4%（95%置信区间，3%至5%）的参与者死亡，9%（置信区间，8%至11%）的参与者ADL进一步衰退，50%（置信区间，48%至52%）的参与者持续存在障碍，37%（置信区间，35%至39%）的参与者恢复了独立。在首次出现障碍后的10年里，16%（置信区间，14%至18%）的参与者有1次或更多次功能衰退发作，28%（置信区间，26%至30%）的参与者从最初的障碍中恢复，并在此期间一直保持独立。IADL的结果模式与之相似。
功能状态为自我报告。
功能障碍和衰退在中年时期很常见，从障碍到独立再回到障碍的转变也很常见。由于老年人的功能衰退有类似特征，目前用于老年人预防的干预措施可能对中年人也有帮助。
美国国立衰老研究所和美国国立推进转化科学中心，通过加利福尼亚大学旧金山分校临床与转化科学研究所提供资金。
