Ferrucci L, Guralnik J M, Simonsick E, Salive M E, Corti C, Langlois J
Geriatric department I Fracticini, National Research Institute (INRCA), Florence, Italy.
J Gerontol A Biol Sci Med Sci. 1996 May;51(3):M123-30. doi: 10.1093/gerona/51a.3.m123.
There is little epidemiologic data on the development of disability over time in older persons. This study uses prospective data from cohorts followed annually for 6 to 7 years to identify persons who developed severe disability and to characterize the time course of their disabling process and subsequent mortality.
Incidence rates of severe disability, defined as need for help in three or more activities of daily living (ADLs), were estimated for 6,640 persons who had not reported severe disability at baseline and at the first four annual follow-up visits. Among persons developing severe disability, those who reported no need for help in ADLs in previous interviews were defined as cases of catastrophic disability, and those who had previously reported some disability in ADLs were defined as cases of progressive disability.
Overall, 212 subjects developed progressive and 227 developed catastrophic disability. The rates of progressive disability and catastrophic disability were 11.3 and 12.1 cases per 1,000 person-years, respectively. For both types of disability, incidence rates increased exponentially with age, but the increase was steeper for progressive disability. At ages 70-74, less than 25% of severe disability was progressive, while over age 85 progressive disability represented more than half of severe disability. Incidence rates of total and both types of severe disability were similar in men and women. Mortality after severe disability onset was extremely high. Survival was unrelated to age at disability onset and type of disability but was significantly longer in women than in men (median 3.44 vs 2.12 years; p < .0001).
Tracking the development of disability provides new and important insights into the disability experience in older men and women that are potentially relevant in planning preventive, intervention, and long-term care strategies.
关于老年人残疾随时间发展的流行病学数据很少。本研究使用对队列进行每年一次随访，持续6至7年的前瞻性数据，以确定出现严重残疾的人群，并描述其致残过程及随后死亡的时间进程。
对6640名在基线及前四次年度随访时未报告严重残疾的人群，估计严重残疾（定义为在三项或更多日常生活活动（ADL）中需要帮助）的发病率。在出现严重残疾的人群中，那些在之前访谈中报告在ADL中不需要帮助的被定义为灾难性残疾病例，而那些之前报告在ADL中有一些残疾的被定义为渐进性残疾病例。
总体而言，212名受试者出现渐进性残疾，227名出现灾难性残疾。渐进性残疾和灾难性残疾的发病率分别为每1000人年11.3例和12.1例。对于这两种类型的残疾，发病率均随年龄呈指数增长，但渐进性残疾的增长更为陡峭。在70 - 74岁年龄段，严重残疾中不到25%是渐进性的，而85岁以上时，渐进性残疾占严重残疾的一半以上。男性和女性的总严重残疾以及两种类型严重残疾的发病率相似。严重残疾发病后的死亡率极高。生存与残疾发病时的年龄和残疾类型无关，但女性的生存期明显长于男性（中位数3.44年对2.12年；p < 0.0001）。
追踪残疾的发展为老年男性和女性的残疾经历提供了新的重要见解，这在规划预防、干预和长期护理策略方面可能具有相关性。
