Injuries, Sickness
Greatly Increase Likelihood of Senior Citizens Becoming More Disabled
Disabled senior
Americans could increase substantially with aging of baby boomers; more
aggressive efforts needed to prevent and manage illnesses and injuries
Nov. 3, 2010 -
In a study examining the factors that play a role in an older adult's
transition to disability, intervening illnesses and injuries that led to
hospitalization or activity restriction were associated with worsening
functional ability, especially among those who were physically frail,
according to a study in todays issue of the Journal of the American
Medical Association (JAMA), a theme issue on aging.
Thomas M. Gill,
M.D., of the Yale University School of Medicine, New Haven, Conn.,
presented the findings of the study at a JAMA media briefing at the
National Press Club.
Among older
persons, disability in essential activities of daily living, such as
bathing, dressing, and walking, is common and associated with an
increased rate of death, institutionalization, and greater use of formal
and informal home services. However, many older persons also recover
from disabilities.
'Health care overhaul creates a three-year Medicare
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Most of today's primary care physicians are not
adequately trained to provide the complex care needed by older adults
with multiple chronic conditions
"Disability
among older persons is a complex and highly dynamic process with high
rates of recovery and frequent transitions between states of disability.
The role of intervening illnesses and injuries (i.e., events) on these
transitions is uncertain," according to background on the study
explained in the article.
Dr. Gill and
colleagues conducted a study to evaluate the association of intervening
events with transitions between states of no disability, mild
disability, severe disability, and death, and to determine the
association of physical frailty with these transitions.
The study,
conducted from March 1998 to December 2008, included 754
community-living persons ages 70 years or older who were nondisabled at
the beginning of the study in 4 essential activities of daily living:
bathing, dressing, walking, and getting out of a chair. Of these
participants, 117 (15.5 percent) remained nondisabled and alive through
the end of follow-up and therefore made no transitions during a median
(midpoint) follow-up of about 10 years.
Telephone
interviews were completed monthly for more than 10 years to assess
disability and to determine exposure to intervening events, which
included illnesses and injuries leading to either hospitalization or
restricted activity.
Participants
were assessed for physical frailty (with a rapid gait test) every 18
months, through 9 years. The primary outcomes measured included
transitions between no disability, mild disability, and severe
disability and 3 transitions from each of these states to death,
evaluated each month.
The researchers
found that among the 637 participants who had at least 1 functional
transition, 578 (90.7 percent) had at least 1 hospital admission and 601
(94.3 percent) had at least 1 month of restricted activity during a
median follow-up of 8.5 years. Hospitalization was associated with
disability for 8 of the 9 transitions (the ninth being severe disability
to no disability).
"Restricted
activity increased the likelihood of transitioning from no disability to
both mild and severe disability, respectively, and from mild disability
to severe disability, but was not associated with recovery from mild or
severe disability," the authors write.
Overall, the
association of hospitalization with the disability transitions was much
more pronounced than the association of restricted activity with
disability transitions.
The researchers
add that regardless of intervening event, the absolute risk of
transitions to new or worsening disability or death was consistently
higher in participants with frailty, while transitions representing
functional recovery were consistently more likely in those who were not
frail.
"For example,
the write, the absolute risk of transitioning from no disability to
mild disability within 1 month after hospitalization for frail
individuals was 34.9 percent vs. 4.9 percent for non-frail individuals."
Among the
possible reasons for hospitalization or restricted activity,
fall-related injury conferred the highest likelihood of developing new
or worsening disability.
"Despite the
reductions observed in the prevalence of disability over the past 2
decades, the absolute number of disabled older Americans could increase
substantially in the coming years with the aging of the baby boom
generation. To obviate this increase, more aggressive efforts will be
needed to prevent and manage intervening illnesses and injuries, given
their apparent role in precipitating and perpetuating the disabling
process," the authors conclude.
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Nov. 3, 2010 -
In a study examining the factors that play a role in an older adult's
transition to disability, intervening illnesses and injuries that led to
hospitalization or activity restriction were associated with worsening
functional ability, especially among those who were physically frail,
according to a study in todays issue of the Journal of the American
Medical Association (JAMA), a theme issue on aging. 
