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

• Published in: PloS one Vol. 8; no. 10; p. e77482
• Main Authors: de Pedro-Cuesta, Jesús, García-Sagredo, Pilar, Alcalde-Cabero, Enrique, Alberquilla, Angel, Damián, Javier, Bosca, Graciela, López-Rodríguez, Fernando, Carmona, Montserrat, Carmona, Monserrat, de Tena-Dávila, María J, García-Olmos, Luis, Salvador, Carlos H
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 31-10-2013; Public Library of Science (PLoS)
• Subjects: Activities of Daily Living; Age Factors; Aged; Chronic Disease; Chronic illnesses; Chronic obstructive pulmonary disease; Classification; Clinical medicine; Clinical trials; Communities; Coronary artery disease; Death; Diagnostic systems; Disability Evaluation; Disease prevention; Epidemiology; Female; Follow-Up Studies; Heart diseases; Heart failure; Heart Failure - complications; Heart Failure - epidemiology; Humans; Lists; Lung diseases; Lung Diseases, Obstructive - complications; Lung Diseases, Obstructive - epidemiology; Male; Medical diagnosis; Middle Aged; Mortality; Obstructive lung disease; Older people; Patients; Primary care; Pulmonary Disease, Chronic Obstructive; Regression analysis; Residence Characteristics; Spain - epidemiology; Stroke; Stroke - complications; Stroke - epidemiology; Telemedicine; World Health Organization; Spain
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0077482

Little is known about changes in disability over time among community-dwelling patients. Accordingly, this study sought to assess medium-term disability transitions.
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.
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.
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.