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. 2012 Mar;60(3):485-92.
doi: 10.1111/j.1532-5415.2011.03867.x. Epub 2012 Feb 21.

All-cause 1-, 5-, and 10-year mortality in elderly people according to activities of daily living stage

Margaret G Stineman  1 , Dawei Xie, Qiang Pan, Jibby E Kurichi, Zi Zhang, Debra Saliba, John T Henry-Sánchez, Joel Streim
Affiliations

All-cause 1-, 5-, and 10-year mortality in elderly people according to activities of daily living stage

Margaret G Stineman et al. J Am Geriatr Soc. 2012 Mar.

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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Conflict of interest statement

Conflict of Interest: There are no personal conflicts of interest of any of the authors.

Figures

Figure 1
Figure 1
12-Year Kaplan-Meier Survival Estimates as a Function of Stages Based on Difficulty and Inability
Figure 2
Figure 2. Plots of Hazards Ratios for Key Variables Violating the Proportional Hazards Assumption of the Cox Regression Model for All-cause Mortality at 1, 5, and 10 Years
Key for figure 2: The plots show separate hazard ratios and 95% confidence limits (y-axes) of all-cause mortality as determined at 1, 5, and 10 years follow-up (x-axes) for those variables that violated the proportional hazards assumption. The variables are ADL stage (panel A), age (panel B), gender (panel C), and various diagnostic condition categories (panel D). These estimates were generated by Cox regressions implemented in the full sample (N=9,272) and adjusted for all variables in the final model. The HRs for ADL I, ADL II, ADL III, and ADL IV (in panel A) are referenced to ADL 0. The HRs for the 3 age categories (in panel B) are referenced to those 70 to 74 years of age. The HRs for male (in panel C) are relative to female. The HRs for each diagnostic condition (in panel D) are referenced to those without the specific condition.
See this image and copyright information in PMC

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