New and worsening conditions and change in physical and cognitive performance during weekly evaluations over 6 months: The women's health and aging study

Background. Despite the large burden of chronic disease in older persons, especially those with disability, little research has documented changes in symptomatology over short periods of time. Additionally, although it has been demonstrated that medical conditions strongly affect functional level, short-term worsening in condition status has not been investigated for its impact on functional change. Methods. In a substudy of the Women's Health and Aging Study, 102 women with mild to severe disability received weekly home visits over a 6-month period. Each week they were queried as to the onset of 14 acute, generally self-limited conditions and the worsening or new diagnosis of 12 chronic conditions (condition reporting). They also received a battery of physical and cognitive performance tests. Results. There was a high rate of condition reporting over 24 weekly interviews. Nearly all women reported acute and episodic conditions; the average number of weeks of reporting one or more conditions was 11.8 per woman. For chronic conditions, the average number of weeks of reporting worsening of one or more conditions was 5.2 per woman. Multiple reports of onset or worsening of specific conditions were common, especially for arthritis of the hands, hips, knees, or feet; urinary problems; dizziness or unsteadiness on feet: and back pain. The total number of condition reports and number of weeks of condition reporting were generally not associated with an individual's slope of change in performance tests. For specific conditions. there were generally small and nonsignificant changes in performance in those who reported onset or worsening after 3 or more weeks of not reporting this. Conclusions. Older disabled women frequently report the onset or worsening of acute and chronic conditions. In weekly observations, these conditions are not related to changes in physical and cognitive performance measures. Possible masons for this are that (a) condition reporting may not be valid, (b) changes or severity of conditions were of insufficient magnitude to affect functioning, or (c) performance measures are not sensitive to the kinds of changes in chronic and acute conditions that affect people From week to week. We concluded that performance measures are not useful in monitoring modest, short-term changes in health status, but may still be valuable for assessing more major changes in health and functioning over time.