Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, the Netherlands.
Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, the Netherlands.
Soc Sci Med. 2019 Feb;222:180-187. doi: 10.1016/j.socscimed.2018.12.028. Epub 2018 Dec 26.
Chronic diseases and functional limitations may have serious and persistent consequences for one's quality of life (QoL). Over time, however, their negative impact on QoL may diminish because of adaptation. Understanding how much people adapt helps to correctly separate the effects attributable to interventions from those arising from adaptation and thus facilitates a better estimation of the effects of disease and treatment on QoL. To date, however, there is little empirical evidence on adaptation in older populations. In particular, it is unclear to which extent dimensions of QoL like health and overall experience with life are influenced by adaptation. This paper studies adaptation to functional limitations in 5000 respondents of the Survey of Health, Ageing and Retirement in Europe (SHARE) who develop disabilities during the span of the 5 waves of data collection between 2004 and 2015. To examine the association between time since the onset of functional limitations and self-perceived health and life satisfaction, a fixed effects ordered logit model is used. We found evidence supporting adaptation in life satisfaction, corresponding to a return to pre-onset levels of life satisfaction. Also in the self-perceived health dimension, adaptation does occur, but it does not occur fast enough to offset the negative changes in underlying health. This means that observational studies that measure one of these two outcome measures should be aware that part or all of the effects found are due to adaptation.
慢性疾病和功能限制可能会对一个人的生活质量（QoL）产生严重且持久的影响。然而，随着时间的推移，由于适应，其对 QoL 的负面影响可能会减轻。了解人们适应的程度有助于正确区分干预措施的效果和适应的效果，从而更准确地估计疾病和治疗对 QoL 的影响。然而，迄今为止，关于老年人适应的实证证据很少。特别是，目前还不清楚健康和整体生活体验等 QoL 维度在多大程度上受到适应的影响。本文研究了欧洲健康、老龄化和退休调查（SHARE）中 5000 名受访者在 2004 年至 2015 年的 5 轮数据收集期间出现残疾时对功能限制的适应情况。为了检验功能限制出现后时间与自我感知健康和生活满意度之间的关系，使用了固定效应有序逻辑模型。我们发现了支持生活满意度适应的证据，这对应着生活满意度回到发病前的水平。在自我感知健康维度上，也确实存在适应，但适应速度不够快，无法抵消潜在健康状况的负面变化。这意味着，测量这两个结果指标之一的观察性研究应该意识到，所发现的部分或全部影响可能是由于适应造成的。
