摘要：Objectives. To investigate the effect of disability severity and the contribution of self-rated health and depressive symptoms to 10-year mortality. Methods. Longitudinal data were collected from 1141 men aged 70 to 89 years from the Finland, Italy, and the Netherlands Elderly Study from 1990 to 2000. Disability severity was classified into 4 categories: no disability, instrumental activities, mobility, and basic activities of daily living. Self-rated health and depressive symptoms were classified into 2 and 3 categories, respectively. Multivariate Cox proportional hazard models were used to calculate mortality risks. Results. Men with severe disability had a risk of mortality that was more than 2-fold higher (hazard ratio [HR]=2.41; 95% confidence interval [CI]=1.84, 3.16) than that of men without disability. Men who had severe disability and did not feel healthy had the highest mortality risk (HR = 3.30; 95% CI = 2.52, 4.33). This risk was lower at lower levels of disability and higher levels of self-rated health. The same trend was observed for depressive symptoms. Conclusions. For adequate prognoses on mortality or for developing intervention strategies, not only physical aspects of health but also other health outcomes should be taken into account. The prediction of mortality in elderly people is a subject with a huge body of knowledge. There is little debate about the importance of functional disability as a predictor of mortality. However, there are still unresolved questions in the pathway from disability to mortality that are important for enhancing insight into long-term prognosis, planning health care facilities, or for developing intervention strategies. First, disabilities in different domains (i.e., in instrumental activities, 1 – 4 in mobility, 5 and in basic activities 6 – 10 ) are known to be associated with mortality risk. These earlier studies are restricted to only one of the disability domains. These domains reflect differences in severity levels of disability, but the relative impact of these domains on mortality is unknown. An earlier study that incorporated disability in both mobility and basic activities reported that men with disability in basic activities and mobility had a higher risk of mortality than those with disability in mobility only. 11 In another study about the association between disability and mortality, it was recommended to use different severity levels of disability (e.g., instrumental activities, mobility, and basic activities) as predictors of mortality. 7 Although it seems plausible that mortality risk increases with the severity of the disability, no earlier study incorporated the three severity levels in one classification, and it is not known whether there is a gradual or exponential increase in risk. In earlier studies in which disability severity was classified in instrumental activities, mobility, and basic activities, disability severity was strongly associated with other health outcomes, such as performance-based functional limitations and chronic diseases. 12 , 13 In addition to physical aspects of health, subjective aspects also may play a role in the association with mortality. It is known from earlier research that factors such as self-rated health and depressive symptoms are associated with disability 14 – 17 as well as with mortality. 1 , 18 – 21 However, it is unclear how the combination of disability and more subjective health aspects contributes to the mortality risk. A person’s actual health and mood probably contribute to the mortality risk besides disability. The aim of the present study was to investigate severity levels of disability as predictor of mortality. Furthermore, we assessed how different combinations of levels of disability and self-rated health and levels of disability and depressive symptoms contributed to mortality during a 10-year follow-up period. We had the opportunity to investigate the different associations in three European countries (i.e., Finland, the Netherlands, and Italy).
