Sonn U
Department of Rehabilitation Medicine Göteborg University, Sweden.
Scand J Rehabil Med Suppl. 1996;34:1-35.
Ability in activities of daily living (ADL), use of assistive devices, and relation to functional limitations and impairments were studied among persons between 70 and 76 years of age within the Inter-Vention study of Elderly in Göteborg (IVEG) Sweden. An ADL index was developed including instrumental activities (I-ADLs) (cleaning, shopping, transportation and cooking), which was combined with Katz' Index of personal daily life activities (P-ADLs) (bathing, dressing, going to the toilet, transfer, continence and feeding). Independence of and dependence on assistance from another person was assessed and it was possible to classify performance according to an ordinal scale of ADL-steps. The reliability and validity of the scale were tested in an out-patient sample (n = 85) as well as in a population of 76-year-olds (n = 659) and were found to be sufficient (coefficients of reproducibility and scalability, internal consistency, inter- observer reliability, content, construct, and criterion validity). The "Staircase of ADL" can be used for observation and documentation of different levels of ability/disability for individuals, groups and for population studies. Most persons (83%) were independent in all activities at age 70 (n = 617). Among survivors followed longitudinally, the incidence of disability was 8% between 70 and 73 and 26% between 73 and 76 years of age. Dependence at age 70 could predict mortality as well as institutionalization. No sex differences were found in the proportion with overall disability. Assistance given by relatives dominated both at 70, 73 and 76 years of age. One fifth at age 70 and almost half of the population at age 76 used assistive devices (AD) in daily life activities, and the use was more frequent in women (52%) than men (37%) at age 76 (n = 595). During the studied age interval, 39% "new users" were found, while 22% were "temporary users". The usage rate was high and the effectiveness of ADs increased the person's ability to master the situation, especially evident as increased safety and reduction of effort in activities of daily living, implying a reduced degree of handicap. Physical impairments and functional limitations had a considerable impact on dependence in daily life activities as persons dependent in ADL had lower maximal walking speed, grip strength, knee extensor strength, stair-climbing capacity and forward reach than those who were independent in ADL (n = 602). Walking speed in both women and men and sight impairment in men had the greatest influence on dependence in ADL. Women and men who stayed independent over the period (70-76) had significantly higher maximal walking speed and knee extensor strength at the age of 70 than those who became dependent or were dependent on both occasions.
在瑞典哥德堡老年人干预研究（IVEG）中，对70至76岁人群的日常生活活动（ADL）能力、辅助设备的使用以及与功能限制和损伤的关系进行了研究。开发了一个ADL指数，包括工具性活动（I-ADL）（清洁、购物、交通和烹饪），并将其与卡茨个人日常生活活动指数（P-ADL）（洗澡、穿衣、上厕所、转移、大小便控制和进食）相结合。评估了对他人帮助的独立性和依赖性，并能够根据ADL步骤的有序量表对表现进行分类。该量表的信度和效度在门诊样本（n = 85）以及76岁人群（n = 659）中进行了测试，发现是足够的（再现性和可扩展性系数、内部一致性、观察者间信度、内容、结构和标准效度）。“ADL阶梯”可用于观察和记录个体、群体以及人群研究中不同能力/残疾水平。大多数人（83%）在70岁时（n = 617）在所有活动中都能独立。在纵向随访的幸存者中，70至73岁之间残疾发生率为8%，73至76岁之间为26%。70岁时的依赖性可预测死亡率以及入住机构的情况。在总体残疾比例方面未发现性别差异。亲属提供的帮助在70岁、73岁和76岁时都占主导地位。70岁时有五分之一的人以及76岁时几乎一半的人群在日常生活活动中使用辅助设备（AD），76岁时女性（52%）使用辅助设备的频率高于男性（37%）（n = 595）。在研究的年龄区间内，发现39%为“新用户”，而22%为“临时用户”。使用率很高，辅助设备的有效性提高了个人应对情况的能力，尤其明显的是在日常生活活动中提高了安全性并减少了努力程度，这意味着残疾程度降低。身体损伤和功能限制对日常生活活动中的依赖性有相当大的影响，因为依赖ADL的人比独立于ADL的人（n = 602）最大步行速度、握力、膝关节伸展力量、爬楼梯能力和前伸距离更低。男性和女性的步行速度以及男性的视力损伤对ADL依赖性影响最大。在该时间段（70 - 76岁）保持独立的男性和女性在70岁时的最大步行速度和膝关节伸展力量明显高于那些变得依赖或在两个时间点都依赖的人。
