Please use this identifier to cite or link to this item:http://hdl.handle.net/20.500.12105/6625
Disability transitions after 30 months in three community-dwelling diagnostic groups in Spain
Pedro-Cuesta, Jesus de ISCIII | Garcia-Sagredo, Pilar ISCIII | Alcalde-Cabero, Enrique ISCIII | Alberquilla, Angel | Damian, Javier ISCIII | Bosca, Graciela ISCIII | Lopez-Rodriguez, Fernando ISCIII | Carmona, Montserrat ISCIII | Tena-Davila, Maria Jose ISCIII | García-Olmos, Luis | Hernandez-Salvador, Carlos ISCIII
PLoS One. 2013; 8(10): e77482.
BACKGROUND: Little is known about changes in disability over time among community-dwelling patients. Accordingly, this study sought to assess medium-term disability transitions. PATIENTS AND METHODS: 300 chronic obstructive pulmonary disease (COPD), chronic heart failure and stroke patients living at home in Madrid were selected from general practitioner lists. In 2009, disability was assessed after a mean of 30 months using the World Health Organisation (WHO) Disability Assessment Schedule 2.0 (WHODAS 2.0). Follow-up was completed using death registries. Losses to follow-up were due to: death, 56; institutionalisation, 9; non-location, 18; and non-participation, 17. Changes in WHODAS 2.0 scores and life status were described and analysed using Cox and multinomial regression. Disability at end of follow-up was imputed for 56 deceased and 44 surviving patients. RESULTS: Mean disability scores for 200 surviving patients at end of follow-up were similar to baseline scores for the whole group, higher than their own baseline scores, and rose by 16.3% when imputed values were added. The strongest Cox predictors of death were: age over 84 years, adjusted hazard ratios with 95%CI 8.18 (3.06-21.85); severe/complete vs. no/mild disability, 5.18 (0.68-39.48); and stroke compared to COPD, 1.40 (0.67-2.91). Non-participants and institutionalised patients had higher proportions with severe/complete baseline disability. A one-point change in baseline WHODAS 2.0 score predicted independent increases in risk of 12% (8%-15%) for severe/complete disability or death. CONCLUSIONS: A considerably high proportion of community-dwelling patients diagnosed with COPD, CHF and stroke undergo medium-term changes in disability or vital status. The main features of the emerging pattern for this group appear to be as follows: approximately two-thirds of patients continue living at home with moderately reduced functional status; 1/3 die or worsen to severe/complete disability; and 1/10 improve. Baseline disability scores, age and diagnosis are associated with disability and death in the medium term.
Activities of Daily Living | Age Factors | Aged | Chronic Disease | Disability Evaluation | Female | Follow-Up Studies | Heart Failure | Humans | Lung Diseases | Male | Middle Aged | Pulmonary Disease, Chronic Obstructive | Residence Characteristics | Spain | Stroke | World Health Organization
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