Functional Impairment and Decline in Middle Age.,Annals of Internal Medicine

What is the problem and what is known about it so far?

To live independently, people must be able to do basic activities of daily living (ADLs), such as taking a bath, putting on clothes, or getting out of a chair or bed, without help from another person. The inability to perform ADLs, also known as “functional impairment,” is common in older adults. Studies suggest that functional impairment is also common in middle-aged adults. It is not clear how many middle-aged adults have functional limitations. For those who have problems with ADLs, it is also unclear how long these problems last.

Why did the researchers do this particular study?

To determine the proportion of middle-aged adults in whom a new functional limitation developed and whether the problem got better, got worse, or stayed the same.

Who was studied?

6874 middle-aged adults who were living in the community. These adults did not have problems performing ADLs when they entered the study.

How was the study done?

The study participants were interviewed by telephone at baseline and every 2 years. At each interview, they were asked whether they had any problems doing basic ADLs, and they answered questions about their general health, medical conditions, and health behaviors. The researchers examined how many participants had a new functional impairment during follow-up. For participants in whom impairment developed, the researchers described those whose impairment got better, those whose impairment got worse, and those whose impairment stayed the same.

What did the researchers find?

Difficulty with at least 1 ADL developed in about 1 in 4 participants between the ages of 50 and 64 years. Two years after functional impairment developed, 50% of participants continued to have limitations and 37% recovered. In 9%, the impairment worsened, and 4% died. During 10 years of follow-up, 28% of participants recovered from their initial episode and remained independent, whereas about 20% had further episodes, with worsening functional impairment, and 19% died.

What were the limitations of the study?

The information provided by the participants on their activity limitations was not verified objectively.

What are the implications of the study?

Functional impairment, or difficulty doing basic ADLs, is common during middle age. Of the middle-aged adults in whom a functional limitation developed, some had further impairment or died during follow-up. These findings suggest that functional impairment may not be a short-term problem during middle age.

问题是什么？到目前为止我们知道什么？

为了独立生活，人们必须能够在没有他人帮助的情况下进行基本的日常生活活动 (ADL)，例如洗澡、穿衣服或从椅子或床上起身。无法执行 ADL，也称为“功能障碍”，在老年人中很常见。研究表明，功能障碍在中年人中也很常见。目前尚不清楚有多少中年人有功能限制。对于那些有 ADL 问题的人，也不清楚这些问题会持续多久。

研究是如何进行的？

研究参与者在基线和每 2 年接受一次电话采访。在每次采访中，他们都被问及在进行基本 ADL 方面是否有任何问题，并回答了有关其一般健康状况、医疗状况和健康行为的问题。研究人员在随访期间检查了有多少参与者出现了新的功能障碍。对于出现损伤的参与者，研究人员描述了损伤改善的参与者、损伤恶化的参与者以及损伤保持不变的参与者。

研究人员发现了什么？

在 50 至 64 岁的参与者中，大约有四分之一的人出现至少 1 个 ADL 的困难。功能障碍出现两年后，50% 的参与者继续有限制，37% 的人康复。在 9% 的患者中，损伤恶化，4% 的患者死亡。在 10 年的随访中，28% 的参与者从最初的发作中恢复并保持独立，而约 20% 的参与者进一步发作，功能障碍恶化，19% 的人死亡。