Abstract

Background

Although disability is often precipitated by an illness/injury, it may arise insidiously. Our objectives were to identify the factors associated with the development of insidious and noninsidious disability and to determine whether these risk factors differ between the two types of disability.

Methods

We prospectively evaluated 754 community-living persons, 70+ years, from 1998 to 2016. The unit of analysis was an 18-month person-interval, with risk factors assessed at the start of each interval. Disability in four activities of daily living and exposure to intervening events, defined as illnesses/injuries leading to hospitalization, emergency department visits, or restricted activity, were assessed each month. Insidious and noninsidious disability were defined based on the absence and presence of an intervening event.

Results

The rate of noninsidious disability (21.7%) was twice that of insidious disability (10.8%). In multivariable recurrent-event Cox analyses, six factors were associated with both disability outcomes: non-Hispanic white race, lower extremity muscle weakness, poor manual dexterity, and (most strongly) frailty, cognitive impairment, and low functional self-efficacy. Three factors were associated with only noninsidious disability (older age, number of chronic conditions, and depressive symptoms), whereas four were associated with only insidious disability (female sex, lives with others, low SPPB score, and upper extremity weakness). The modest differences in risk factors identified for the two outcomes in multivariable analyses were less apparent in the bivariate analyses.

Conclusions

Although arising from different mechanisms, insidious and noninsidious disability share a similar set of risk factors. Interventions to prevent disability should prioritize this shared set of risk factors.

中文翻译：

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与隐匿性和非隐匿性残疾相关的因素。

摘要

背景

虽然残疾通常是由疾病/伤害引起的，但它也可能在不知不觉中发生。我们的目标是确定与隐匿性和非隐匿性残疾发展相关的因素，并确定这些风险因素在两种类型的残疾之间是否存在差异。

方法

我们前瞻性地评估了 1998 年至 2016 年 70 岁以上的 754 名社区居民。分析单位是 18 个月的人间隔，在每个间隔开始时评估风险因素。每月评估四项日常生活活动的残疾和接触干预事件，定义为导致住院、急诊就诊或活动受限的疾病/伤害。隐匿性和非隐匿性残疾是根据干预事件的不存在和存在来定义的。

结果

非隐匿性残疾率 (21.7%) 是隐匿性残疾 (10.8%) 的两倍。在多变量复发事件 Cox 分析中，有六个因素与两种残疾结果相关：非西班牙裔白人种族、下肢肌肉无力、手部灵活性差，以及（最强烈）虚弱、认知障碍和低功能自我效能感。三个因素仅与非隐匿性残疾有关（年龄较大、慢性病的数量和抑郁症状），而四个仅与隐匿性残疾有关（女性、与他人同住、SPPB 评分低和上肢无力）。在多变量分析中为两种结果确定的风险因素的适度差异在双变量分析中不太明显。

结论

尽管产生于不同的机制，隐匿性和非隐匿性残疾共享一组相似的风险因素。预防残疾的干预措施应优先考虑这组共同的风险因素。