Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (UMC Utrecht).
Department for the Chronically Ill, University of Applied Sciences Utrecht, The Netherlands.
J Gerontol A Biol Sci Med Sci. 2020 Jan 1;75(1):197-203. doi: 10.1093/gerona/glz049.
To investigate trends over age by comorbidity status for the risk of limitations in individual activities of daily living for community-living older persons.
A longitudinal population-based study was conducted in 9,319 community-living Dutch persons aged 60 years and older. Self-reported multiple chronic conditions (MCC) and nine instrumental activities of daily livings (IADLs) were assessed in 15 studies of the Dutch National Care for the Elderly Program (TOPICS-MDS). Risks of limitations in IADLs, odds ratios (per 5 years), and rate ratios (per 5 years) were calculated with mixed logistic and negative binomial regression models with age as the underlying timescale, stratified by number of MCC (no, 1-2, ≥ 3 MCC), and corrected for confounders.
At inclusion, the number of IADL limitations was highest for the "≥3 MCC" group (2.00 interquartile range [1.00-4.00]) and equal for "no MCC" or "1-2 MCC" (1.00 interquartile range [0.00-2.00]). Trends of individual IADLs depicted a higher risk in IADL limitation with increasing age over 2 years of follow-up, except for handling finances for the "no MCC" group. The longitudinal age effect on IADL limitations varied subject to MCC, being strongest for the "no MCC" group for most IADLs; grooming and telephone use were almost unaltered by age and MCC.
We observed a decline in IADL functioning with increasing age over 2 years of follow-up in persons with and without MCC. The impact of MCC on IADL decline varied per IADL activity.
本研究旨在通过共病状态调查年龄相关的活动受限风险，以了解社区居住的老年人日常活动受限的情况。
本研究为一项基于人群的纵向研究，纳入了 9319 名 60 岁及以上的社区居住荷兰人。在荷兰国家老年护理计划（TOPICS-MDS）的 15 项研究中，通过问卷调查评估了参与者的多种慢性疾病（MCC）和 9 项工具性日常生活活动（IADL）。采用混合逻辑回归和负二项回归模型，以年龄作为潜在时间尺度，根据共病数量（无、1-2 种、≥3 种）对数据进行分层，校正混杂因素后，计算了 IADL 受限的风险比（每 5 年）和率比（每 5 年）。
纳入时，“≥3 种 MCC”组的 IADL 受限数量最高（2.00 四分位距[1.00-4.00]），“无 MCC”或“1-2 种 MCC”组的 IADL 受限数量相同（1.00 四分位距[0.00-2.00]）。在 2 年的随访期间，除了“无 MCC”组的财务管理外，随着年龄的增长，个体 IADL 的趋势显示出更高的 IADL 受限风险。MCC 对 IADL 受限的纵向年龄效应因 MCC 而异，对于“无 MCC”组，大多数 IADL 的影响最大；修饰和电话使用几乎不受年龄和 MCC 的影响。
在有或无 MCC 的人群中，我们观察到 IADL 功能在 2 年的随访期间随年龄增长而下降。MCC 对 IADL 下降的影响因 IADL 活动而异。
