OBJECTIVES: To evaluate the prognostic effect of changes in physical function at different intervals over the prior year on subsequent outcomes after accounting for present function. DESIGN: Prospective longitudinal study. SETTING: Greater New Haven, Connecticut, from March 1998 to January 2006. PARTICIPANTS: Community-living persons aged 71 and older who completed an 18-month comprehensive assessment (N=658). MEASUREMENTS: Disability in 13 activities of daily living, instrumental activities of daily living, and mobility activities was assessed at the 18-month comprehensive assessment and at 12, 6, and 3 months before 18 months. Time to death and long-term nursing home admission, defined as 3 months and longer, were ascertained for up to 5 years after 18 months. RESULTS: In the bivariate models, disability at 18 months and change in disability between 18 months and each of the 3 prior time-points (12, 6, 3 months) were significantly associated with time to death. The risk of death, for example, increased by 24% for each 1-point increase in 18-month disability score (on a scale from 0 to 13) and by 22% for each 1-point change in disability score between 18 months and prior 12 months (on a scale from -13 to 13). In a set of multivariable models with and without covariates, the associations were maintained for 18-month disability but not for change in disability between 18 months and each of the 3 prior time-points. The results were comparable for time to long-term nursing home admission except that 2 of the associations were not statistically significant. CONCLUSION: When evaluating risk of adverse outcomes, such as death and long-term nursing home admission, an assessment of change in physical function at different intervals over the prior year, although a strong bivariate predictor, did not provide useful prognostic information beyond that available from current level of function.
OBJECTIVES: To evaluate the prognostic effect of changes in physical function at different intervals over the prior year on subsequent outcomes after accounting for present function. DESIGN: Prospective longitudinal study. SETTING: Greater New Haven, Connecticut, from March 1998 to January 2006. PARTICIPANTS: Community-living persons aged 71 and older who completed an 18-month comprehensive assessment (N=658). MEASUREMENTS: Disability in 13 activities of daily living, instrumental activities of daily living, and mobility activities was assessed at the 18-month comprehensive assessment and at 12, 6, and 3 months before 18 months. Time to death and long-term nursing home admission, defined as 3 months and longer, were ascertained for up to 5 years after 18 months. RESULTS: In the bivariate models, disability at 18 months and change in disability between 18 months and each of the 3 prior time-points (12, 6, 3 months) were significantly associated with time to death. The risk of death, for example, increased by 24% for each 1-point increase in 18-month disability score (on a scale from 0 to 13) and by 22% for each 1-point change in disability score between 18 months and prior 12 months (on a scale from -13 to 13). In a set of multivariable models with and without covariates, the associations were maintained for 18-month disability but not for change in disability between 18 months and each of the 3 prior time-points. The results were comparable for time to long-term nursing home admission except that 2 of the associations were not statistically significant. CONCLUSION: When evaluating risk of adverse outcomes, such as death and long-term nursing home admission, an assessment of change in physical function at different intervals over the prior year, although a strong bivariate predictor, did not provide useful prognostic information beyond that available from current level of function.
Authors: Thomas M Gill; Evelyne A Gahbauer; Terrence E Murphy; Ling Han; Heather G Allore Journal: Ann Intern Med Date: 2012-01-17 Impact factor: 25.391
Authors: Allison M Gustavson; Michelle R Rauzi; Molly J Lahn; Hillari S N Olson; Melissa Ludescher; Stephanie Bazal; Elizabeth Roddy; Christine Interrante; Estee Berg; Jennifer P Wisdom; Howard A Fink Journal: Int J Telerehabil Date: 2021-06-22