OBJECTIVES Focus on decline in performance of activities of daily living (ADL) has not been matched by studies of recovery of function. Advised by a broad conceptual model of physical resilience, we ascertain characteristics that identify (1) maintenance, (2) decline, and (3) recovery of personal self-maintenance activities over six years in an older, community representative, African American and white sample. DESIGN Longitudinal study, analyses included descriptive statistics and repeated measures proportional hazards. SETTING/PARTICIPANTS Community-representative participants of the Duke Established Populations for Epidemiologic Studies of the Elderly (EPESE), unimpaired at baseline (n = 3187; 46% white, 54% African American; 64% female, 36% male), followed annually for up to 6 years. MEASURES Data included information on basic activities of daily living (BADL), demographic characteristics, health status, social services provided and received, household size, neighborhood safety, and survival status. RESULTS Over 6 years, ∼75% remained unimpaired, of whom 30% were unimpaired when they dropped out or died. Of ∼25% who became impaired, just under half recovered. Controlled analyses indicated that those who became impaired were in poorer health, younger, and more likely to be African American. Characteristics of recovery included younger age, not hospitalized in the previous year, and larger household size. CONCLUSIONS/IMPLICATIONS Maintenance of health status facilitated continued unimpaired BADL. While decline was associated with poorer health, younger age, and being African American, recovery was also associated with younger age, together with larger household size, and no further deterioration in health as measured here. Maintenance of good health is preferred, but following decline in functioning, increased effort to improve health and avoid further decline, which takes into account not only physical but also personal social conditions, is needed.

中文翻译：

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具有代表性的老年社区居民双种族样本中功能维持和恢复的决定因素

目标 关注日常生活活动能力 (ADL) 的下降与功能恢复的研究并不相符。在广泛的身体恢复力概念模型的建议下，我们确定了识别（1）维持，（2）衰退和（3）在老年人、社区代表、非裔美国人和白人中恢复个人自我维持活动超过六年的特征样本。设计 纵向研究，分析包括描述性统计和重复测量比例风险。设置/参与者 杜克大学的社区代表参与者建立了老年人流行病学研究人群 (EPESE)，基线时未受损（n = 3187；46% 白人，54% 非裔美国人；64% 女性，36% 男性），每年进行随访长达 6 年。措施 数据包括关于日常生活的基本活动 (BADL)、人口特征、健康状况、提供和接受的社会服务、家庭规模、邻里安全和生存状况的信息。结果 6 年中，约 75% 的人保持健康，其中 30% 的人在辍学或死亡时未受损。在约 25% 的受损患者中，只有不到一半康复。受控分析表明，那些受损的人健康状况更差、更年轻，而且更有可能是非裔美国人。康复的特征包括年龄较小、前一年未住院以及家庭规模较大。结论/影响 保持健康状态有助于持续未受损的 BADL。虽然下降与健康状况较差、年龄较小和成为非裔美国人有关，恢复还与年龄较小、家庭规模较大以及此处衡量的健康状况没有进一步恶化有关。保持良好的健康是首选，但在功能下降之后，需要加大努力改善健康并避免进一步下降，这不仅考虑到身体状况，还考虑到个人社会条件。