Abstract

Objectives

Discordance between self-reported functional limitations and performance-based physical functioning may have a negative impact in functional independence in older adults. We longitudinally examined baseline apathy- and depressive symptomatology as associates of discordance.

Method

469 participants from the multi-site cohort study NESDO were included. Self-reported functional limitations were assessed by two items derived from the WHO-Disability Assessment Schedule. Performance-based physical functioning included walking speed and handgrip-strength. Both measures were rescaled, with final sum-scores ranging from 0 to 6. Discordance-scores were computed by subtracting sum-scores on performance-based measures from self-reported functional limitations. Using latent growth curve analysis, we estimated individual trajectories of discordance at baseline, 2-and 6-years follow-up, consisting of the baseline discordance-score (intercept) and the yearly change of discordance-score (slope). We then estimated associations with apathy and depression indicators.

Results

At baseline, persons (mean age 70.48 years, 65% female, 73% depressed) on average overestimated their daily functioning compared to performance tests (b = 0.77, p < 0.001). The average discordance-scores yearly increased by 0.15 (p < 0.001). Only in models adjusted for several demographic and clinical characteristics, depression severity was negatively associated with discordance-scores at baseline (b=−0.01, p = 0.02), while apathy was not (b=−0.02, p = 0.21). No associations with change over time were found.

Conclusion

In older persons, not indifference and diminished goal-directed activity, but negative emotions appear to underlie underestimation of one’s physical capacity. Further research is needed to determine (1) to what extent targeting discordance results in actual preservation of physical functioning and (2) whether older persons with apathy and/or depression need different approaches for this purpose.

中文翻译：

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老年人身体机能失调的模式；冷漠和抑郁的不同关联？NESDO 研究的结果

摘要

目标

自我报告的功能限制和基于表现的身体功能之间的不一致可能会对老年人的功能独立性产生负面影响。我们纵向检查基线冷漠和抑郁症状作为不和谐的关联。

方法

包括来自多地点队列研究 NESDO 的 469 名参与者。自我报告的功能限制通过来自 WHO-Disability Assessment Schedule 的两个项目进行评估。基于表现的身体机能包括步行速度和握力。这两项措施都进行了重新调整，最终总分从 0 到 6 不等。通过从自我报告的功能限制中减去基于绩效的措施的总分来计算不一致分数。使用潜在增长曲线分析，我们估计了基线、2 年和 6 年随访时的个体不一致轨迹，包括基线不一致分数（截距）和不一致分数的年度变化（斜率）。然后，我们估计了与冷漠和抑郁指标的关联。

结果

在基线时，与性能测试相比，人们（平均年龄 70.48 岁，65% 女性，73% 抑郁）平均高估了他们的日常功能（b  = 0.77，p  < 0.001）。平均不一致分数每年增加 0.15 ( p  < 0.001)。仅在针对若干人口统计学和临床​​特征调整的模型中，抑郁严重程度与基线时的不一致评分呈负相关（b = -0.01，p  = 0.02），而冷漠则不是（b = -0.02，p  = 0.21）。没有发现与时间变化的关联。

结论

在老年人中，不是冷漠和减少以目标为导向的活动，而是负面情绪似乎是低估一个人的身体能力的基础。需要进一步的研究来确定（1）目标不一致在多大程度上导致身体功能的实际保留，以及（2）冷漠和/或抑郁的老年人是否需要为此目的采取不同的方法。