Mortalität und funktionelle Einschränkungen bei chronisch Kranken: Ergebnisse einer Follow-up-Studie an älteren Patienten nach Herzinfarkt

Long-term care is considered to be a major social medical problem in the elderly. Empirical data about mortality and functional deficits in every-day life is sorely needed for service programme management, planning, and health care policy-making. To set up an example for chronically diseased persons a follow-up study was conducted on patients suffering from coronary heart disease. The figure of 1710 probands who had survived their first myocardial infarction at an age of 60 to 74 during the time period from 1985 to 1992 was based on the register of acute coronary events with reference to the population of Augsburg, Germany. The probands were followed up in 1995. Hence, the observation time ranged from 2 to 10 years. 832 subjects (261 women, mean age 73.3; 571 men, mean age 71.9) were interviewed using a standardised questionnaire (net response rate 79%). 641 (37%) had died. The observed survival rates per year, which had been estimated by the life table method, were almost constant (93 - 95%) with the exception of the first 2 years (90%). Unexpectedly, the survival rates were not sex-related, but dependent on the age at the time of event. Nearly 60% out of the patients aged 60- 64 (n = 577) and 40% out of the persons aged 70 - 74 (n = 567) survived for at least 10 years. On being asked to describe their health status, about 75% of the age group 60 -64 and 65% of the age group 70 - 74 rated their general health to be at least fair, independent of the years already survived after myocardial infarction. Women reported worse overall health than men. To assess the functional status a short questionnaire recommended as valid by the Organization of Economic Cooperation and Development, was applied (OECD-lndex). This indicator focusses on sensory deficits and mobility-related dysfunctions. Apart from impaired hearing, all self-reported deficiencies occurred more often in women than in men. This difference could not be observed in the group of probands older than 80. According to the OECD-definition 44% of the subjects (57% of the females, 38% of the males) were classified as disabled. The disabled probands differed from the non-disabled significantly in subjective complaints and major geriatric symptoms (e.g. pain, incontinence). The findings of this study support the already suggested purpose to employ both health outcome variables - the self-rated health and the functional status by OECD - as a comparable standard for population surveys.