All-cause 1-, 5-, and 10-year Mortality in Elderly People According to Activities of Daily Living Stage

Overview

Journal J Am Geriatr Soc

Specialty Geriatrics

Date 2012 Feb 23

PMID 22352414

Citations 69

Authors

Margaret G Stineman

Dawei Xie

Qiang Pan

Jibby E Kurichi

Zi Zhang

Debra Saliba

John T Henry-Sanchez

Joel Streim

Affiliations

Soon will be listed here.

Abstract

Objectives: To examine the independent association between five stages of activities of daily living (ADLs) and mortality after accounting for known diagnostic and sociodemographic risk factors.

Design: For five stages of ADLs (0 to IV), determined according to the severity and pattern of ADL limitations, unadjusted life expectancies and adjusted associations with mortality were estimated using a Cox proportional hazards regression model.

Setting: Community.

Participants: Nine thousand four hundred forty-seven participants aged 70 and older from the second Longitudinal Study of Aging.

Measurements: One-, 5-, and 10-year survival and time to death.

Results: Median life expectancy was 10.6 years for participants with no ADL limitations and 6.5, 5.1, 3.8, and 1.6 years for those at ADL stages I, II, III, and IV, respectively. The sociodemographic- and diagnostic-adjusted hazard of death at 1 year was five times as great at stage IV as at stage 0 (hazard ratio = 5.6, 95% confidence interval = 3.8-8.3). The associations between ADL stage and mortality declined over time but remained statistically significant at 5 and 10 years.

Conclusion: ADL stage continued to explain mortality risk after adjusting for known risk factors including advanced age, stroke, and cancer. ADL stages might aid clinical care planning and policy as a powerful prognostic indicator particularly of short-term mortality, improving on current ADL measures by profiling activity limitations of relevance to determining community support needs.

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References

Cesari M, Onder G, Zamboni V, Manini T, Shorr R, Russo A . Physical function and self-rated health status as predictors of mortality: results from longitudinal analysis in the ilSIRENTE study. BMC Geriatr. 2008; 8:34. PMC: 2628909. DOI: 10.1186/1471-2318-8-34. View

Lee Y . The predictive value of self assessed general, physical, and mental health on functional decline and mortality in older adults. J Epidemiol Community Health. 2000; 54(2):123-9. PMC: 1731623. DOI: 10.1136/jech.54.2.123. View

Stineman M, Ross R, Fiedler R, Granger C, Maislin G . Staging functional independence validity and applications. Arch Phys Med Rehabil. 2003; 84(1):38-45. DOI: 10.1053/apmr.2003.50060. View

Edwards B, Ward E, Kohler B, Eheman C, Zauber A, Anderson R . Annual report to the nation on the status of cancer, 1975-2006, featuring colorectal cancer trends and impact of interventions (risk factors, screening, and treatment) to reduce future rates. Cancer. 2009; 116(3):544-73. PMC: 3619726. DOI: 10.1002/cncr.24760. View

Stineman M, Kurichi J, Kwong P, Maislin G, Reker D, Vogel W . Survival analysis in amputees based on physical independence grade achievement. Arch Surg. 2009; 144(6):543-51. PMC: 2869628. DOI: 10.1001/archsurg.2009.37. View

Lawton M, Brody E . Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist. 1969; 9(3):179-86. View

Covinsky K, Justice A, Rosenthal G, Palmer R, Landefeld C . Measuring prognosis and case mix in hospitalized elders. The importance of functional status. J Gen Intern Med. 1997; 12(4):203-8. PMC: 1497092. DOI: 10.1046/j.1525-1497.1997.012004203.x. View

Keller B, Potter J . Predictors of mortality in outpatient geriatric evaluation and management clinic patients. J Gerontol. 1994; 49(6):M246-51. DOI: 10.1093/geronj/49.6.m246. View

Stineman M, Ross R, Granger C, Maislin G . Predicting the achievement of 6 grades of physical independence from data routinely collected at admission to rehabilitation. Arch Phys Med Rehabil. 2003; 84(11):1647-56. DOI: 10.1053/s0003-9993(03)00317-4. View

10.

Bassuk S, Berkman L, Amick 3rd B . Socioeconomic status and mortality among the elderly: findings from four US communities. Am J Epidemiol. 2002; 155(6):520-33. DOI: 10.1093/aje/155.6.520. View

11.

Xu J, Kochanek K, Murphy S, Tejada-Vera B . Deaths: final data for 2007. Natl Vital Stat Rep. 2014; 58(19):1-19. View

12.

Covinsky K, Eng C, Lui L, Sands L, Yaffe K . The last 2 years of life: functional trajectories of frail older people. J Am Geriatr Soc. 2003; 51(4):492-8. DOI: 10.1046/j.1532-5415.2003.51157.x. View

13.

Stringhini S, Sabia S, Shipley M, Brunner E, Nabi H, Kivimaki M . Association of socioeconomic position with health behaviors and mortality. JAMA. 2010; 303(12):1159-66. PMC: 2918905. DOI: 10.1001/jama.2010.297. View

14.

Jette D, Warren R, Wirtalla C . The relation between therapy intensity and outcomes of rehabilitation in skilled nursing facilities. Arch Phys Med Rehabil. 2005; 86(3):373-9. DOI: 10.1016/j.apmr.2004.10.018. View

15.

Katz S, Ford A, Moskowitz R, Jackson B, JAFFE M . STUDIES OF ILLNESS IN THE AGED. THE INDEX OF ADL: A STANDARDIZED MEASURE OF BIOLOGICAL AND PSYCHOSOCIAL FUNCTION. JAMA. 1963; 185:914-9. DOI: 10.1001/jama.1963.03060120024016. View

16.

Croxson S, Price D, Burden M, Jagger C, Burden A . The mortality of elderly people with diabetes. Diabet Med. 1994; 11(3):250-2. DOI: 10.1111/j.1464-5491.1994.tb00267.x. View

17.

Lubitz J, Cai L, Kramarow E, Lentzner H . Health, life expectancy, and health care spending among the elderly. N Engl J Med. 2003; 349(11):1048-55. DOI: 10.1056/NEJMsa020614. View

18.

Stineman M, Streim J . The biopsycho-ecological paradigm: a foundational theory for medicine. PM R. 2010; 2(11):1035-45. PMC: 3071421. DOI: 10.1016/j.pmrj.2010.06.013. View

19.

Ganguli M, Dodge H, Shen C, Pandav R, DeKosky S . Alzheimer disease and mortality: a 15-year epidemiological study. Arch Neurol. 2005; 62(5):779-84. DOI: 10.1001/archneur.62.5.779. View

20.

C Carey E, Walter L, Lindquist K, Covinsky K . Development and validation of a functional morbidity index to predict mortality in community-dwelling elders. J Gen Intern Med. 2004; 19(10):1027-33. PMC: 1492580. DOI: 10.1111/j.1525-1497.2004.40016.x. View