Department of Physical Medicine and Rehabilitation, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 66, Sec. 1, Fengxing Rd., Tanzi Dist., Taichung City 427, Taiwan.
Department of Public Health, China Medical University, No. 100, Sec. 1, Jingmao Rd., Beitun Dist., Taichung City 406, Taiwan.
BMC Geriatr. 2020 Dec 9;20(1):530. doi: 10.1186/s12877-020-01939-4.
This study aims to identify the age trajectories of disability in instrumental activities of daily life (IADLs) over 11 years and their correlates, and to estimate disability-free life expectancy for identified trajectory groups in middle-aged and older adults.
We included 3118 participants aged 50 and over without IADL limitations at baseline from the Taiwan Longitudinal Study in Aging, followed across 1996-2007. We used group-based trajectory models to identify age trajectories of IADL disability, and multiple logistic regressions to examine their correlates. Sullivan method was used to compute IADL disability-free life expectancy for trajectory groups at different ages.
We identified two trajectories groups: 67.7% of participants classified as the late-onset group and 32.3% as the early-onset group. Female (adjusted odds ratio [aOR]: 1.93, 95% confidence interval [95% CI]: 1.54, 2.41), not being employed (aOR: 1.30, 95% CI: 1,08, 1,56), poor/fair self-rated health (aOR: 1.31, 95% CI:1.09, 1.58), hypertension (aOR: 1.32, 95% CI: 1.07, 1.63), diabetes mellitus (aOR: 2.29, 95% CI: 1.72, 3.07), arthritis (aOR: 1.42, 95% CI: 1.11, 1.81), stroke (aOR: 2.21, 95% CI: 1.04, 4.70), and one-point increase in a 10-item depression scale (aOR: 1.04, 95% CI: 1.02, 1.06) were associated with early-onset of disability, whereas higher education (aOR: 0.59, 95% CI: 0.42, 0.81), regular exercise (aOR: 0.76, 95% CI: 0.62, 0.93), and participating voluntary or club activities (aOR: 0.78, 95% CI: 0.65, 0.93) related to the late-onset. IADL disability-free life expectancies at 65 years old in the late-onset group were 15.6 years for women and 14.4 for men, respectively, comprising 56.6 and 64.2% of their remaining life, whereas those of the early-onset group were 4.8 and 4.6 years for women and men respectively, comprising 22.5 and 27.2% of remaining life.
Early-onset of IADLs disability may correlate to chronic conditions, and engagement in employment, exercise, and social participation were associated with a reduced risk of early disability in IADLs.
本研究旨在确定日常生活活动（IADL）障碍在 11 年内的年龄轨迹及其相关因素，并估计中年和老年人中确定的轨迹组的无残疾预期寿命。
我们纳入了来自台湾老龄化纵向研究的 3118 名基线时无 IADL 限制的 50 岁及以上的参与者，随访时间为 1996 年至 2007 年。我们使用基于群组的轨迹模型来识别 IADL 残疾的年龄轨迹，并使用多因素逻辑回归来检查其相关因素。Sullivan 法用于计算不同年龄轨迹组的 IADL 无残疾预期寿命。
我们确定了两个轨迹组：67.7%的参与者为晚发型组，32.3%为早发型组。女性（调整后的优势比 [aOR]：1.93，95%置信区间 [95%CI]：1.54，2.41）、未就业（aOR：1.30，95%CI：1.08，1.56）、自评健康状况差/一般（aOR：1.31，95%CI：1.09，1.58）、高血压（aOR：1.32，95%CI：1.07，1.63）、糖尿病（aOR：2.29，95%CI：1.72，3.07）、关节炎（aOR：1.42，95%CI：1.11，1.81）、中风（aOR：2.21，95%CI：1.04，4.70）和抑郁量表的 10 个项目增加一个点（aOR：1.04，95%CI：1.02，1.06）与残疾的早发有关，而较高的教育水平（aOR：0.59，95%CI：0.42，0.81）、定期锻炼（aOR：0.76，95%CI：0.62，0.93）和参与志愿或俱乐部活动（aOR：0.78，95%CI：0.65，0.93）与晚发型有关。65 岁时晚发型组的 IADL 无残疾预期寿命分别为女性 15.6 年和男性 14.4 年，分别占其剩余寿命的 56.6%和 64.2%，而早发型组的女性和男性分别为 4.8 年和 4.6 年，分别占其剩余寿命的 22.5%和 27.2%。
IADL 障碍的早发可能与慢性疾病有关，而就业、锻炼和社会参与与 IADL 早发残疾的风险降低有关。
