Guralnik J M, LaCroix A Z, Abbott R D, Berkman L F, Satterfield S, Evans D A, Wallace R B
Epidemiology, Demography, and Biometry Program, National Institute on Aging, Bethesda, MD 20892.
Am J Epidemiol. 1993 Apr 15;137(8):845-57. doi: 10.1093/oxfordjournals.aje.a116746.
To assess the role of demographic factors and chronic conditions in maintaining mobility in older persons, this study utilized longitudinal data collected as part of the Established Populations for Epidemiologic Studies of the Elderly between 1981 and 1987 on 6,981 men and women aged 65 years and older in East Boston, Massachusetts; Iowa and Washington counties, Iowa; and New Haven, Connecticut. Results are presented for those who at baseline reported intact mobility, defined as the ability to climb stairs and walk a half mile without help, and who were followed annually for up to 4 years for changes in mobility status. Age, income, education, and chronic conditions present at baseline and occurring during follow-up were evaluated for their association with loss of mobility. Over the follow-up period, 55.1% of subjects maintained mobility, 36.2% lost mobility, and 8.7% died without evidence of mobility loss prior to death. In both men and women, increasing age and lower income levels were associated with increased risk of losing mobility, even after controlling for the presence of chronic conditions at baseline. After adjustment for age, income, and chronic conditions, lower education levels were a significant risk factor for mobility loss in men, but not in women. Baseline reports of previous heart attack, stroke, high blood pressure, diabetes, dyspnea, and exertional leg pain were associated with small but significant risks for mobility loss. There was a stepwise increase in the risk of mobility loss according to the number of chronic conditions present at baseline that was very consistent between men and women. The occurrence during the study of a new heart attack, stroke, cancer, or hip fracture was associated with a substantially greater risk of mobility loss than was associated with the presence of these conditions at baseline.
为评估人口统计学因素和慢性病在维持老年人活动能力方面的作用，本研究利用了作为老年人流行病学研究既定人群的一部分所收集的纵向数据，这些数据来自1981年至1987年期间马萨诸塞州东波士顿、爱荷华州爱荷华县和华盛顿县以及康涅狄格州纽黑文的6981名65岁及以上的男性和女性。研究结果呈现给那些在基线时报告活动能力完好的人，活动能力完好定义为能够在无帮助的情况下爬楼梯和行走半英里，并且对其每年随访长达4年以观察活动能力状态的变化。评估了基线时以及随访期间出现的年龄、收入、教育程度和慢性病与活动能力丧失之间的关联。在随访期间，55.1%的受试者维持了活动能力，36.2%丧失了活动能力，8.7%在死亡前没有活动能力丧失的证据。在男性和女性中，即使在控制了基线时存在的慢性病之后，年龄增长和收入水平较低也与活动能力丧失风险增加相关。在调整年龄、收入和慢性病因素后，较低的教育水平是男性活动能力丧失的一个重要风险因素，但在女性中并非如此。既往心脏病发作、中风、高血压、糖尿病、呼吸困难和运动性腿痛的基线报告与活动能力丧失的小但显著风险相关。根据基线时存在的慢性病数量，活动能力丧失风险呈逐步增加，男性和女性之间非常一致。在研究期间新发心脏病发作、中风、癌症或髋部骨折与活动能力丧失风险显著增加相关，这种风险比基线时存在这些疾病所带来的风险要大得多。
