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All-Cause 1-, 5-, and 10-Year Mortality in Elderly People According to Activities of Daily Living Stage

Authors

  • Margaret G. Stineman MD,

    Corresponding author
    1. Physical Medicine and Rehabilitation, Perelman School of Medicine
    • Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics
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  • Dawei Xie PhD,

    1. Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics
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  • Qiang Pan MA,

    1. Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics
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  • Jibby E. Kurichi MPH,

    1. Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics
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  • Zi Zhang MD,

    1. Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics
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  • Debra Saliba MD,

    1. Greater Los Angeles Veterans Affairs Geriatric Research, Education and Clinical Center, University of California at Los Angeles/JH Borun Center for Gerontological Research, Los Angeles, California
    2. RAND, Santa Monica, California
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  • John T. Henry-Sánchez MD,

    1. Hospital de La Concepcion, San German, Puerto Rico
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  • Joel Streim MD

    1. Geriatric Psychiatry Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania
    2. Veterans Integrated Service Network 4 Mental Illness Research Education and Clinical Center at the Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania
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Address correspondence to Margaret G. Stineman, MD, The Center for Clinical Epidemiology and Biostatistics of the University of Pennsylvania, 904 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104. E-mail: mstinema@exchange.upenn.edu

Abstract

Objectives

To examine the independent association between five stages of activities of daily living (ADLs) and mortality after accounting for known diagnostic and sociodemographic risk factors.

Design

For five stages of ADLs (0 to IV), determined according to the severity and pattern of ADL limitations, unadjusted life expectancies and adjusted associations with mortality were estimated using a Cox proportional hazards regression model.

Setting

Community.

Participants

Nine thousand four hundred forty-seven participants aged 70 and older from the second Longitudinal Study of Aging.

Measurements

One-, 5-, and 10-year survival and time to death.

Results

Median life expectancy was 10.6 years for participants with no ADL limitations and 6.5, 5.1, 3.8, and 1.6 years for those at ADL stages I, II, III, and IV, respectively. The sociodemographic- and diagnostic-adjusted hazard of death at 1 year was five times as great at stage IV as at stage 0 (hazard ratio = 5.6, 95% confidence interval = 3.8–8.3). The associations between ADL stage and mortality declined over time but remained statistically significant at 5 and 10 years.

Conclusion

ADL stage continued to explain mortality risk after adjusting for known risk factors including advanced age, stroke, and cancer. ADL stages might aid clinical care planning and policy as a powerful prognostic indicator particularly of short-term mortality, improving on current ADL measures by profiling activity limitations of relevance to determining community support needs.

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