Hébert R, Brayne C, Spiegelhalter D
Gerontology and Geriatrics Research Centre, Sherbrooke Geriatric University Institute, Québec, Canada.
Am J Epidemiol. 1997 May 15;145(10):935-44. doi: 10.1093/oxfordjournals.aje.a009053.
With the aging of the population, functional decline is one of the major challenges to health care systems. The objective of this study was to estimate the incidence of functional decline and improvement in a community-dwelling population of people aged 75 years and above. A representative sample of elderly people living at home in the city of Sherbrooke (Québec, Canada) was assessed yearly on three occasions (1991-1993) by a nurse. Disabilities were measured by the Functional Autonomy Measurement System, a 29-item rating scale developed according to the World Health Organization classification of disabilities. From the 655 subjects who agreed to participate, a total of 572 subjects completed the study, including 68 who subsequently died. The probability of declining was 20.1% for the first year and 12.4% for the second year. The incidence of functional decline among previously stable subjects was 11.9% (95% confidence interval (CI) 8.9-15.9). Age was strongly related to decline (relative risk (RR) = 1.15/year, 95% CI 1.09-1.21), but there was no significant sex effect (RRmale = 0.88, 95% CI 0.55-1.39). The incidence of improvement among previously disabled subjects was estimated at 7.5% (95% CI 5.1-10.9) for the first year and 17.9% (95% CI 14.0-23.0) for the second year. Neither age (RR = 1.07, 95% CI 0.99-1.15) nor sex (RRmale = 1.70, 95% CI 0.90-3.18) was significantly associated with the probability of improving. This study stresses the importance of precise measurement of disabilities and the complex and dynamic process of functional transitions.
随着人口老龄化，功能衰退是医疗保健系统面临的主要挑战之一。本研究的目的是估计75岁及以上社区居住人群中功能衰退和改善的发生率。对加拿大魁北克省舍布鲁克市居家生活的老年人进行了具有代表性的抽样，并由一名护士在1991年至1993年期间每年进行三次评估。残疾情况通过功能自主测量系统进行测量，这是一个根据世界卫生组织残疾分类制定的包含29个条目的评定量表。在655名同意参与的受试者中，共有572名受试者完成了研究，其中68名随后死亡。第一年功能衰退的概率为20.1%，第二年为12.4%。先前功能稳定的受试者中功能衰退的发生率为11.9%（95%置信区间（CI）8.9 - 15.9）。年龄与功能衰退密切相关（相对风险（RR）= 1.15/年，95% CI 1.09 - 1.21），但性别没有显著影响（男性RR = 0.88，95% CI 0.55 - 1.39）。先前残疾的受试者中，第一年改善的发生率估计为7.5%（95% CI 5.1 - 10.9），第二年为17.9%（95% CI 14.0 - 23.0）。年龄（RR = 1.07，95% CI 0.99 - 1.15）和性别（男性RR = 1.70，95% CI 0.90 - 3.18）均与改善的概率无显著关联。本研究强调了精确测量残疾以及功能转变的复杂动态过程的重要性。
