title: Prediction of severe, persistent activity-of-daily-living disability in older adults.
abstract: In a prospective cohort of nondisabled adults aged 65 years or more in the Established Populations for Epidemiologic Studies of the Elderly (1981-1987 and 1985-1992), we used a competing risk approach to predict the 5-year risk of severe, persistent activities-of-daily-living (ADLs) disability, defined as dependence in ≥3 ADLs for 2 consecutive annual interviews or for 1 interview followed by death in the subsequent year. During 5 years, 6.8% developed severe, persistent ADL dependence, and 14.6% died without severe, persistent ADL dependence in the derivation cohort (n = 8,301); the corresponding percentages were 6.8% and 15.8% in the validation cohort (n = 4,177). A model based on age, current employment, visual impairment, self-rated health, diabetes mellitus, history of stroke or brain hemorrhage, cognitive function, and self-reported physical function showed good calibration. Discrimination, assessed by C statistics, for <70, 70-74, 75-79, and ≥80 years, was 0.75, 0.74, 0.65, and 0.66 in the derivation cohort and 0.70, 0.72, 0.70, and 0.65 in the validation cohort, respectively. In conclusion, a simple risk score based on routinely available clinical information can predict severe, persistent disability in 5 years. Future studies should examine whether physical performance measures can further improve prediction in the oldest old.
authors.forename: Dae Hyun
authors.initials: DH
authors.lastname: Kim
authors.forename: Anne B
authors.initials: AB
authors.lastname: Newman
authors.forename: Lewis A
authors.initials: LA
authors.lastname: Lipsitz
mesh_terms: D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003071:Cognition; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D004651:Employment / Q000706:statistics & numerical data; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006304:Health Status; D006801:Humans; D008297:Male; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index
keywords: activities of daily living; aged; prognosis