title: Divergent effects of beta-blocker therapy on self-estimated and objectively scored activities of daily living.
abstract: To identify factors that influence changes in the activities of daily living (ADL) assessed by a standardized scoring system, ADL-20, and factors affecting the self-estimate of the changes in ADL, we conducted a 1-yr follow-up study of 1,163 outpatients aged 50 yr or older. The follow-up rate was 83.1%. A decrease in the ADL score was associated with advancing age and a lower prescription rate of beta-blockers. Analysis of the modalities of ADL revealed an association between a decreasing mobility score and a lower prescription rate of beta-blockers. In patients with impaired ADL at the time of enrollment, worsening of the ADL score was also associated with a lower baseline ADL score and a history of cardiovascular events. The prescription rate of diuretics was lower in patients who exhibited an improvement in ADL score. There was a considerable dissociation between the self-estimate of changes in ADL and the actual change in ADL-20 score. In more than 60% of patients with impaired baseline ADL, the self-estimate of changes was worse than the actual change in the ADL score. The "worse-than-actual" self-estimate of changes in ADL was associated with a higher prescription rate of beta-blockers. Thus, a history of cardiovascular events accelerates the aging-related deterioration of ADL. The use of a beta-blocker may worsen the self-estimate of the changes in ADL, while the actual ADL is preserved or slightly improved during beta-blocker therapy.
authors.affiliation: Third Department of Internal Medicine, University of the Ryukyus School of Medicine, Okinawa, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Kamiyama
authors.forename: H
authors.initials: H
authors.lastname: Muratani
authors.forename: Y
authors.initials: Y
authors.lastname: Kimura
authors.forename: K
authors.initials: K
authors.lastname: Fukiyama
authors.forename: T
authors.initials: T
authors.lastname: Omae
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology*; D000319:Adrenergic beta-Antagonists / Q000009:adverse effects* / Q000627:therapeutic use; D000368:Aged; D003071:Cognition / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000523:psychology; D008297:Male; D008606:Mental Processes / Q000502:physiology
chemical_list: D000319:Adrenergic beta-Antagonists