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Yale study tracks factors leading to
physical decline in older adults
November
2010--A
study by Yale School of Medicine researchers
reveals that the illnesses and injuries that
can restrict the activity of older adults or
land them in the hospital are linked to
worsening functional ability, especially
among those who are physically frail.
The report appears in JAMA's November 3
theme issue on aging.
Thomas M. Gill, M.D., the Humana Foundation
Professor of internal medicine (geriatrics),
investigative medicine and epidemiology and
public health at Yale, will present the
findings at a JAMA media
briefing at the National Press Club November
2 at 10 a.m.
"We now have a much better understanding of
the complex and highly dynamic disabling
process," said Gill, who is also an
attending physician at Yale-New Haven
Hospital.
Among older adults, disability in essential
activities of daily living, such as bathing,
and dressing, is common and associated with
an increased rate of death,
institutionalization, and greater use of
formal and informal home services.
But many older adults also recover from
disabilities. Gill points to high rates of
recovery and frequent transitions between
states of disability, but he said the role
of intervening illnesses and injuries on
these transitions was little understood
until this study shed some light on it.
Gill and his co-authors followed 754 adults
age 70 and older living in the Greater New
Haven area, with monthly phone interviews
for over 10 years starting in 1998.
The team assessed disability and ascertained
exposure to intervening illnesses and
injuries. Physical frailty—slow walking
speed—was assessed every 18 months for nine
years.
The team evaluated the relationship between
two types of intervening
events—hospitalization and restricted
activity, and transitions between no
disability, mild disability, severe
disability and death.
The team found that among the 637
participants, who had at least one
functional transition, 90.7 percent had at
least one hospital admission and 94.3
percent had at least one month of restricted
activity. Hospitalization was associated
with disability for eight of the nine
transitions.
Among the possible reasons for
hospitalization or restricted activity,
fall-related injury led to the highest
likelihood of developing new or worsening
disability.
Gill notes that despite the reductions
observed in the prevalence of disability
over the past two decades, the number of
disabled older Americans could increase
substantially in the coming years with the
aging of the baby boom generation. "To
address this increase, more aggressive
efforts will be needed to prevent and manage
intervening illnesses and injuries, given
their apparent role in precipitating and
perpetuating the disabling process," said
Gill.
