Abstract
BackgroundLittle is known about changes in disability over time among community-dwelling patients. Accordingly, this study sought to assess medium-term disability transitions.Patients and Methods300 chronic obstructive pulmonary disease (COPD), chronic heart failure and stroke patients living at home in Madrid were selected from general practitioner lists. In 2009, disability was assessed after a mean of 30 months using the World Health Organisation (WHO) Disability Assessment Schedule 2.0 (WHODAS 2.0). Follow-up was completed using death registries. Losses to follow-up were due to: death, 56; institutionalisation, 9; non-location, 18; and non-participation, 17. Changes in WHODAS 2.0 scores and life status were described and analysed using Cox and multinomial regression. Disability at end of follow-up was imputed for 56 deceased and 44 surviving patients.ResultsMean disability scores for 200 surviving patients at end of follow-up were similar to baseline scores for the whole group, higher than their own baseline scores, and rose by 16.3% when imputed values were added. The strongest Cox predictors of death were: age over 84 years, adjusted hazard ratios with 95%CI 8.18 (3.06-21.85); severe/complete vs. no/mild disability, 5.18 (0.68-39.48); and stroke compared to COPD, 1.40 (0.67-2.91). Non-participants and institutionalised patients had higher proportions with severe/complete baseline disability. A one-point change in baseline WHODAS 2.0 score predicted independent increases in risk of 12% (8%-15%) for severe/complete disability or death.ConclusionsA considerably high proportion of community-dwelling patients diagnosed with COPD, CHF and stroke undergo medium-term changes in disability or vital status. The main features of the emerging pattern for this group appear to be as follows: approximately two-thirds of patients continue living at home with moderately reduced functional status; 1/3 die or worsen to severe/complete disability; and 1/10 improve. Baseline disability scores, age and diagnosis are associated with disability and death in the medium term.
Highlights
Disability assessment in clinical practice has been used to monitor individual patient outcomes
In the case of the 18 patients who could not be traced, the reason frequently given by neighbourhood informants to explain this was a change of address, whether the new residence was unknown or known, institutional or non-institutional
Compared to the whole group in W1, the 18 patients lost to follow-up: were an average of 8.8 years younger, with only one subject aged ≥85 years; comprised mainly men, with an F/M ratio of 1/2; had a high stroke frequency (10 subjects) and a higher degree of disability; and registered a mean (SD) WHODAS score of 44.7 (23.5), all of which suggested a profile clearly different from that of baseline participants
Summary
Disability assessment in clinical practice has been used to monitor individual patient outcomes. Results: Mean disability scores for 200 surviving patients at end of follow-up were similar to baseline scores for the whole group, higher than their own baseline scores, and rose by 16.3% when imputed values were added. Nonparticipants and institutionalised patients had higher proportions with severe/complete baseline disability. A one-point change in baseline WHODAS 2.0 score predicted independent increases in risk of 12% (8%-15%) for severe/ complete disability or death. Conclusions: A considerably high proportion of community-dwelling patients diagnosed with COPD, CHF and stroke undergo medium-term changes in disability or vital status. The main features of the emerging pattern for this group appear to be as follows: approximately two-thirds of patients continue living at home with moderately reduced functional status; 1/3 die or worsen to severe/complete disability; and 1/10 improve. Age and diagnosis are associated with disability and death in the medium term
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