PLoS ONE (Jan 2013)

Disability transitions after 30 months in three community-dwelling diagnostic groups in Spain.

  • Jesús de Pedro-Cuesta,
  • Pilar García-Sagredo,
  • Enrique Alcalde-Cabero,
  • Angel Alberquilla,
  • Javier Damián,
  • Graciela Bosca,
  • Fernando López-Rodríguez,
  • Montserrat Carmona,
  • María J de Tena-Dávila,
  • Luis García-Olmos,
  • Carlos H Salvador

DOI
https://doi.org/10.1371/journal.pone.0077482
Journal volume & issue
Vol. 8, no. 10
p. e77482

Abstract

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BACKGROUND:Little is known about changes in disability over time among community-dwelling patients. Accordingly, this study sought to assess medium-term disability transitions. PATIENTS AND METHODS:300 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. 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. 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. 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. Baseline disability scores, age and diagnosis are associated with disability and death in the medium term.