DISABILITY AND SEVERE GASTROINTESTINAL HEMORRHAGE - A PROSPECTIVE-STUDY OF COMMUNITY-DWELLING OLDER PERSONS

OBJECTIVE: To describe the occurrence of severe gastrointestinal bleed ing in community-dwelling older persons and to examine whether disabil ity is a risk factor for this life-threatening condition independent o f other known predictors. DESIGN: Prospective cohort survey. SETTING: Three communities of the Established Populations for Epidemiologic Stu dies of the Elderly (EPESE). PARTICIPANTS: 8205 persons age greater th an or equal to 68 years. MEASUREMENTS: The hospital discharge diagnose s provided by the Medicare Provider Analysis and Review files and the death certificates were prospectively surveyed for 3 years. Those with at least 1 discharge diagnosis of gastrointestinal bleeding and who r eceived a blood transfusion or died were identified as cases of severe gastrointestinal hemorrhage. Physical disability, cognitive function, smoking and alcohol intake habits, body mass index, blood pressure, c hronic conditions, number of hospital admissions in past year and medi cations taken were assessed at baseline. RESULTS: The occurrence rate of severe gastrointestinal bleeding was 10.8 per 1000 person-years (24 1 events/22,277 person-years). In proportional hazards regression mode ls, compared with no disability, greater than or equal to 1 disabiliti es in the Rosow-Breslau scale (RR = 2.1, 95% CI = 1.5-2.9), and greate r than or equal to 1 ADLs limitations (RR = 3.1, 95% CI = 2.1-4.6) ind ependently predicted gastrointestinal hemorrhage after adjusting for a ge, gender, body mass index, comorbidity, number of hospital admission s, blood pressure, intake of coumarin, corticosteroids, aspirin and ot her nonsteroidal antiinflammatory drugs. CONCLUSIONS: In this prospect ive analysis, disability is an independent predictor of gastrointestin al hemorrhage. Further studies are needed to explain the mechanisms by which disability may cause gastrointestinal hemorrhage. Because physi cal disability is potentially modifiable, strategies to lower the risk of gastrointestinal bleeding should be evaluated.