Longitudinal Study of Transitions in Disability and Death among Older Persons

老年人残疾和死亡转变的纵向研究

• 批准号: 7826726
• 负责人: Haiqun Lin
• 金额: $ 32.66万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-05-15 至 2012-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7826726
• 关键词: Accounting; Acquired Immunodeficiency Syndrome; Activities of Daily Living; Acute; Address; Affect; Aftercare; Age; Aging; Aging-Related Process; Alzheimer' s Disease; Bathing; Cancer Patient; Cardiovascular Diseases; Cause of Death; Cessation of life; Characteristics; Chronic; Chronic Disease; Clinical; Communities; Comorbidity; Complex; Data; Dependence; Deterioration; Disabled Persons; Disease Progression; Dropout; Elderly; Evaluation; Event; Evolution; Gender; Goals; Health; Hearing; Heterogeneity; Immune system; Impaired cognition; Impairment; Individual; Infection; Interview; Joints; Knowledge; Literature; Long-Term Care; Longitudinal Studies; Malignant Neoplasms; Measurement; Measures; Mental Depression; Methodology; Methods; Modeling; Movement; Outcome; Parkinson Disease; Participant; Pathway interactions; Patient Dropouts; Patients; Pattern; Performance; Persons; Physical activity; Population Study; Posture; Process; Quality of life; Recording of previous events; Recovery; Recurrence; Research; Research Personnel; Retrospective Studies; Risk; Risk Factors; Role; Sampling; Selection Bias; Sensory; Sterile coverings; Stroke; Subgroup; Time; Veterans; Walking; age related; base; cognitive function; cohort; community living; conditioning; cost; disability; disability burden; follow-up; frailty; functional decline; functional disability; functional status; immune function; mortality; prevent; protective effect; public health relevance; response; therapy design

DESCRIPTION (provided by applicant): The overall objective of this proposal is to develop proper methods for characterizing aging-related changes in activities of daily living (ADLs) while accounting for differential survival patterns among older persons. The Yale Precipitating Events Project (PEP) is an ongoing longitudinal study of ADL disability, which has followed a large cohort of community-living older persons for over ten years. Monthly interviews and comprehensive assessments at eighteen-month intervals have been conducted to assess ADL disability, possible risk factors, potential intervening events, and deaths. PEP has documented relevant information that helps to elucidate the mechanisms underlying the occurrence and recovery of ADL disability and provided strong evidence that disability is a reversible and recurrent event with considerable heterogeneity and multiple potential pathways. However participants with greater disability tend to die earlier, hence the estimation of the extent of and overall burden of disability using available follow-up observations may be biased because the amount of ADL data varies according to participants' survival times. In current analytic methods for longitudinal study, death is typically dealt with in a similar fashion as dropout in non-aging research or treated as independent censoring, and often retrospective analysis is conducted conditioning on the proximity of death time. Most dropout models assume the existence of potential response after dropout, which does not apply to the aging-related functional change in older persons when death is the main reason for truncated measurements. Thus, a different analytic strategy is needed to deal with death in longitudinal aging research or any research in which death is an inevitable event. Our first aim is to depict the ADL ordinal response, which we view as manifested trajectory of underlying disabling process that is related to the risk process of death. Our second aim is to discover the distinct patterns representing the complex relationship between the disabling process and death. Our third aim is to study the dynamic transitions among the ADL states (i.e., (re)occurrence, worsening, improvement, and recovery of ADL disability) and death. In all the aims, the role of risk factors such as age, gender, cognitive impairment, physical activity level, depression, existence of acute or chronic comorbid conditions (e.g., stroke, hearing and sensory impairment) and physical frailty will be investigated. The findings from our proposal will provide aging researchers with an informative picture of aging-related ADL trajectories with varying survival patterns. The use of PEP data with monthly assessments addresses the previous concern that lack of frequent measurements that cover more than the period immediately before death has limited our understanding of the risk of death and biased the findings on ADL trajectories. The methods developed in this proposal are generally applicable to other longitudinal studies where death is a competing event, such as the longitudinal study of cognitive function in Veterans with Alzheimer's disease, study of the immune function in AIDS patients and study of quality of life in post-treatment cancer patients. PUBLIC HEALTH RELEVANCE: Disability in activities of daily living (ADL) in older persons incurs high cost in personal and long-term cares often leads to adverse health outcomes. Investigating patterns and factors associated with occurrence, deterioration, improvement and recovery of ADL and with death in older persons thus constitutes an important clinical and scientific task.

描述（由申请人提供）：该提案的总体目的是开发适当的方法来表征与衰老相关的日常生活活动（ADL）的变化，同时考虑老年人之间的差异生存模式。耶鲁大学促成事件项目（PEP）是一项正在进行的ADL残疾纵向研究，该研究遵循了十多年的社区生活的大量老年人。已经进行了18个月间隔的每月访谈和​​全面评估，以评估ADL残疾，可能的危险因素，潜在的中间事件和死亡。 PEP已经记录了相关信息，有助于阐明ADL残疾发生和恢复的基础机制，并提供了有力的证据，表明残疾是一种可逆性和反复发生的事件，具有相当多的异质性和多个潜在途径。但是，更大的残疾参与者往往会更早死亡，因此使用可用的后续观察结果估计残疾的程度和总体负担可能会偏向，因为ADL数据的量根据参与者的生存时间而变化。在目前的纵向研究分析方法中，通常以类似于非衰老研究或视为独立审查的辍学方式处理死亡，并且经常根据死亡时间的接近性进行回顾性分析。大多数辍学模型都假定辍学后的潜在反应，当死亡是截断测量的主要原因时，它不适用于老年人与衰老相关的功能变化。因此，需要采取不同的分析策略来处理纵向老化研究或任何不可避免的事件的研究中的死亡。我们的第一个目的是描绘ADL序响应，我们认为这是与死亡风险过程有关的基本禁用过程的明显轨迹。我们的第二个目的是发现代表残疾过程与死亡之间复杂关系的不同模式。我们的第三个目的是研究ADL状态之间的动态过渡（即（重新）发生，恶化，改善和恢复ADL残疾）和死亡。在所有目的中，都将研究危险因素，例如年龄，性别，认知障碍，体育锻炼水平，抑郁，急性或慢性合并状况（例如，中风，听力和感觉障碍）和身体虚弱的情况。我们提案中的发现将为老龄化研究人员提供有关与衰老相关的ADL轨迹的信息，并具有不同的生存模式。使用每月评估的PEP数据的使用解决了先前的关注，即缺乏频繁的测量值，这些测量涵盖了超过死亡之前的时间，这限制了我们对死亡风险的理解，并偏向于ADL轨迹的发现。该提案中开发的方法通常适用于死亡是竞争事件的其他纵向研究，例如对患有阿尔茨海默氏病的退伍军人认知功能的纵向研究，对艾滋病患者的免疫功能的研究以及治疗后癌症患者的生活质量研究。公共卫生相关性：老年人日常生活活动（ADL）的残障会导致个人和长期护理的高成本通常会导致不利的健康状况。研究与发生，恶化，改善和恢复ADL以及老年人死亡相关的模式和因素构成了一项重要的临床和科学任务。