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Study looks at events that lead to disability among the elderly
Illnesses and injuries leading to either hospitalization or restricted activity are strongly associated with the
development of disability for older persons living in the community, regardless of their physical condition, according to a
study in the November 3 issue of JAMA.
The authors provide as background information that while the prevalence of disability is decreasing, there are currently more
than 7 million chronically disabled individuals aged 65 years or older in the United States. "Disability is associated with
increased mortality and leads to additional adverse outcomes, such as nursing home placement and greater use of formal and
informal home services, all of which place a substantial burden on older persons, informal caregivers, and health care
resources. In the aggregate, the additional cost of medical and long-term care for newly disabled U.S. elderly individuals is
estimated to be $26 billion per year."
Thomas M. Gill, M.D., and colleagues from Yale University School of Medicine, New Haven, Conn., assessed 754 people aged 70
years or older, who were not disabled (not requiring personal assistance) in four essential activities of daily living:
bathing, dressing, walking inside the house, and transferring from a chair. Participants were categorized into 2 groups
according to the presence of physical frailty and were followed up with monthly telephone interviews for up to 5 years to
determine exposure to intervening events (illnesses or injuries) and the occurrence of disability.
"During the 5-year follow-up period, disability developed among 417 (55.3 percent) participants, 372 (49.3 percent) were
hospitalized and 600 (79.6 percent) had at least one episode of restricted activity," the authors found. "… participants who
developed disability were significantly more likely to have been hospitalized or to have had restricted activity than those
who did not develop disability."
"In absolute terms, illnesses and injuries leading to hospitalization accounted for about 50 percent to 80 percent of the
disability outcomes. Another 5 percent to 19 percent of the disability outcomes were attributable to illnesses and injuries
leading to restricted activity but not to hospitalization. Depending on the specific disability outcome, the risk of
disability was elevated more than 5-fold in the setting of restricted activity." The authors add that "falls and fall-related
injuries resulting in hospitalization or restricted activity conferred the highest risk of disability…"
"The results of the current study highlight the importance of intervening events as a potential target for the prevention of
disability, regardless of the presence of physical frailty," the authors write. "In the setting of an acute illness or injury
leading to hospitalization, functional outcomes are improved by management of older persons on specialized inpatient services
and, posthospitalization, by highly coordinated gerocentric care provided in the home."
(JAMA. 2004;292:2115-2124. Available post-embargo at http://www.jama.com)
Editor's Note: The work for this article was funded by a grant from the National Institute on Aging and grants from the
Robert Wood Johnson Foundation, Paul Beeson Physician Faculty Scholar in Aging Research Program, and Patrick and Catherine
Weldon Donaghue Medical Research Foundation. The study was conducted at the Yale Claude D. Pepper Older Americans
Independence Center. Dr. Gill is the recipient of a Midcareer Investigator Award in Patient-Oriented Research from the
National Institute on Aging.
Contact: Karen Peart
203-432-1326
JAMA and Archives Journals Website
Studiul se uitã la evenimente care conduc la invaliditate în rândul persoanelor în vârstã - Study looks at events that lead to disability among the elderly - articole medicale engleza - startsanatate