03415nas a2200385 4500008004100000022001400041245011100055210006900166260001300235300001100248490000700259520232400266653003102590653000902621653002202630653002002652653002102672653003302693653001102726653002502737653001102762653002002773653000902793653003702802653001702839653001602856653002602872653001802898100001502916700001902931700001202950700001702962700001402979856003602993 1994 eng d a0895-435600aPhysical disability in older adults: a physiological approach. Cardiovascular Health Study Research Group.0 aPhysical disability in older adults a physiological approach Car c1994 Jul a747-600 v473 a

Measures of physical function have been developed primarily to assess health status, prognosis, and service needs. They are now, increasingly, being used as outcome measures in studies seeking to determine the causes of disability. However, the extent to which these standardized measures, as they currently are constituted, are meaningful for the evaluation of underlying pathophysiology is not defined. To assess evidence for an etiologic rationale for these measures, we evaluated self-report of difficulty in physical function in the Cardiovascular Health Study, a study of 5201 men and women 65 years and older in four U.S. communities. We determined (by factor analysis) that self-reported difficulty with each of 17 tasks of daily life aggregates in four groups; i.e. difficulty in one task is associated with having difficulty in the other tasks in the group. These groups include (1) activities primarily dependent on mobility and exercise tolerance; (2) complex activities heavily dependent on cognition and sensory input; (3) selected basic self-care activities; and (4) upper extremity activities. Groups 2 and 3 are similar, but not identical, to Instrumental Activities of Daily Living (IADL) and Activities of Daily Living (ADL), respectively. We then tested whether these groupings were associated with different underlying impairments. Multiple logistic regression analyses indicate that there are constellations of physiologic and disease characteristics significantly (p < 0.01) associated with difficulty in each of these four groups of activities, among 15 chronic diseases and conditions ascertained. Some diseases are uniquely associated with difficulty in one group of tasks; some overlap, and are associated with 2, 3 or 4 groups of tasks. The associations found with difficulty in performing tasks in groups 2 and 3 were frequently stronger than those with the larger groups of ADL or IADL tasks, suggesting increased specificity of associations found with these new groupings. These results suggest that re-grouping of tasks of daily life may provide a more refined physiologically-based outcome measure for use in evaluating causes of disability. The ability to define risk factors for disability may be enhanced by choosing outcome measures with a demonstrated physiologic rationale.

10aActivities of Daily Living10aAged10aAged, 80 and over10aChronic Disease10aDisabled Persons10aFactor Analysis, Statistical10aFemale10aGeriatric Assessment10aHumans10aLogistic Models10aMale10aOutcome Assessment (Health Care)10aRisk Factors10aSex Factors10aSocioeconomic Factors10aUnited States1 aFried, L P1 aEttinger, W, H1 aLind, B1 aNewman, A, B1 aGardin, J uhttps://chs-nhlbi.org/node/141703435nas a2200457 4500008004100000022001400041245013200055210006900187260001300256300001200269490000700281520215700288653003102445653000902476653002202485653001402507653002802521653002002549653001902569653002802588653002102616653001102637653001802648653001902666653001902685653001102704653001802715653000902733653002302742653003102765653001702796653001602813653001802829100001902847700001502866700001402881700001702895700001402912700001502926856003602941 1994 eng d a0002-861400aSelf-reported causes of physical disability in older people: the Cardiovascular Health Study. CHS Collaborative Research Group.0 aSelfreported causes of physical disability in older people the C c1994 Oct a1035-440 v423 a

OBJECTIVE: To determine the major conditions and symptoms reported to cause difficulty in 17 physical tasks of daily life and the criterion validity of self-report of diseases given as the causes of the difficulty in functioning, in community-dwelling older people.

DESIGN: Cross sectional analyses of data obtained in an observational cohort study.

SETTING: Research clinics in four US communities: Winston-Salem, NC, Hagerstown, MD, Pittsburgh, PA, and Sacramento, CA.

PARTICIPANTS: 5201 community-dwelling people > or = 65 years old.

RESULTS: Arthritis and other musculoskeletal diseases were given as the primary causes of difficulty in performing physical tasks by 49.0% of the participants reporting difficulty in any task, followed by heart disease (13.7%), injury (12.0%), old age (11.7%), lung disease (6.0%), and stroke (2.9%). The self-reports of diseases that caused disability varied by task. Whereas arthritis was given as a cause of difficulty in most of the 17 different tasks, heart and lung disease were more likely to be reported as causing difficulty with activities requiring high aerobic work capacity such as walking one-half mile or doing heavy housework. Stroke was more likely to be reported as causing difficulty with use of the upper extremities and in performing basic activities of daily living. There was a high degree of consistency (91%) between the diseases and symptoms reported to cause disabilities. The percentage of people who reported a disease as the cause of their difficulty performing a task and had independent confirmation of the diagnosis was 85% in men and 71% in women, and varied according to type of disease and the individual's cognitive status and health status.

CONCLUSION: These data suggest that age-related chronic diseases are important causes of disability in older people but that the type of disability is dependent on the underlying disease that causes the disability. Also, self-report of the cause of disability appears to be generally accurate but is influenced by gender, health status, and type of disease.

10aActivities of Daily Living10aAged10aAged, 80 and over10aArthritis10aCardiovascular Diseases10aChronic Disease10aCohort Studies10aCross-Sectional Studies10aDisabled Persons10aFemale10aHealth Status10aHealth Surveys10aHeart Diseases10aHumans10aLung Diseases10aMale10aObserver Variation10aReproducibility of Results10aRisk Factors10aSex Factors10aUnited States1 aEttinger, W, H1 aFried, L P1 aHarris, T1 aShemanski, L1 aSchulz, R1 aRobbins, J uhttps://chs-nhlbi.org/node/1424