Divergent effects of beta-blocker therapy on self-estimated and objectively scored activities of daily living.

Abstract

To identify factors that influence changes in the activities of daily living (ADL) assessed by a standardized scoring system, ADL-20, and factors affecting the self-estimate of the changes in ADL, we conducted a 1-yr follow-up study of 1,163 outpatients aged 50 yr or older. The follow-up rate was 83.1%. A decrease in the ADL score was associated with advancing age and a lower prescription rate of beta-blockers. Analysis of the modalities of ADL revealed an association between a decreasing mobility score and a lower prescription rate of beta-blockers. In patients with impaired ADL at the time of enrollment, worsening of the ADL score was also associated with a lower baseline ADL score and a history of cardiovascular events. The prescription rate of diuretics was lower in patients who exhibited an improvement in ADL score. There was a considerable dissociation between the self-estimate of changes in ADL and the actual change in ADL-20 score. In more than 60% of patients with impaired baseline ADL, the self-estimate of changes was worse than the actual change in the ADL score. The "worse-than-actual" self-estimate of changes in ADL was associated with a higher prescription rate of beta-blockers. Thus, a history of cardiovascular events accelerates the aging-related deterioration of ADL. The use of a beta-blocker may worsen the self-estimate of the changes in ADL, while the actual ADL is preserved or slightly improved during beta-blocker therapy.