title: Disability transitions after 30 months in three community-dwelling diagnostic groups in Spain.
abstract: BACKGROUND
  Little is known about changes in disability over time among community-dwelling patients. Accordingly, this study sought to assess medium-term disability transitions.
  
  
  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.
authors.affiliation: Applied Epidemiology, National Centre for Epidemiology and Carlos III Institute of Health, Madrid, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: de Pedro-Cuesta
authors.affiliation: Telemedicine and Health Unit, Carlos III Institute of Health, Madrid, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: García-Sagredo
authors.affiliation: Applied Epidemiology, National Centre for Epidemiology and Carlos III Institute of Health, Madrid, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Alcalde-Cabero
authors.affiliation: Multiprofessional Education Unit for Family and Community Care (Centre), Servicio Madrileño de Salud, Madrid, Spain.
authors.forename: Angel
authors.initials: A
authors.lastname: Alberquilla
authors.affiliation: Applied Epidemiology, National Centre for Epidemiology and Carlos III Institute of Health, Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Damián
authors.affiliation: Telemedicine and Health Unit, Carlos III Institute of Health, Madrid, Spain.
authors.forename: Graciela
authors.initials: G
authors.lastname: Bosca
authors.affiliation: Telemedicine and Health Unit, Carlos III Institute of Health, Madrid, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: López-Rodríguez
authors.forename: Montserrat
authors.initials: M
authors.lastname: Carmona
authors.affiliation: Bioengineering and Telemedicine Unit, Puerta de Hierro University Teaching Hospital, Madrid, Spain.
authors.forename: Monserrat
authors.initials: M
authors.lastname: Carmona
authors.affiliation: Telemedicine and Health Unit, Carlos III Institute of Health, Madrid, Spain.
authors.forename: María J
authors.initials: MJ
authors.lastname: de Tena-Dávila
authors.affiliation: Multiprofessional Education Unit for Family and Community Care (South-east), Servicio Madrileño de Salud, Madrid, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: García-Olmos
authors.affiliation: Telemedicine and Health Unit, Carlos III Institute of Health, Madrid, Spain.
authors.forename: Carlos H
authors.initials: CH
authors.lastname: Salvador
mesh_terms: D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D002908:Chronic Disease; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D008173:Lung Diseases, Obstructive / Q000150:complications* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive; D012111:Residence Characteristics; D013030:Spain / Q000453:epidemiology; D020521:Stroke / Q000150:complications* / Q000453:epidemiology; D014944:World Health Organization