This study examines age distribution and risk factors for the onset of severe disability among community-dwelling older adults with functional limitations. Data were obtained from the initial community-dwelling sample (n = 6,088) of the National Long-Term Care Survey in 1982 and the follow-up interviews in 1984, 1989, 1994, and 1999. Multiple proportional hazard regression was conducted using age at onset of severe disability as the dependent variable. Explanatory variables included chronic diseases and sociodemographic and personal characteristics. Of the 3,485 elders who were not severely disabled initially, 1,364 were identified as developing severe disability over time. The onset age ranged from 66 to 109 years with the peak occurring at 82 to 83 years. The predictors for earlier onset of severe disability were paralysis, arthritis, obesity, hypertension, and middle education level (Grades 9-12). These findings provide practical implications for identifying at-risk individuals and developing health behavior interventions to delay onset of severe disability.
Berkman, L., Seeman, T., Albert, M., Blazer, D., Kahn, R., Mohs, R., et al. (1993). High, usual and impaired functioning in community-dwelling older men and women: Findings from the MacArthur Foundation Research Network on Successful Aging. Journal ofClinical Epidemiology, 46, 1129-1140.
2.
Brooks, P. (2002). Impact of osteoarthritis on individuals and society: How much disability? Social consequences and health economic implications . Current Opinion in Rheumato, 114, 573-577.
3.
Clark, R. (1998). An introduction to the National Long-Term Care Survey. Available from www.cds.duke.edu
4.
Coppin, A., Ferrucci, L., Lauretani, F., Phillips, C., Chang, M., Bandinelli, B., et al. (2006). Low socioeconomic status and disability in old age: Evidence from the InChianti Study for the mediating role of physiological impairments. The Journals of Gerontology Series A: Biological Sciences and MedicalSciences, 61, 86-91.
5.
Cox, D. ( 1972). Regression models and life tables. Journal of the Royal Statistical Society, 34, 187-220.
6.
Cyarto, E., Moorhead, G., & Brown, W. (2004). Updating the evidence relating to physical activity intervention studies in older people. Journal of Science and Medicine in Sport, 7, 30-38.
7.
Dunlop, D., Manheim, L., Sohn, M., Liu, X., & Chang, R. (2002). Incidence of functional limitation in older adults: The impact of gender, race, and chronic conditions. Archives of Physical Medicine and Rehabilitation, 83, 964-971.
8.
Ferraro, K., Su, Y., Gretebeck, R., Black, D., & Badylak, C. (2002). Body mass index and disability in adulthood: A 20-year panel study. American Journal of Public Health, 92, 834-840.
9.
Ferrucci, L., Guralnik, J., Studenski, S., Fried, L., Cutler, G., & Walston, J. (2004). Designing randomized, controlled trials aimed at preventing or delaying functional decline and disability in frail, older persons: A consensus report. Journal of the American Geriatrics Society, 52, 625.
10.
Fried, L., & Guralnik, J. (1997). Disability in older adults: Evidence regarding significance, etiology, and risk. Journal of the American Geriatrics Society, 45, 92-100.
11.
Guralnik, J., LaCroix, A., & Abbott, R. (1993). Maintaining mobility in late life. Demographic characteristics and chronic conditions. American Journal of Epidemiology, 137, 845-857.
12.
House, J., Lantz, P., & Herd, P. (2005). Continuity and change in the social stratification of aging and health over the life course: Evidence from a nationally representative longitudinal study from 1986 to 2001/2002 (Americans' Changing Lives Study) . The Journals of Gerontology: Series B, 60, S15-S26.
13.
Jenkins, K. (2004). Obesity's effects on the onset of functional impairment among older adults. The Gerontologist, 44, 206-216.
14.
Katz, S., Ford, A., Moskowitz, R., Jackson, B., & Jaffee, M. (1963). Studies of illness in the aged: The index of ADL, a standardized measure of biological and psychosocial function. Journal of theAmerican Medical Association, 185, 914-919.
15.
Manton, K., Corder, L., & Stallard, E. (1993). Estimates of change in chronic disability and institutional incidence and prevalence rates in the U.S. elderly population from the 1982, 1984, and 1989 National Long-Term Care Survey. The Journals ofGerontology: Social Science, 48, S153-S166.
16.
Manton, K., & Gu, X. (2001). Changes in the prevalence of chronic disability in the United States Black and nonBlack population above age 65 from 1982 to 1999. Proceedings of the National Academy of Sciences of the United States of America, 98, 6354-6359.
17.
Manton, K., Gu, X., Huang, H., & Kovtun, M. (2004). Fuzzy set analyses of genetic determinants of health and disability status. StatisticalMethods in Medical Research, 13, 395-408.
18.
McCrone, S., Brendle, D., & Barton, K. (2001). A multibehavioral intervention to decrease cardiovascular disease risk factors in older men. AACN Clinical Issues, 12, 5-16.
19.
Penninx, B., Guralnik, J., Bandeen-Roche, K., Kasper, J., Simonsick, E., & Fried, L. (2000). The protective effect of emotional vitality on adverse health outcomes in disabled older women. Journal of the American Geriatrics Society, 48, 1359-1366.
20.
Reynolds, S., Saito, Y., & Crimmins, E. (2005). The impact of obesity on active life expectancy in older American men and women. The Gerontologist, 45, 438-444.
21.
Robert, S., & House, J. (1994). Sociodemographic status and health across the life course. In R. Abeles, H. Gift, & M. Ory (Eds.), Aging and quality of life (pp. 253-274). New York: Springer.
22.
Rogers, R., Rogerts, A., & Belanger, A. (1992). A disability-free life among the elderly in the United States: Sociodemographic correlates of functional health. Journal of Aging and Health, 4, 19-42.
23.
SAS Institute, Inc. (2004). SAS/STAT user's guide (Version 9.1.2). Cary, NC: Author.
24.
Stallard, E. (2000). Retirement and health: Estimates and projections of acute and long-term care needs and expenditures of the U.S. elderly population . In Retirement needs framework (SOA Monograph M-RS00-1, p. 175). Schaumburg, IL: Society of Actuaries.
25.
Stallard, E., & Yee, R. (2000). Non-insured home and community-based long-term care incidence and continuance tables. Actuarial report issued by the long-term care experience committee. Schaumburg, IL: Society of Actuaries.
26.
Stuck, A., Walthert, J., Nikolaus, T., Bula, C., Hohmann, C., & Beck, J. (1999). Risk factors for functional status decline in community-living elderly people: A systematic literature review. Social Science & Medicine, 48, 445-469.
27.
Verbrugge, L., & Jette, A. (1994). The disablement process. Social Science & Medicine, 38, 1-14.
28.
Woodward, M. (1999). Epidemiology study design and data analysis: Texts in statistical science. New York: Chapman and Hall.
29.
World Health Organization. (1980). International classification of impairments, disabilities, and handicaps. Geneva: Author.
30.
Wu, B., Carter, M., Goins, T., & Cheng C. (2005). Emerging services for community-based long-term care (CBLTC) in urban China: A systematic analysis of Shanghai's community-based agencies. Journal of Aging and Social Policy, 17, 37-60.
