老年幸存者和死亡者的三年功能轨迹：死亡消除了种族差异。
Three Year Functional Trajectories Among Old Age Survivors and Decedents: Dying Eliminates a Racial Disparity.
机构信息
Hospital and Palliative Nurses Association, Pittsburgh, PA, USA.
Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
出版信息
J Gen Intern Med. 2018 Feb;33(2):177-181. doi: 10.1007/s11606-017-4232-6. Epub 2017 Dec 4.
BACKGROUND
Long-term trajectories of disability comparing decedents and survivors and differences by race have not been assessed.
OBJECTIVE
To examine self-reported difficulty in walking a quarter mile and the need for assistance with activities of daily living (ADL) beginning 3 years before death among decedents and age- and gender-matched survivors.
DESIGN
A case-control sample drawn from the Health, Aging and Body Composition Study (Health ABC). Data were collected between 1997 and 2015.
PARTICIPANTS
Of the 1991 participants who died by the end of the study, 1410 were interviewed for 3 years prior to death, including an interview 6 months before dying. Of these, 1379 decedents were successfully matched by age and gender with 1379 survivors and tracked over the same 3-year period.
MAIN MEASURES
Self-reported difficulty walking a quarter mile and the ability to perform activities of daily living without assistance (bathing, dressing, transferring).
KEY RESULTS
Decedents (mean age at death, 84) increased in mobility disability from 44.1% 3 years before death to 69.4% 6 months before death and in ADL disability from 32.9% to 58.4%. Among survivors, mobility disability increased from 31.4% to 40.7% and ADL disability from 17.4% to 31.4%. The proportion of decedents and survivors with mobility disability differed significantly in adjusted models at all assessment points (p < 0.0001). African-American survivors were significantly more disabled than White survivors at all points (p < 0.0001), but trajectories of disability among decedents did not differ by race in the last 18 months of life (p = 0.35).
CONCLUSIONS
Trajectories of self-reported disability differ between survivors and decedents. Older adults who died were more disabled 3 years before death and also had a greater risk of increasing disability over each subsequent 6-month assessment. The gap in disability between African Americans and Whites was erased in the final 1 to 1.5 years before death.
背景
尚未评估比较死者和幸存者的长期残疾轨迹以及按种族划分的差异。
目的
检测死者和年龄及性别匹配的幸存者在死亡前 3 年内自我报告的行走四分之一英里的困难程度以及日常生活活动（ADL）的辅助需求。
设计
从健康、老龄化和身体成分研究（Health ABC）中抽取的病例对照样本。数据收集于 1997 年至 2015 年期间。
参与者
在研究结束时死亡的 1991 名参与者中，有 1410 名在死亡前 3 年内接受了访谈，包括在死亡前 6 个月进行的访谈。其中，1379 名死者按年龄和性别与 1379 名幸存者成功匹配，并在相同的 3 年期间进行了跟踪。
主要措施
自我报告的行走四分之一英里的困难程度以及无需帮助洗澡、穿衣、转移等进行日常生活活动的能力。
主要结果
死者（死亡时的平均年龄为 84 岁）的移动能力残疾从死亡前 3 年的 44.1%增加到死亡前 6 个月的 69.4%，ADL 残疾从 32.9%增加到 58.4%。在幸存者中，移动能力残疾从 31.4%增加到 40.7%，ADL 残疾从 17.4%增加到 31.4%。在所有评估点，死者和幸存者的移动能力残疾比例在调整模型中差异显著（p < 0.0001）。非洲裔美国幸存者在所有时间点都比白人幸存者残疾程度更严重（p < 0.0001），但在生命的最后 18 个月内，死者的残疾轨迹没有因种族而不同（p = 0.35）。
结论
幸存者和死者的自我报告残疾轨迹不同。死亡前 3 年，死亡的老年人残疾程度更高，并且在后每 6 个月评估中残疾程度增加的风险更大。在死亡前 1 至 1.5 年内，非洲裔美国人和白人之间的残疾差距消失了。
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