Hughes S, Gibbs J, Dunlop D, Edelman P, Singer R, Chang R W
Prevention Research Center, School of Public Health, University of Illinois at Chicago 60607-3025, USA.
J Am Geriatr Soc. 1997 Aug;45(8):905-10. doi: 10.1111/j.1532-5415.1997.tb02957.x.
To determine factors that predict decline in manual performance using a multivariate model of determinants of functional limitation.
Longitudinal observational study.
Ambulatory general medicine clinics, residences of homebound individuals, and a continuing care retirement community.
Subjects were 485 persons more than 60 years of age and included continuing care retirement community (CCRC) residents (n = 215), chronically homebound older persons (n = 65), and ambulatory older adults (n = 205). Mean age at baseline was 78 years.
Independent variables included demographics, physician measures of upper-extremity joint impairment, comorbidities derived from physical examination and chart abstract, self-assessed arthritis pain, depression, and anxiety. The major dependent variable was 2-year decline in timed manual performance below a threshold associated with need for long-term care services.
The proportion of subjects who exceed a Timed Manual Performance Test threshold of 350 seconds increased slowly from baseline through Year 4 for all age groups but rose rapidly from Year 4 to Year 6 for the oldest group (> 85 years at baseline). Using a discrete survival model, we found that age, education, grip strength, and psychological status predicted crossing the manual performance threshold within a 2-year period.
The findings, coupled with earlier findings that upper extremity joint impairment predicted both grip strength and manual performance, suggest that joint impairment may be an important risk factor for future functional limitation. Since diminished hand function has been shown to predict dependency, development and testing of interventions to maintain or restore upper extremity joint function and reduce pain would appear to be a high research priority.
使用功能受限决定因素的多变量模型来确定预测手动操作能力下降的因素。
纵向观察性研究。
门诊普通内科诊所、居家个体住所和持续护理退休社区。
485名年龄超过60岁的受试者，包括持续护理退休社区（CCRC）居民（n = 215）、长期居家老年人（n = 65）和门诊老年成年人（n = 205）。基线时的平均年龄为78岁。
自变量包括人口统计学特征、医生对上肢关节损伤的评估、体格检查和病历摘要得出的合并症、自我评估的关节炎疼痛、抑郁和焦虑。主要因变量是定时手动操作能力在2年内下降至与长期护理服务需求相关的阈值以下。
所有年龄组中，超过定时手动操作测试阈值350秒的受试者比例从基线到第4年缓慢增加，但最年长组（基线时> 85岁）从第4年到第6年迅速上升。使用离散生存模型，我们发现年龄、教育程度、握力和心理状态可预测在2年内超过手动操作阈值。
这些发现，再加上早期关于上肢关节损伤可预测握力和手动操作能力的发现，表明关节损伤可能是未来功能受限的重要危险因素。由于手部功能下降已被证明可预测依赖性，因此开发和测试维持或恢复上肢关节功能并减轻疼痛的干预措施似乎是一项高度优先的研究任务。
