Ford A B, Folmar S J, Salmon R B, Medalie J H, Roy A W, Galazka S S
Department of Epidemiology and Biostatistics, Case Western Reserve University School of Medicine, Cleveland, Ohio 44106.
J Am Geriatr Soc. 1988 Mar;36(3):187-97. doi: 10.1111/j.1532-5415.1988.tb01799.x.
This report advocates conceptual separation and parallel assessment of medically diagnosed health conditions and functional disability in clinical and epidemiological studies of the aged. Data from a study of urban elderly are presented to demonstrate how this can be done and to reexamine the meaning of self-reported illness and disability. One hundred thirteen subjects 74 to 95 years old, recruited from a longitudinal study of a representative sample of the elderly population of Cleveland, Ohio, participated in structured interviews and epidemiologically based medical examinations, conducted by a physician-nurse team at the place of residence. The presence or absence of 11 common chronic conditions was determined according to preestablished criteria, by self-report and, separately, by medical diagnostic evaluation. Functional disability was estimated by self-report and by physician-nurse assessment, using established measures of mobility and activities of daily living. Results indicate that interview self-report can provide useful estimates of the prevalence of medical conditions and functional disabilities in elderly populations, although self-report alone is not a sufficiently sensitive measure to be used for case-finding or diagnosis. When functional disabilities are matched against the specific medical conditions that cause them and disease-specific mortality is also taken into account, a three-dimensional classification results that has implications for future clinical and survey work with the elderly.
本报告主张在老年人群的临床和流行病学研究中，对医学诊断的健康状况和功能残疾进行概念上的区分和并行评估。文中呈现了一项针对城市老年人的研究数据，以说明如何做到这一点，并重新审视自我报告的疾病和残疾的含义。从俄亥俄州克利夫兰市老年人群代表性样本的纵向研究中招募了113名74至95岁的受试者，他们在居住地接受了由医生-护士团队进行的结构化访谈和基于流行病学的医学检查。根据既定标准，通过自我报告以及分别通过医学诊断评估来确定11种常见慢性病的有无。使用既定的活动能力和日常生活活动测量方法，通过自我报告和医生-护士评估来估计功能残疾情况。结果表明，访谈自我报告可以为老年人群中医疗状况和功能残疾的患病率提供有用的估计，尽管仅靠自我报告并非用于病例发现或诊断足够敏感的测量方法。当将功能残疾与导致其的特定医疗状况相匹配，并且考虑到疾病特异性死亡率时，会得出一个三维分类结果，这对未来针对老年人的临床和调查工作具有启示意义。
