Abstract:
Background:Difficulties with daily functioning are common in middle-aged adults. However, little is known about the epidemiology or clinical course of these problems, including the extent to which they share common features with functional impairment in older adults. Objective:To determine the epidemiology and clinical course of functional impairment and decline in middle age. Design:Cohort study. Setting:The Health and Retirement Study. Participants:6874 community-dwelling adults aged 50 to 56 years who did not have functional impairment at enrollment. Measurements:Impairment in activities of daily living (ADLs), defined as self-reported difficulty performing 1 or more ADLs, assessed every 2 years for a maximum follow-up of 20 years, and impairment in instrumental ADLs (IADLs), defined similarly. Data were analyzed by using multistate models that estimate probabilities of different outcomes. Results:Impairment in ADLs developed in 22% of participants aged 50 to 64 years, in whom further functional transitions were common. Two years after the initial impairment, 4% (95% CI, 3% to 5%) of participants had died, 9% (CI, 8% to 11%) had further ADL decline, 50% (CI, 48% to 52%) had persistent impairment, and 37% (CI, 35% to 39%) had recovered independence. In the 10 years after the initial impairment, 16% (CI, 14% to 18%) had 1 or more episodes of functional decline and 28% (CI, 26% to 30%) recovered from their initial impairment and remained independent throughout this period. The pattern of findings was similar for IADLs. Limitation:Functional status was self-reported. Conclusion:Functional impairment and decline are common in middle age, as are transitions from impairment to independence and back again. Because functional decline in older adults has similar features, current interventions used for prevention in older adults may hold promise for those in middle age. Primary Funding Source:National Institute on Aging and National Center for Advancing Translational Sciences through the University of California, San Francisco, Clinical and Translational Sciences Institute.
journal_name
Ann Intern Medjournal_title
Annals of internal medicineauthors
Brown RT,Diaz-Ramirez LG,Boscardin WJ,Lee SJ,Steinman MAdoi
10.7326/M17-0496subject
Has Abstractpub_date
2017-12-05 00:00:00pages
761-768issue
11eissn
0003-4819issn
1539-3704pii
2662101journal_volume
167pub_type
杂志文章abstract::Patients with variant angina refractory to medical therapy pose a difficult management problem. We report two patients with variant angina who had focal spasm in coronary arteries with fixed obstructions of less than 20% of the luminal diameter. Ischemic episodes were accompanied by malignant ventricular arrhythmias a...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-94-6-771
更新日期:1981-06-01 00:00:00
abstract::Cystic fibrosis was diagnosed after age 13 in 25 patients. All had an elevated sweat chloride and either a sibling with cystic fibrosis or typical pulmonary infection or digestive symptoms caused by exocrine pancreatic deficiency. Fourteen had long-standing pulmonary or digestive symptoms. In contrast, four of eight p...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-87-2-188
更新日期:1977-08-01 00:00:00
abstract:Background:Triplex vaccine was developed to enhance cytomegalovirus (CMV)-specific T cells and prevent CMV reactivation early after hematopoietic stem cell transplant (HCT). Objective:To determine the safety and efficacy of Triplex. Design:First-in-patient, phase 2 trial. (ClinicalTrials.gov: NCT02506933). Setting:3...
journal_title:Annals of internal medicine
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.7326/M19-2511
更新日期:2020-03-03 00:00:00
abstract::Severe hypocalcemia secondary to magnesium depletion has been described in numerous patients with gastrointestinal disorders. The development of profound hypomagnesemia in chronic renal disease is a rare finding. We studied three patients with advanced renal failure and magnesium depletion. Severe hypocalcemia also wa...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-88-2-206
更新日期:1978-02-01 00:00:00
abstract::Essential trace elements such as zinc, iron, and copper participate in various enzyme reactions directly related to the regulation of blood pressure and indirectly related to generation of oxidative metabolic energy, alterations in blood lipid levels, and alterations in taste acuity. The toxicological action of severa...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-98-5-823
更新日期:1983-05-01 00:00:00
abstract:BACKGROUND:Magnetic resonance imaging (MRI) is avoided in most patients with implanted cardiac devices because of safety concerns. OBJECTIVE:To define the safety of a protocol for MRI at the commonly used magnetic strength of 1.5 T in patients with implanted cardiac devices. DESIGN:Prospective nonrandomized trial. (C...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章,多中心研究
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更新日期:2011-10-04 00:00:00
abstract::Medical devices have become an integral part of hospital-based care but also predispose patients to more than 850 000 device-related infections annually. Devices predispose to infection by damaging or invading epithelial and mucosal barriers to infection, by supporting growth of microorganisms and thus serving as rese...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-89-5-764
更新日期:1978-11-01 00:00:00
abstract::The coexistence of chronic idiopathic thrombocytopenic purpura and myasthenia gravis has been infrequently reported. We report another case and show the coexistence of autoantibodies to the platelet glycoprotein IIb and IIIa complex and the acetylcholine receptor. Autoantibody levels were followed during 8 weeks of tr...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-100-6-829
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journal_title:Annals of internal medicine
pub_type: 杂志文章,多中心研究,随机对照试验
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更新日期:2009-04-07 00:00:00
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journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:1996-03-15 00:00:00
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journal_title:Annals of internal medicine
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更新日期:1998-01-01 00:00:00
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journal_title:Annals of internal medicine
pub_type: 杂志文章
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更新日期:2016-01-19 00:00:00
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journal_title:Annals of internal medicine
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pub_type: 指南,杂志文章
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更新日期:1992-11-01 00:00:00
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journal_title:Annals of internal medicine
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更新日期:2008-11-18 00:00:00
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journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
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更新日期:1995-12-01 00:00:00
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pub_type: 临床试验,杂志文章,随机对照试验
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journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-98-2-177
更新日期:1983-02-01 00:00:00
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更新日期:1991-08-15 00:00:00
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journal_title:Annals of internal medicine
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更新日期:1983-01-01 00:00:00
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更新日期:2015-02-03 00:00:00
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journal_title:Annals of internal medicine
pub_type: 杂志文章
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更新日期:1983-08-01 00:00:00
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journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-147-6-200709180-00006
更新日期:2007-09-18 00:00:00
abstract::Abdominal aortic aneurysms (AAAs) occur in 1 of 20 older men, remain asymptomatic for many years, and, if left untreated, cause death from rupture in about one third of patients. Ultrasonography is a suitable screening test for AAA, and elective repair can prevent rupture. Although these features suggest a promising t...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
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更新日期:2003-09-16 00:00:00
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journal_title:Annals of internal medicine
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更新日期:2008-09-02 00:00:00
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journal_title:Annals of internal medicine
pub_type: 杂志文章,多中心研究,随机对照试验
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更新日期:2020-04-21 00:00:00
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pub_type: 杂志文章,meta分析,评审
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更新日期:2015-12-01 00:00:00
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journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-83-4-480
更新日期:1975-10-01 00:00:00