Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
School of Public Health, Wuhan University, Wuhan, China.
J Nutr Health Aging. 2024 Jan;28(1):100022. doi: 10.1016/j.jnha.2023.100022. Epub 2024 Jan 1.
To investigate the association between duration of disability in activity of daily living (ADL) and overall survival in older individuals.
A prospective cohort study.
Community-based data from Chinese Longitudinal Healthy Longevity Survey.
In total, 13,560 participants without ADL disability and 2772 participants with ADL disability at baseline were included.
ADL disability was assessed using Katz index scale, which included six essential ADLs: dressing, bathing, transferring, toileting, continence, and eating. Dependence of each item was scored on a scale of 1, the maximum total score was 6. At baseline, duration of ADL disability was defined as the maximum duration among the six items. The study outcome was overall survival. Accelerated failure time models were constructed to investigate the association between duration of ADL disability and overall survival. Subgroup analyses by sex, age, and multimorbidites, as well as sensitive analyses were conducted.
During 81,868.7 person-years follow-up, 11,092 deaths were recorded. Overall, ADL disability was associated with lower overall survival compared to non-ADL disability. With duration of ADL disability extending, the overall survival strikingly dropped in the first 12 months, reaching its lowest point with adjusted time ratio (TR) at 0.66 (95%CI: 0.61-0.72, p < 0.001), then moderately grew until the 60th month, finally stayed constant thereafter. Participants with ADL scores of 1-3 had higher survival compared to those with scores of 4-6, and both groups followed a similar trend of varied survival to the whole cohort. Moreover, subgroup analyses and sensitivity analyses showed the robustness of these findings.
Our findings first address a golden time window for the older individuals with ADL disability. More attention should be given to them, especially in the first 12 months since diagnosis, to reduce mortality and extend the lifespan.
探讨日常生活活动（ADL）残疾持续时间与老年人总体生存的关系。
前瞻性队列研究。
中国长寿纵向研究的社区基础数据。
共纳入 13560 名无 ADL 残疾的参与者和 2772 名基线时 ADL 残疾的参与者。
ADL 残疾采用 Katz 指数量表评估，包括六项基本 ADL：穿衣、洗澡、转移、如厕、控便和进食。每项依赖程度评分 1 分，总分最高 6 分。基线时，ADL 残疾的持续时间定义为六项中最长的持续时间。研究结果为总生存。构建加速失效时间模型来研究 ADL 残疾持续时间与总体生存之间的关系。进行了性别、年龄和多合并症的亚组分析以及敏感性分析。
在 81868.7 人年的随访中，记录了 11092 例死亡。总体而言，与非 ADL 残疾相比，ADL 残疾与较低的总体生存率相关。随着 ADL 残疾持续时间的延长，在最初的 12 个月内，总体生存率明显下降，调整后的时间比（TR）达到 0.66（95%CI：0.61-0.72，p<0.001），达到最低点，然后适度增长，直到第 60 个月，此后保持不变。ADL 评分为 1-3 的参与者的生存率高于评分为 4-6 的参与者，并且这两组的生存率变化趋势与整个队列相似。此外，亚组分析和敏感性分析表明了这些发现的稳健性。
我们的研究结果首次为 ADL 残疾的老年人确定了一个黄金时间窗口。应该更加关注他们，特别是在诊断后的最初 12 个月内，以降低死亡率并延长寿命。
