Martín Moreno Vicente, Martínez Sanz María Inmaculada, González Irene Sánchez, Vázquez Miguel Recuero, Maroto Sara Guerra, Gallardo Miriam Fernández, Fernández Amanda Martín, Hernando Julia Herranz, Calderón María Palma Benítez, Rico Elena Pérez, Jiménez Laura Calderón, Rodríguez Elena Sánchez, Samperiz Helena Alonso, Saiz Irene León, Marcos Guerra Juana
Orcasitas Health Care Center, Madrid, Spain.
i+12 Research Institute of the Doce de Octubre hospital; GIDO collaborative group codirector, Madrid, Spain.
PLoS One. 2025 May 19;20(5):e0318481. doi: 10.1371/journal.pone.0318481. eCollection 2025.
Functional dependence for the performance of basic activities of daily living (ADLs) is one of the main causes of institutionalization. This study analyzed the interrelationships between basic and instrumental activities of daily living, use of assistive mobility devices, socioeconomic factors, changes during COVID-19 pandemic confinement, and 3-year survival in the ADL-dependent people of the Orcasitas neighborhood of Madrid (Spain).
A longitudinal descriptive study, carried out on the entire population of functional dependent patients (Barthel ≤ 60) in the Orcasitas neighborhood. We included 127 patients, 78.7% women and 21.3% men, with a mean age of 86 years. Pre-pandemic, post-confinement (June 2020) and June 2023 data were contrasted.
Results: The use of crutches-cane was associated with a higher probability of being independent in performing ADLs, leaving home (OR 4.848; CI 1.428-16.458), improving functional capacity during confinement (OR 3.621; CI 1.409-9.308), and even ceasing to be functionally dependent (OR 0.394; CI 0.165-0.941). Using a wheelchair was associated with a higher level of dependency (OR 2.583; CI 1.167-5.714) and higher mortality (HR 1.913; CI 1.106-3.309). After COVID-19 pandemic confinement, having a financial income of less than 11,200 euros/year (OR 2.413; CI 1.159-5.023), or using a wheelchair (OR 2.464; CI 1.009-6.017), increased the risk of living homebound. Living homebound decreased the probability of survival, while maintaining the ability to leave home increased it (OR 3.880; CI 1.834-8.211). Economic capacity modulated the results. Lower economic capacity was associated with higher mortality (HR 2.47 (Exp(B) 0.405; CI 0.232-0.708). Living in confinement and having a low economic income were associated with higher mortality (OR 0.127; CI 0.029-0.562), mortality that was also higher with respect to those who could leave their home (OR 6.697; CI 2.084-21.525).
Functional ADL-dependence affects multiple facets of the person. Confinement triggered changes in the baseline conditions of this cohort, which were influenced by the level of dependency, mobility capacity and economic income level. Economic capacity modulated the results, showing that social inequalities influence survival. The ability to leave home and the use of a wheelchair should be included in the assessment of the risk level of this population group.
日常生活活动（ADL）功能依赖是机构化照护的主要原因之一。本研究分析了马德里（西班牙）奥卡西塔斯社区日常生活基本活动与工具性活动、辅助移动设备的使用、社会经济因素、新冠疫情封锁期间的变化以及ADL依赖人群的3年生存率之间的相互关系。
对奥卡西塔斯社区所有功能依赖患者（巴氏指数≤60）进行纵向描述性研究。我们纳入了127例患者，其中女性占78.7%，男性占21.3%，平均年龄为86岁。对比了疫情前、封锁后（2020年6月）和2023年6月的数据。
结果显示：使用拐杖或手杖与ADL独立完成、离家外出的可能性更高相关（比值比4.848；可信区间1.428 - 16.458），在封锁期间功能能力改善相关（比值比3.621；可信区间1.409 - 9.308），甚至与不再处于功能依赖状态相关（比值比0.394；可信区间0.165 - 0.941）。使用轮椅与更高水平的依赖相关（比值比2.583；可信区间1.167 - 5.714）以及更高的死亡率相关（风险比1.913；可信区间1.106 - 3.309）。新冠疫情封锁后，年收入低于11200欧元（比值比2.413；可信区间1.159 - 5.023），或使用轮椅（比值比2.464；可信区间1.009 - 6.017），会增加居家不出的风险。居家不出会降低生存概率，而保持离家外出能力则会增加生存概率（比值比3.880；可信区间1.834 - 8.211）。经济能力调节了结果。较低的经济能力与较高的死亡率相关（风险比2.47（指数B 0.405；可信区间0.232 - 0.708）。处于封锁状态且经济收入低与较高的死亡率相关（比值比0.127；可信区间0.029 - 0.562），相对于能够离家外出的人，死亡率也更高（比值比6.697；可信区间2.084 - 21.525）。
ADL功能依赖会影响人的多个方面。封锁引发了该队列基线状况的变化，这些变化受到依赖程度、移动能力和经济收入水平的影响。经济能力调节了结果，表明社会不平等会影响生存。离家外出能力和轮椅的使用应纳入该人群风险水平的评估中。
