Recovery from disability among community-dwelling older persons.

摘要

CONTEXT: Previous studies have found that a sizeable minority of newly disabled older persons recover independent function; however, long intervals between assessments have led to difficulty in determining the true incidence and duration of disability, and therefore in accurately characterizing the probability and course of recovery. OBJECTIVES: To determine the rate of and time to recovery of independent function in community-dwelling older persons who become newly disabled in their activities of daily living (ADLs), to determine the duration of recovery, and to compare the likelihood of recovery among pertinent subgroups of older persons. DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort study, with monthly assessments of ADL function, for 754 initially nondisabled, community-dwelling persons aged 70 years or older, performed in a small urban area from March 1998 to May 2003. MAIN OUTCOME MEASURES: Demographic features, chronic conditions, cognitive function, and physical frailty were determined during comprehensive assessments at 18-month intervals. Disability, defined as needing personal assistance with 1 or more key ADLs (bathing, dressing, walking, and transferring), was assessed during monthly telephone interviews. RESULTS: A total of 420 participants (56%) experienced disability during a median follow-up of 51 months. Of these participants, 399 (81%) recovered (ie, regained independence in all 4 ADLs) within 12 months of their initial disability episode, and a majority (57%) of these maintained independence for at least 6 months. Among participants who experienced 3 or more consecutive months of disability, a majority (60%) recovered, but only a third of these maintained independence for at least 6 months. Persons who were cognitively impaired, physically frail, or severely disabled (ie, in 3-4 ADLs) at onset were less likely to recover than those who were cognitively intact, nonfrail, or mildly disabled, respectively. Nonetheless, a majority of participants within each subgroup recovered. CONCLUSIONS: Newly disabled older persons recover independent ADL function at rates far exceeding those that have been previously reported. Recovery from disability, however, is often short-lasting, suggesting that additional efforts are warranted to maintain independence in this high-risk group.