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
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.