Recovery From Disability Among Community-Dwelling Older Persons

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Journal of American Medicine Vol. 291 No. 13, April 7, 2004

291:1596-1602

Vol. 291 No. 13, April 7, 2004

Recovery From Disability Among Community-Dwelling Older Persons

E. Hardy, MD; M. Gill, MD

Context

Previous studies have found that a sizeable minority of newly disabled

older

persons recover independent function; however, long intervals between

assessments

have led to difficulty in determining the true incidence and duration of

disability, and

therefore in accurately characterizing the probability and course of

recovery.

Objectives

To determine the rate of and time to recovery of independent function in

community-dwelling older persons who become newly disabled in their

activities of

daily living (ADLs), to determine the duration of recovery, and to

compare the

likelihood of recovery among pertinent subgroups of older persons.

Design, Setting, and Participants

Prospective cohort study, with monthly assessments of ADL function, for

754 initially nondisabled, community-dwelling persons aged 70 years or

older, performed in a small urban area from March 1998 to May 2003.

Main Outcome Measures

Demographic features, chronic conditions, cognitive function, and

physical frailty were determined during comprehensive assessments at

18-month intervals. Disability, defined as needing personal assistance

with 1 or more key ADLs (bathing, dressing, walking, and transferring),

was assessed during monthly telephone interviews.

Results

A total of 420 participants (56%) experienced disability during a median

follow-up of 51 months. Of these participants, 399 (81%) recovered (ie,

regained independence in all 4 ADLs) within 12 months of their initial

disability episode, and a majority (57%) of these maintained

independence for at least 6 months. Among participants who experienced

3 or more consecutive months of disability, a majority (60%) recovered,

but only a third of these maintained independence for at least 6 months.

Persons who were cognitively impaired, physically frail, or severely

disabled (ie, in 3-4 ADLs) at onset were less likely to recover than

those who were cognitively intact, nonfrail, or mildly disabled,

respectively. Nonetheless, a majority of participants within each

subgroup recovered.

Conclusions

Newly disabled older persons recover independent ADL function at rates

far exceeding those that have been previously reported. Recovery from

disability, however, is often short-lasting, suggesting that additional

efforts are warranted to maintain independence in this high-risk group.

Author Affiliations: Department of Internal Medicine, Yale University

School of Medicine, New Haven, Conn.