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Factors Associated With Recovery of Independence Among Newly Disabled Older Persons
Susan E. Hardy, MD;
Thomas M. Gill, MD
Arch Intern Med. 2005;165:106-112.
Background Recent evidence indicates that most older persons who develop disability in their activities of daily living (ADLs) regain independent function, but many of these persons subsequently experience recurrent disability. The aims of this study were to identify independent predictors of time to and duration of recovery of independent ADL function among newly disabled community-dwelling older persons.
Methods From a cohort of 754 persons 70 years or older, we studied the 420 participants who experienced at least 1 episode of disability involving 1 or more key ADLs (bathing, dressing, walking, or transferring) during a median follow-up of 53 months. Comprehensive evaluations at baseline and every 18 months included demographic, medical, cognitive, psychological, social, behavioral, and physical factors. Activities of daily living function and hospital admissions were assessed during monthly telephone interviews, with a completion rate of 99.4%.
Results Of the 420 newly disabled participants, 342 (81.4%) recovered independent ADL function after a mean ± SD of 4.9 ± 0.5 months. In multivariable proportional hazards analysis, habitual physical activity, mild disability (1-2 ADLs) at onset, and hospitalization in the month of disability onset were independently associated with shorter time to recovery. Among participants who recovered, 251 (73.4%) experienced recurrent disability or death after a mean ± SD of 7.3 ± 8.5 months. Younger age, greater habitual physical activity, higher functional self-efficacy, and shorter duration of the prior disability episode were independently associated with longer duration of recovery.
Conclusions Habitual physical activity is an independent predictor of time to and duration of recovery of independent ADL function among newly disabled community-dwelling older persons. Because the other independent predictors for time to recovery differ from those for maintenance of recovery, different mechanisms may underlie these 2 recovery outcomes, suggesting that different interventions may be required to promote recovery than to maintain independent ADL function after recovery.
Author Affiliations: Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn.
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