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Events, Person-Years, and Event Rates (per 100 person years) Over 6 y for Incident ADL Inability Events Among 5,729 CHS Participants Free of ADL Disability at Baseline
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Background
Incident disability rates enable the comparison of risk across populations. Understanding these by age, sex and race is important for planning for the care of older adults and targeting prevention.
Methods
We calculated incident disability rates among older adults in the Cardiovascular Health Study, a study of 5,888 older adults aged ≥...
Context in source publication
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Citations
... Although previous studies have found late-life disability to be associated with socioeconomic status [7,22] and that there are differences in late-life disability both by gender [23,24] and by socioeconomic status [12], little is known about whether the association between late-life disability and socioeconomic status differs by gender. Thus, we aimed to assess the associations between late-life disability and socioeconomic status from a gender perspective in a sample of community-dwelling older adults from three countries (Canada, Brazil and Colombia). ...
... Finally, multiple linear regression models were used to examine gender-specific associations between late-life disability (frequency and limitation subscales) and SES. We adjusted multiple linear regression models for the following variables based on precedents suggesting that they were risk factors for late-life disability while also being related to SES measures: age, number of chronic diseases, self-rated health and depressive symptoms [23,34,35]. A 5% level of statistical significance was used for all analyses and estimates were reported with their 95% confidence intervals (CI). ...
... On the other hand, women had lower scores in the limitation subscale compared to men, indicating less self-perceived capability in performing life tasks and therefore more disability. Our finding is consistent with large representative studies that have extensively reported a higher prevalence of disability among women, measured by limitations in functional upper and lower extremities and difficulties in activities of daily living (basic and instrumental) [23,24,42]. Part of the explanation for this may be that women in later life have a higher prevalence of comorbidity, depression and cognitive impairment, which may lead to an increased perception of limitations and restrictions in activities [43]. ...
Disability is a dynamic process and can be influenced by a sociocultural environment. This study aimed to determine whether the associations between socioeconomic status and late-life disability differ by gender in a multi-sociocultural sample from different countries. A cross-sectional study was developed with 1362 older adults from The International Mobility in Aging Study. Late-life disability was measured through the disability component of the Late-Life Function Disability Instrument. Level of education, income sufficiency and lifelong occupation were used as indicators of SES. The results indicated that a low education level β = −3.11 [95% CI −4.70; −1.53] and manual occupation β = −1.79 [95% −3.40; −0.18] were associated with frequency decrease for men, while insufficient income β = −3.55 [95% CI −5.57; −1.52] and manual occupation β = −2.25 [95% CI −3.89; −0.61] played a negative role in frequency for women. For both men β = −2.39 [95% −4.68; −0.10] and women β = −3.39 [95% −5.77; −1.02], insufficient income was the only factor associated with greater perceived limitation during life tasks. This study suggested that men and women had different late-life disability experiences. For men, occupation and education were associated with a decrease in the frequency of participation, while for women this was associated with income and occupation. Income was associated with perceived limitation during daily life tasks for both genders.
... Though women have higher rates of disability, they still have a longer life expectancy than men. [55][56][57][58] These differences lead to unanswered questions: Can we distinguish between those who are aging vs. those who are dying? Can we identify clues forecasting CV events, and are there patterns of decline that can predict these events? ...
Exposure of biological systems to acute or chronic insults triggers a host of molecular and physiological responses to either tolerate, adapt, or fully restore homeostasis; these responses constitute the hallmarks of resilience. Given the many facets, dimensions, and discipline‐specific focus, gaining a shared understanding of “resilience” has been identified as a priority for supporting advances in cardiovascular health. This report is based on the working definition: “Resilience is the ability of living systems to successfully maintain or return to homeostasis in response to physical, molecular, individual, social, societal, or environmental stressors or challenges,” developed after considering many factors contributing to cardiovascular resilience through deliberations of multidisciplinary experts convened by the National Heart, Lung, and Blood Institute during a workshop entitled: “Enhancing Resilience for Cardiovascular Health and Wellness.” Some of the main emerging themes that support the possibility of enhancing resilience for cardiovascular health include optimal energy management and substrate diversity, a robust immune system that safeguards tissue homeostasis, and social and community support. The report also highlights existing research challenges, along with immediate and long‐term opportunities for resilience research. Certain immediate opportunities identified are based on leveraging existing high‐dimensional data from longitudinal clinical studies to identify vascular resilience measures, create a ‘resilience index,’ and adopt a life‐course approach. Long‐term opportunities include developing quantitative cell/organ/system/community models to identify resilience factors and mechanisms at these various levels, designing experimental and clinical interventions that specifically assess resilience, adopting global sharing of resilience‐related data, and cross‐domain training of next‐generation researchers in this field.
... Older racial/ethnic minorities face additional barriers to maintaining independent living. As a group, older Black adults have been found to report significantly higher levels of disability than White adults [104][105][106][107][108]. Older African Americans consistently report diminished capacities to perform activities of daily living compared with other racial/ethnic groups [105,107,109]. ...
... While previous research suggests that these higher rates of disability occur due to lower income and education attainment [106,107,109], there are additional social determinants of health, such as lack of access to quality health care [111,112] and healthy food choices ("food deserts") that underlie health disparities among racial minority groups. The onset of diseases also differs by racial groups in the United States. ...
Disability prevention and preservation of independence is crucial for successful aging of older adults. To date, relatively little is known regarding disparities in independent aging in a disadvantaged older adult population despite widely recognized health disparities reported in other populations and disciplines. In the U.S., the Southeastern region also known as “the Deep South”, is an economically and culturally unique region ravaged by pervasive health disparities – thus it is critical to evaluate barriers to independent aging in this region along with strategies to overcome these barriers. The objective of this narrative review is to highlight unique barriers to independent aging in the Deep South and to acknowledge gaps and potential strategies and opportunities to fill these gaps. We have synthesized findings of literature retrieved from searches of computerized databases and authoritative texts. Ultimately, this review aims to facilitate discussion and future research that will help to address the unique challenges to the preservation of independence among older adults in the Deep South region.
... Generally, conclusions about how health inequalities evolve across the life course depend on whether time is measured by elapsed age or proximity to death. Although older Black adults experience a higher prevalence of disability compared to their White peers of the same age [15,26,27], Lunney et al. [15] find that Black-White differences in disability are "erased in the final 1 to 1.6 years before death", suggesting that "dying eliminate[s] a health disparity." This result is consistent with work finding no racial differences in disability in the two years before death [12]. ...
Objectives
To consider trends and disparities in end-of-life health in the US.
Methods
I use data from the National Health Interview Survey, linked to death records through 2015, for respondents who died at ages 65+ to compare the prevalence of three health outcomes in the last six years of life across time, sex, age, race, and educational attainment. Self-rated health (SRH) is available for respondents interviewed in years 1987–2014, while information on activities of daily living (ADL) and instrumental activities of daily living (IADL) is available for the period 1997–2014.
Results
By the end of the study period, individuals reported two fewer months of fair/poor health at the end of life than those dying in earlier years. In contrast, time lived with at least one activity limitation at the end of life generally remained comparable. Compared to men, women on average reported an additional year of living with an IADL limitation before death, and an additional eight months with an ADL limitation. Despite sex differences in disability, both sexes reported similar periods of fair/poor SRH before death. Similarly, while individuals who lived to older ages experienced a longer disabled period before death than individuals who died at younger ages, all age groups were equally likely to report fair/poor SRH. Black adults and adults with less formal schooling also spent more time with an end-of-life disability. For men, these racial and socioeconomic disparities lessened as death approached. For women, inequalities persisted until death.
Discussion
These findings suggest that despite increasing life expectancy, the period of poor health and disability prior to death has not recently been extended. Black women and women with less than a high school degree, require extended support at the end of life.
... The results also show that prevalence of impairment was higher in non-whites, which is consistent with the findings of a study undertaken in the United States in 2013 with non-institutionalized adults, which showed that overall prevalence of any disability (vision, cognition, mobilitymainly arthritis and back problems -self-care, and independent living) was higher among black adults 19 . One possible explanation for this is that the non-white population tend to have lower levels of income and education 20,21 . Socioeconomic disparities can influence different areas of an individual's life. ...
The aim of this study was to estimate the relationship between personal and environmental factors and the prevalence of acquired physical impairment in adults and older persons in Brazil. We conducted a cross-sectional study using data from the 2013 National Health Survey. The response variable was self-reported acquired physical impairment. The explanatory variables were sex, race/skin color, education level, social class, paid employment, private health insurance , running water, and connection to a sewer network. The strength of association between the explanatory variables and response variable and respective 95% confidence intervals were estimated using Poisson Regression. Physical impairment was reported by 1.25% of the study population (n=55,369). After complete adjustment, being male and non-white, having a lower level of education , living alone, not being in paid employment , not having private health insurance, not having running water, and not living in a house connected to a sewer network were associated with higher prevalence of acquired physical impairment. The findings show that prevalence of physical impairment was higher among vulnerable groups and that personal and environmental factors are important elements that need to be assessed at the population level.
... (Hawking et al., 2011) Moreover, the prevalence of disability across all domains including functional activities, activities of daily living, and instrumental activities of daily living is reported to be greater in women than in men for all older age groups. (Newman and Brach, 2001;Jacob et al., 2018) As the population continues to age, the absolute number of older adults with disabilities is projected to double in developed countries placing increased demands on health and social resources. (Government of Canada, 2011;Arim, 2012) Several studies have shown that the prevalence of physical disability has decreased over time in older adults in Canada, England and the United States from the 1980s. ...
The objective of this study was to explore how behavioural risk factors (smoking, physical activity, and nutrition) cluster together and assess how clusters of behavioural risk factors are associated with functional disability by age and sex at the individual and population level. We used currently available baseline cross-sectional data from the Canadian Longitudinal Study on Aging (CLSA). The CLSA is a national, population-based longitudinal study established to understand and examine health of an aging population. This study included 51,338 Canadian men and women aged 45 to 85 years residing in the community in 10 Canadian provinces. Behavioural risk factors included smoking, physical activity, and nutrition. The main outcome used in the study was functional disability, which was assessed using a questionnaire adapted from the Older Americans Resources and Services Multidimensional Assessment Questionnaire. In this analyses of unique combinations of the risk factors of smoking, physical activity, and nutritional risk, the magnitude of the association of the behavioural risk factors with functional disability was dependent on which risk factors were included and differed by age and sex strata. Of the risk factors, physical activity accounted for between 70% to 90% of the total population level risk in individuals with all three risk factors, suggesting it is a key driver of the population burden of disability. Together, these results show that considering unique clusters of risk factors, as well as age and sex, is essential for tailoring public health strategies to reduce the burden of disability among aging populations.
... Functional status is associated with hospitalization, health decline, and death in older adults [1][2][3]. Since muscle power (the product of force and velocity) is a critical predictor of functioning in older adults [4], the evaluation of physical function and muscle power is especially important in older women who are at a higher risk for age-related functional decline [5]. Reliability data for the more commonly used tests determining functional status in healthy, older adults is lacking. ...
Evaluation of the long-term reliability of muscle power and functional performance tests in older, healthy adults is warranted since determining whether performance is consistent over longer durations is more relevant for intervention studies. Objective. To assess the long-term test–retest reliability of measures of muscle power and lower body functional performance in healthy, nonexercising, older women. Methods. Data were derived from a nonexercising control group (n = 18; age = 73.3 (3.4) years; height = 159.6 (7.7) cm; body mass = 69.5 (12.7) kg; BMI = 27.3 (4.8)) of a randomized controlled trial of muscle power training in older women. Participants underwent lower extremity muscle power (Biodex) and functional testing (Short Physical Performance Battery, gait speed, 30-second chair stands, stair climbing, and 400-meter walk) at week 0 (baseline), 9, and 15. Results. For the upper leg, intraclass correlation coefficients (ICCs) were very high for knee extension power (0.90–0.97) and high to very high for knee flexion power (0.83–0.96). For lower-leg power, ICCs were high to very high for plantar flexion and dorsiflexion (0.83–0.96). ICCs for functional performance were moderate to very high (0.64–0.93). Coefficient of variation of the typical error (CVTE) was
... treatment effect was not different across subgroups. As originally described by Katz (2) and many other studies since (eg, (22)(23)(24)(25)), some ADL disabilities were more common than others. Walking, bathing, dressing, and transferring were similarly responsible (~21%-24%) for incident ADL disability with very few participants losing the ability to toilet (6%) or eat (3%) independently. ...
... The selection criteria for inclusion in ASPREE ensured that participants had generally lower age-matched levels of major disease and disability than the general populations of the United States and Australia (8). In this cohort, the incidence of ADL disability (20.6/1000 person-years) was lower than in the Cardiovascular Health Study (27/1000 person-years) (24). Other cohorts such as the Rush Memory and Aging Study reported a higher incidence of ADL disability (~30% over ~3.5 years follow-up in those who survived this period), though many in that study would not have met the CVD exclusion criteria of ASPREE, so may have been at higher risk of incident disability (25). ...
Background
Cerebrovascular events, dementia and cancer can contribute to physical disability with activities of daily living (ADL). It is unclear whether low-dose aspirin reduces this burden in aging populations. In a secondary analysis, we now examine aspirin’s effects on incident and persistent ADL disability within a primary prevention aspirin trial in community-dwelling older adults.
Methods
The ASPREE (ASPirin in Reducing Events in the Elderly) trial of daily 100mg aspirin versus placebo recruited 19,114 healthy adults aged 70+ years (65+ years if U.S. minority) in Australia and the U.S. Six basic ADLs were assessed every six months. Incident ADL disability was defined as inability or severe difficulty with ≥1 ADL; persistence was confirmed if the same ADL disability remained after six months. Proportional hazards modelling compared time to incident or persistent ADL disability for aspirin versus placebo; death without prior disability was a competing risk.
Results
Over a median 4.7 years, incident ADL disability was similar in those receiving aspirin (776/9525) and placebo (787/9589) with walking, bathing, dressing and transferring the most commonly reported. Only 24% of incident ADL disability progressed to persistent. Persistent ADL disability was lower in the aspirin group (4.3 versus 5.3 events/1000py; HR=0.81, 95% CI:0.66-1.00), with bathing and dressing the most common ADL disabilities in both groups. Following persistent ADL disability there were more deaths in the aspirin group (24 versus 12).
Discussion
Low-dose aspirin in initially healthy older people did not reduce risk of incident ADL disability, although there was evidence of reduced persistent ADL disability.
... While women outlive men in almost every society, women may suffer from more physical limitations than men of the same age in later life (16). We examine both disability prevalence and incidence, as disability prevalence rates provide good estimates of the disability burden, and disability incidence rates from representative samples are excellent measures of risk (17). While cross-sectional studies typically find that women are more likely to report disabilities than men, a systematic review of gender differences in disability incidence has not yielded consistent findings (18). ...
Background:
Inequality in gender varies across social contexts, which may influence the health of both men and women. Based on theories of gender as a social system, we examine whether systematic gender inequality at the macro level influences health of men and women.
Methods:
Using harmonized panel data from the Gateway to Global Aging Data in 23 high and middle income countries (N=168,873), we estimate disability prevalence and incidence for men and women ages 55 to 89 (2000-2016). Within each country or geographic region, we also investigate gender differences in age gradients of the probability of disability onset. We, then, pool data from all countries and test the hypothesis that gender inequality increases the probability of disability onset.
Results:
We found substantial cross-country variation in disability incidence rates, and this variation is greater for women than for men. Among ages 65-69, disability incidence rates ranged from 0.4 to 5.0 for men and from 0.5 to 9.4 for women. Our within-country analysis showed significant gender differences in age gradients of the probability of disability onset in the U.S., Korea, Southern Europe, Mexico, and China, but not in Northern, Central, and Eastern Europe, England and Israel. Testing hypothesized effects of gender inequality, we find that gender inequality is significantly associated with the probability of disability onset for women, but not for men.
Conclusions:
Macro-level societal gender inequality is significantly associated with the probability of disability onset for women. Reducing and eliminating gender inequality is crucial to achieving good health for women.
... Functional impairment also often leads to reduced physical activity, which can exacerbate functional decline and other comorbid conditions such as obesity, diabetes, arthritis, and cardiovascular disease. Despite the well-developed literature on the prevalence of poor function (1,2,7), there remains a paucity of research on recovery from functional impairment. ...
Background
Despite evidence that African Americans shoulder a high burden of mobility limitation, little is known about factors associated with recovery.
Methods
Participants from the Jackson Heart Study underwent three in-person exams from 2000-2013. Mobility limitations were assessed over this period by self-reported limitations in walking half a mile or climbing stairs during annual phone calls. The outcome of interest, recovery from mobility limitation, was defined as no mobility limitation the year following an incident event. Candidate predictor variables were assessed in logistic regression models, including sociodemographic, psychosocial, and health measures. Inverse probability weights were used to address missing data in the outcome.
Results
Among 4,526 participants [mean (SD) age = 54.5 (12.8) years] without a mobility limitation at baseline, 1,445 (32%) had an incident mobility limitation over 12 years of follow-up, and 709 (49%) reported recovery from mobility limitation by one year later. Low income and daily discrimination were associated with a lower likelihood of recovery even after adjustment for covariates. In adjusted models, greater comorbidity was associated with a lower likelihood of recovering (p-value for trend = 0.05). History of heart failure and cancer were associated with a lower likelihood of recovering from mobility limitation (OR: 0.52, 95% CI: 0.29, 0.94 and 0.74, 95% CI: 0.55, 1.00). Adiposity, smoking status, and physical activity were not associated with recovery from mobility limitation.
Conclusion
Half of incident mobility limitations in this population of middle-aged African Americans were transient. Adverse sociodemographic factors and comorbidities were associated with lower likelihood of recovery.
