Am J Epidemiol 2003; 158:1090-1096.
Copyright © 2003 by the Johns
Hopkins Bloomberg School of Public Health
ORIGINAL CONTRIBUTIONS |
Prognostic Effect of Prior Disability Episodes among Nondisabled Community-living Older Persons
1 Department of Internal Medicine, Yale University School of Medicine, New Haven, CT.
2 National Alzheimer’s Coordinating Center, University of Washington School of Public Health and Community Medicine, Seattle, WA.
The objective of this prospective cohort study, conducted in 1998–2002 in New Haven, Connecticut, was to determine the prognostic effect of prior episodes of disability. The analytical sample included 580 community-living persons aged 71 years or older who were nondisabled during an 18-month face-to-face assessment (i.e., zero-time). During monthly telephone interviews, participants were assessed for disability in activities of daily living. The primary explanatory variable was a history of disability in the year prior to zero-time as determined from the monthly interviews. The primary outcome was time to onset of disability over a 3-year period subsequent to zero-time. In Cox proportional hazards analyses that adjusted for several potential confounders, a prior history of disability was found to be significantly associated with development of any disability (i.e., 
1 month) and persistent disability (i.e., 2 months); hazard ratios were 2.0 (95% confidence interval: 1.4, 2.7) and 2.0 (95% confidence interval: 1.3, 2.9), respectively. These strong associations were maintained after participants who had a prior history of chronic disability were excluded. Results demonstrate the long-term, deleterious effect of short-term disability among community-living older persons. More frequent assessments of functional status may be warranted in epidemiologic studies and clinical trials when disability is a primary focus.
activities of daily living; aged; cohort studies; disability evaluation
Abbreviations: Abbreviations: ADL, activities of daily living; CI, confidence interval.
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