The disablement process:: Factors associated with progression of disability and recovery in French elderly people

Purpose: To study the factors associated with progression, recovery and death from different grades of disability in elderly people. Method: The sample included 3198 participants of the PAQUID ('Personnes Agees QUID') cohort, aged 65 and over and community-dwellers at baseline. Subjects were re-interviewed 1, 3, 5, 8 and 10 years after baseline. A five-state Markov model was used to estimate transition intensities between four grades of disability and toward death. We used a hierarchic scale of disability, which combines basic and instrumental activities of daily living and mobility. Several explanatory variables were investigated: medical, personal and environmental factors. Results: The factors associated with progression and/or no recovery of disability were cardiovascular diseases, stroke and diabetes, low cognition, visual impairment and dyspnoea ( for pathologies and impairments), older age, female gender, low educational level ( for risk factors), depression ( for intra-individual factor) and being married, recent hospitalization and number of drugs ( for extra-individual factors). Older age, male gender, tobacco consumption and living in an urban area were associated with mortality. Conclusions: These. ndings confirm the independent contribution of each group of variables in the disablement process and stress their different impact on progression of disability or on recovery from different grades of disability.