Articles
Incidence of functional limitation in older adults: The impact of gender, race, and chronic conditions☆,☆☆,★,★★,♢,♢♢

Presented in part at the American Public Health Association meeting, November 1999, Chicago, IL.
https://doi.org/10.1053/apmr.2002.32817Get rights and content

Abstract

Dunlop DD, Manheim LM, Sohn M-W, Liu X, Chang RW. Incidence of functional limitation in older adults: the impact of gender, race, and chronic conditions. Arch Phys Med Rehabil 2002;83:964-71. Objectives: To evaluate the relation of chronic conditions, gender, and race to the incidence of activities of daily living (ADLs) limitation in older adults. Design: The 2-year cumulative incidence of functional limitation was estimated from survival analysis methods by using elders without baseline functional limitations. Setting: Longitudinal Study of Aging (LSOA). Initial interviews: 1984; reinterviews: 1986, 1988, and 1990. Participants: A total of 4205 elderly subjects from the LSOA. Interventions: Not applicable. Main Outcome Measures: Dependent variables: self-reported moderate (1–2 ADLs) and severe (≥3 ADLs) functional limitation. Independent variables: sociodemographics, self-reported chronic conditions, and prior levels of functional limitation. Results: Gender and race predicted moderate functional limitation onset, after controlling for age and education. Arthritis, diabetes, prior cerebrovascular disease (CVD), incontinence, and impaired vision were significant predictors of moderate functional limitation onset after controlling for demographics. Differences in the prevalence of chronic conditions appear to explain why moderate functional limitation incidence rates are higher in older women and blacks. Gender, but not race, predicted onset of severe functional limitation, after controlling for age and education. Prior moderate functional limitation, CVD, and vision impairment predicted onset of severe functional limitation after controlling for demographics. Conclusion: Prevention of functional decline should target chronic conditions and moderate functional limitation in older adults. © 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Section snippets

Sample

Data were obtained from the LSOA.35 The LSOA is a prospective survey of community-dwelling persons at or over the age of 70 years who were initially interviewed in the 1984 National Health Interview Survey, Supplement on Aging36, 37 and reinterviewed in 1986, 1988, and 1990. A total of 5095 white and black older adults (of 5151 elderly) participated in the LSOA. To make statements about incidence of functional limitation and future quality of life, we limited our analyses to a cohort of 4205

Characteristics of study sample

The mean age of subjects at baseline (N=4205) was 79 years. Subjects were predominantly white (82%), female (67%), and most (57%) were not married. By the 1990 interview, 6 years postbaseline, 23.5% (988/4205) of the initial sample had died.

It is evident that rates of chronic conditions differ by gender and race (table 1).

. Prevalence of chronic conditions at baseline by gender and race among older adults without baseline functional limitation

Empty CellEmpty CellMenWomen
Empty CellTotal (N=4205)White (n=1303)Black (n=168)White

Discussion

The purpose of the present study was to evaluate the relation of chronic conditions, gender, and race to the 2-year cumulative incidence of functional limitation in older adults. The causal relationship between gender, race, and chronic conditions on one hand and functional limitation on the other that is suggested by cross-sectional studies has been confirmed by only a few longitudinal studies.4, 17, 21, 22, 29 Our study is unique in that it evaluated the impact of gender, race, and chronic

Conclusion

The present study shows that chronic conditions play a prominent role in the development of future functional limitation among elderly Americans. Additionally, current moderate functional limitation is the strongest predictor of future severe functional limitation. Differences in the prevalence of chronic conditions appear to explain why functional limitation incidence rates are higher in older women and blacks. Arthritis, CVD, diabetes, and vision impairment are prominent risk factors for

Acknowledgements

The National Center for Health Statistics is the original source of these data from the Longitudinal Study of Aging, 1984–1990. The authors gratefully acknowledge programming support from Mary Ann Chamberlain, MS, and Jing Song, MS, and the comments of Alan Dyer, PhD, Judith Falconer, PhD, OTS, and Eric Ortland.

References (54)

  • MA Severson et al.

    Patterns and predictors of institutionalization in community-based dementia patients

    J Am Geriatr Soc

    (1994)
  • TE Stump et al.

    Changes in physician utilization over time among older adults

    J Gerontol B Psychol Sci Soc Sci

    (1995)
  • BK Keller et al.

    Predictors of mortality in outpatient geriatric evaluation and management clinic patients

    J Gerontol

    (1994)
  • C Boult et al.

    Decreasing disability in the 21st century: the future effects of controlling six fatal and nonfatal conditions

    Am J Public Health

    (1996)
  • L Ferrucci et al.

    Hospital diagnoses, Medicare charges and nursing home admissions in the year when older persons become severely disabled

    JAMA

    (1997)
  • AA Guccione et al.

    The effects of specific medical conditions on the functional limitations of elders in the Framingham Study

    Am J Public Health

    (1994)
  • C Boult et al.

    Chronic conditions that lead to functional limitation in the elderly

    J Gerontol

    (1994)
  • KD Lindsted et al.

    Self-report of physical activity and patterns of mortality in Seventh-Day Adventist men

    J Clin Epidemiol

    (1991)
  • H Aguero-Torres et al.

    Dementia is the major cause of functional dependence in the elderly: 3-year follow-up data from a population-based study

    Am J Public Health

    (1998)
  • J Woo et al.

    Impact of chronic diseases on functional limitations in elderly Chinese aged 70 years and over: a cross-sectional and longitudinal survey

    J Gerontol A Biol Sci Med Sci

    (1998)
  • L Ferrucci et al.

    Progressive versus catastrophic disability: a longitudinal view of the disablement process

    J Gerontol A Biol Sci Med Sci

    (1996)
  • MA Rudberg et al.

    Functional limitation pathways and transitions in community-dwelling older persons

    Gerontologist

    (1996)
  • EM Crimmins et al.

    Changing mortality and morbidity rates and the health status and life expectancy of the older population

    Demography

    (1994)
  • JM Guralnik et al.

    Physical disability in older Americans

    J Gerontol

    (1993)
  • KG Manton et al.

    Estimates of change in chronic disability and institutional incidence and prevalence rates in the U.S. elderly population from the National Long Term Care Survey

    J Gerontol

    (1993)
  • EM Crimmins et al.

    Further evidence on recent trends in the prevalence and incidence of disability among older Americans from two sources: the LSOA and the NHIS

    J Gerontol B Psychol Sci Soc Sci

    (1997)
  • DD Dunlop et al.

    Disability in activities of daily living: patterns of change and a hierarchy of disability

    Am J Public Health

    (1997)

    • Cited by (0)

    ☆

    Supported by the AARP Andrus Foundation and by the Multipurpose Arthritis Center (grant no. AM 30692).

    ☆☆

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.

    ★

    Reprint requests to Dorothy Dunlop, PhD, Institute for Health Services Research and Policy Studies, Northwestern University, 629 Noyes St, Evanston, IL 60208, e-mail: [email protected].

    ★★

    Suppliers

    ♢

    a. SPSS Inc, 233 S Wacker Dr, 11th Fl, Chicago, IL 60606.

    ♢♢

    b. SAS Institute Inc, SAS Campus Dr, Cary, NC 27513.

    View full text
    Copyright © 2002 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.