Fillenbaum Gerda G, Sloane Richard, Burchett Bruce M, Hall Katherine, Pieper Carl F, Whitson Heather E, Colón-Emeric Cathleen S
Duke University School of Medicine, Durham, NC; Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC.
Duke University School of Medicine, Durham, NC; Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC.
J Am Med Dir Assoc. 2020 Aug;21(8):1141-1147.e1. doi: 10.1016/j.jamda.2019.12.021. Epub 2020 Feb 7.
Focus on decline in performance of activities of daily living (ADL) has not been matched by studies of recovery of function. Advised by a broad conceptual model of physical resilience, we ascertain characteristics that identify (1) maintenance, (2) decline, and (3) recovery of personal self-maintenance activities over six years in an older, community representative, African American and white sample.
Longitudinal study, analyses included descriptive statistics and repeated measures proportional hazards.
SETTING/PARTICIPANTS: Community-representative participants of the Duke Established Populations for Epidemiologic Studies of the Elderly (EPESE), unimpaired at baseline (n = 3187; 46% white, 54% African American; 64% female, 36% male), followed annually for up to 6 years.
Data included information on basic activities of daily living (BADL), demographic characteristics, health status, social services provided and received, household size, neighborhood safety, and survival status.
Over 6 years, ∼75% remained unimpaired, of whom 30% were unimpaired when they dropped out or died. Of ∼25% who became impaired, just under half recovered. Controlled analyses indicated that those who became impaired were in poorer health, younger, and more likely to be African American. Characteristics of recovery included younger age, not hospitalized in the previous year, and larger household size.
CONCLUSIONS/IMPLICATIONS: Maintenance of health status facilitated continued unimpaired BADL. While decline was associated with poorer health, younger age, and being African American, recovery was also associated with younger age, together with larger household size, and no further deterioration in health as measured here. Maintenance of good health is preferred, but following decline in functioning, increased effort to improve health and avoid further decline, which takes into account not only physical but also personal social conditions, is needed.
对日常生活活动能力（ADL）下降的关注尚未与功能恢复的研究相匹配。在一个广泛的身体恢复力概念模型的指导下，我们确定了在一个具有社区代表性的老年非裔美国人和白人样本中，在六年时间里识别（1）个人自我维持活动的维持、（2）下降和（3）恢复的特征。
纵向研究，分析包括描述性统计和重复测量比例风险分析。
设置/参与者：杜克大学老年人流行病学研究既定人群（EPESE）的社区代表性参与者，基线时未受损（n = 3187；46%为白人，54%为非裔美国人；64%为女性，36%为男性），每年随访长达6年。
数据包括关于日常生活基本活动（BADL）、人口统计学特征、健康状况、提供和接受的社会服务、家庭规模、邻里安全和生存状况的信息。
在6年中，约75%的人保持未受损，其中30%在退出研究或死亡时仍未受损。在约25%受损的人中，不到一半恢复了。对照分析表明，受损的人健康状况较差、年龄较小，且更可能是非裔美国人。恢复的特征包括年龄较小、前一年未住院以及家庭规模较大。
结论/启示：健康状况的维持有助于BADL持续未受损。虽然下降与健康状况较差、年龄较小和非裔美国人身份有关，但恢复也与年龄较小、家庭规模较大以及在此处测量的健康状况没有进一步恶化有关。保持良好的健康状况是首选，但在功能下降后，需要加大努力改善健康状况并避免进一步下降，这不仅要考虑身体状况，还要考虑个人社会状况。
