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Hays RD, Haas A, Haviland AM, Martino SC, Orr N, Binion J, Elliott MN. Factors associated with self-reports of limitations in activities of daily living among Medicare Fee-for-Service recipients. BMC Geriatr 2024; 24:648. [PMID: 39090545 PMCID: PMC11295787 DOI: 10.1186/s12877-024-05242-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 07/24/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND Physical function is an important indicator of physical health and predicts mortality. This study identified characteristics associated with limitations in Medicare recipients' activities of daily living. METHODS 2019 Consumer Assessment of Healthcare Providers and Systems Fee-for-Service Medicare Survey data: 79,725 respondents (34% response rate) who were 65 and older and 53% female; 7% Black, 5% Hispanic, 4% Asian American, Native Hawaiian, or other Pacific Islander, 2% Multiracial, 1% American Indian/Alaskan Native; 35% with high school education or less. Walking, getting in and out of chairs, bathing, dressing, toileting, and eating (scored as having no difficulty versus being able to do with difficulty or unable to do) and a scale of these items were regressed on patient characteristics. RESULTS After adjustment for all characteristics, function limitations were found for those who smoked (effect sizes of significant associations range .04-.13), had chronic health conditions (.02-.33), were 85 years or older (.09-.46), needed assistance completing the survey (.32-1.29), were female (.05-.07), and had low income and assets (.15-.47). CONCLUSIONS These nationally representative U.S. estimates of physical function characteristics are useful for interventions for vulnerable population subgroups.
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Affiliation(s)
- Ron D Hays
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, US
- UCLA Department of Medicine, Division of General Internal Medicine & Health Services Research, Los Angeles, 1100 Glendon Avenue, CA, 90024, US
| | - Ann Haas
- RAND Corporation, 4570 Fifth Ave, Pittsburgh, PA, 15213, US
| | - Amelia M Haviland
- Carnegie Mellon University, Hamburg Hall, 5000 Forbes Ave, Pittsburgh, PA, 15213, US
| | | | - Nate Orr
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, US
| | - Joy Binion
- Centers for Medicare & Medicaid Services, 7500 Security Blvd, Baltimore, MD, 21244, US
| | - Marc N Elliott
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, US.
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do Nascimento CF, Batista AFDM, Duarte YAO, Chiavegatto Filho ADP. Early identification of older individuals at risk of mobility decline with machine learning. Arch Gerontol Geriatr 2022; 100:104625. [DOI: 10.1016/j.archger.2022.104625] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/09/2022] [Accepted: 01/19/2022] [Indexed: 12/20/2022]
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El Fakiri F, Bouwman-Notenboom J, Agyemang C. Ethnic differences in functional limitations: a comparison of older migrants and native Dutch older population. Eur J Public Health 2021; 32:214-219. [PMID: 34557916 PMCID: PMC8975522 DOI: 10.1093/eurpub/ckab080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Although the older migrants population in Europe is expected to grow substantially in the coming years, there is little information about their health status and particularly functional limitations. This study examined the association of ethnicity and mobility, hearing and visual limitations in comparison to the general population in the Netherlands, and whether relevant characteristics explained the potential differences between older migrants and non-migrants. Methods Secondary data analysis of 12 652 subjects 55 years and older who participated in the health survey in the four largest Dutch cities. To establish limitations in vision, hearing and mobility, the Organization for Economic Co-operation and Development (OECD) questionnaire was used. Logistic regression analysis was used to examine the association between limitations and ethnic background, subsequently adjusting for demographic and socio-economic characteristics and relevant health- and lifestyle-related factors. Results Older migrants had higher prevalences of functional limitations. The age- and- gender adjusted ORs were 2 to 8-fold compared with older non-migrants. After adjusting for socioeconomic status and health-and lifestyle indicators, Moroccan, Turkish and Surinamese migrants still had increased ORs for visual limitations [ORs (95% CI), respectively: 2.48 (1.49–4.14), 3.08 (1.75–5.41) and 1.97 (1.33–2.91)] compared with the Dutch. For mobility limitations, only the Turkish migrants had an OR twice as high (2.19; 1.08–4.44) as the non-migrants. No significant differences were found between Antillean/Aruban migrants and non-migrants. Conclusions Important ethnic inequalities exist in various functional limitations, particularly in vision. These results underline the importance of tailored preventive interventions in older migrants to detect and prevent these limitations at an early stage.
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Affiliation(s)
- Fatima El Fakiri
- Department of Epidemiology, Health Promotion and Care Innovation, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | | | - Charles Agyemang
- Department of Public & Occupation Health, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Ang S. Intersectional cohort change: Disparities in mobility limitations among older Singaporeans. Soc Sci Med 2019; 228:223-231. [PMID: 30927616 DOI: 10.1016/j.socscimed.2019.03.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 03/05/2019] [Accepted: 03/22/2019] [Indexed: 11/18/2022]
Abstract
Mobility is fundamental to independent living, but past research on physical function and mobility in older adults has not considered both intersectional social identities and cohort change in tandem. This paper utilizes data on mobility limitations from older adults in multi-ethnic Singapore to test whether cohort change varies simultaneously by gender and ethnicity. Panel data (n = 9334 person-years) collected over six years (2009-2015) were used to estimate aging vector models. Findings show that after adjusting for all covariates, Malay and Indian males in later-born cohorts have an increased number of mobility limitations compared to earlier-born cohorts. While a similar trend was also found for Chinese males and females in unconditional models, these were fully mediated by sociodemographic and health variables. These results highlight the importance of considering cohort change at the intersection of gender and ethnicity, bringing attention to possible inequities between ethnic groups.
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Affiliation(s)
- Shannon Ang
- Department of Sociology, University of Michigan, Ann Arbor, USA; Population Studies Center, University of Michigan, Ann Arbor, USA; Sociology, School of Social Sciences, Nanyang Technological University, Singapore.
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Groessl EJ, Kaplan RM, Rejeski WJ, Katula JA, Glynn NW, King AC, Anton SD, Walkup M, Lu CJ, Reid K, Spring B, Pahor M. Physical Activity and Performance Impact Long-term Quality of Life in Older Adults at Risk for Major Mobility Disability. Am J Prev Med 2019; 56:141-146. [PMID: 30573142 PMCID: PMC6309909 DOI: 10.1016/j.amepre.2018.09.006] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 09/03/2018] [Accepted: 09/04/2018] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Older adults are a rapidly growing segment of the U.S. POPULATION Mobility problems that lead to further disability can be addressed through physical activity interventions. Quality of life outcome results are reported from a large trial of physical activity for sedentary older adults at risk for mobility disability. METHODS Data were from the Lifestyle Interventions and Independence for Elders study. This multisite RCT compared physical activity to health education among 1,635 randomly assigned sedentary older adults at risk for mobility disability in 2010-2011. Measures included demographics; comorbidity; a timed 400-meter walk; the Short Physical Performance Battery; and the Quality of Well-Being Scale (0-1.0 scale). Baseline and long-term follow-up (2.6 years) health-related quality of life data were collected as a secondary outcome. Multivariate linear regression modeling was used to examine covariates of health-related quality of life over time in 2017. RESULTS The sample had an overall mean Quality of Well-Being score of 0.613. Both groups declined in quality of life over time, but assignment to the physical activity intervention resulted in a slower decline in health-related quality of life scores (p=0.03). Intervention attendance was associated with higher health-related quality of life for both groups. Baseline characteristics including younger age, fewer comorbid conditions, non-white ethnicity, and faster 400-meter walk times were also associated with higher health-related quality of life over time. CONCLUSIONS Declining mobility measured by physical performance is associated with lower quality of life in sedentary older adults. Physical activity interventions can slow the decline in quality of life, and targeting specific subgroups may enhance the effects of such interventions.
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Affiliation(s)
- Erik J Groessl
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California; Health Services Research and Development Unit, VA San Diego Healthcare System, San Diego, California.
| | - Robert M Kaplan
- Clinical Excellence Research Center, Department of Medicine, Stanford University, Stanford, California
| | - W Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina
| | - Jeffrey A Katula
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina
| | - Nancy W Glynn
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Abby C King
- Department of Health Research and Policy and Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Stephen D Anton
- Department of Aging and Geriatric Research, University of Florida, Gainesville, Florida
| | - Michael Walkup
- Department of Biostatistical Sciences, Wake Forest University, Winston-Salem, North Carolina
| | - Ching-Ju Lu
- Department of Aging and Geriatric Research, University of Florida, Gainesville, Florida
| | - Kieran Reid
- Nutrition, Exercise Physiology and Sarcopenia Laboratory, Tufts University, Boston, Massachusetts
| | - Bonnie Spring
- Department of Medicine, Northwestern University, Chicago, Illinois
| | - Marco Pahor
- Department of Aging and Geriatric Research, University of Florida, Gainesville, Florida
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Garcia MA, Downer B, Crowe M, Markides KS. Aging and Disability Among Hispanics in the United States: Current Knowledge and Future Directions. Innov Aging 2017; 1:igx020. [PMID: 30480115 PMCID: PMC6177050 DOI: 10.1093/geroni/igx020] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Hispanics are the most rapidly aging minority population in the United States. Our objective is to provide a summary of current knowledge regarding disability among Hispanics, and to propose an agenda for future research. RESEARCH DESIGN AND METHODS A literature review was conducted to identify major areas of research. A life course perspective and the Hispanic Paradox were used as frameworks for the literature review and for identifying future areas of research. RESULTS Four research areas were identified: (1) Ethnic disparities in disability; (2) Heterogeneity of the U.S. older Hispanic population; (3) Risk factors for disability; and (4) Disabled life expectancy. Older Hispanics are more likely than non-Hispanic whites to be disabled or to become disabled. Disability varied by country of origin, nativity, age of migration, and duration in the United States. Important risk factors for disability included chronic health conditions, depression, and cognitive impairment. Protective factors included positive affect and physical activity. Older Hispanics have longer life expectancy than non-Hispanic whites but spend a greater proportion of old age disabled. Future research should continue to monitor trends in disability as younger generations of Hispanics reach old age. Attention needs to be given to regional variation within the United States for disability prevalence, early-life risk factors, and factors that may contribute to variation in disabled life expectancy. There is also an urgent need for interventions that can effectively prevent or delay the onset of disability in older Hispanics. DISCUSSION AND IMPLICATIONS Considerable research has examined disability among older Hispanics, but continued research is needed. It is important that research findings be used to inform public policies that can address the burden of disability for older Hispanic populations.
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Affiliation(s)
- Marc A Garcia
- Division of Rehabilitation Sciences, Sealy Center on Aging, University of Texas Medical Branch
| | - Brian Downer
- Division of Rehabilitation Sciences, Sealy Center on Aging, University of Texas Medical Branch
| | - Michael Crowe
- Department of Psychology, University of Alabama at Birmingham
| | - Kyriakos S Markides
- Department of preventive medicine and Community Health, University of Texas Medical Branch, Galveston, Texas
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Payne CF, Gómez-Olivé FX, Kahn K, Berkman L. Physical Function in an Aging Population in Rural South Africa: Findings From HAALSI and Cross-National Comparisons With HRS Sister Studies. J Gerontol B Psychol Sci Soc Sci 2017; 72:665-679. [PMID: 28369527 PMCID: PMC6075193 DOI: 10.1093/geronb/gbx030] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 03/13/2017] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES We use recently-collected data from the Health and Aging in Africa: a Longitudinal Study of an INDEPTH Community in South Africa (HAALSI) cohort from Agincourt, South Africa, to describe physical functioning in this aging population, and place the overall level and age-trajectories of physical health in the context of other Health and Retirement Study (HRS) sister studies in low- and middle-income countries (LMICs). METHOD We conduct multiple regression to estimate associations of physical functioning assessed from both self-report (activities of daily living [ADL] limitation, self-reported health) and performance (grip strength, gait speed) with socio-demographic and health characteristics in HAALSI, and use fully-interacted regression models to compare age-patterns of physical functioning outcomes cross-nationally. RESULTS Gender differences in self-reported health are minimal, and men had 30% higher odds of being ADL limited controlling for socio-demographic and health characteristics. Measured physical performance is closely tied with socioeconomic conditions, but self-reported measures have a much smaller or weaker socioeconomic gradient. In international age-adjusted comparisons, the HAALSI sample had lower physical performance outcomes than most comparison populations. DISCUSSION As the first HRS sister study undertaken in Africa, HAALSI adds vital information on population aging and health in the region. Continuing waves of HAALSI data will be a key resource for understanding differences in the complex processes of disability across LMIC contexts.
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Affiliation(s)
- Collin F Payne
- Center for Population and Development Studies, Harvard University, Cambridge, Massachusetts
| | - Francesc Xavier Gómez-Olivé
- Center for Population and Development Studies, Harvard University, Cambridge, Massachusetts
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Centre for Global Health Research, Epidemiology and Global Health, Umeå University, Sweden
| | - Lisa Berkman
- Center for Population and Development Studies, Harvard University, Cambridge, Massachusetts
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Bakk L, Cadet T, Lien L, Smalley A. Home Modifications among Community-Dwelling Older Adults: A Closer Look at Race and Ethnicity. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2017; 60:377-394. [PMID: 28657880 DOI: 10.1080/01634372.2017.1341444] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This study investigated racial and ethnic differences in home modification use. Data from the 2011 National Health and Aging Trends Study were used (n=6,764). Compared with non-Hispanic Whites, Hispanics were less likely to have a grab bar (odds ratio (OR) = 0.6), bath seat (OR = 0.8), or raised toilet (OR = 0.6). Non-Hispanic Blacks were less likely to have a grab bar (OR = 0.7) or bath seat (OR = 0.7) than non-Hispanic Whites, but more likely to have a raised toilet (OR = 1.3). English proficiency largely explained ethnic differences, while health status partially accounted for racial disparities.
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Affiliation(s)
- Louanne Bakk
- a Institute on Innovative Aging Policy and Practice, School of Social Work , University at Buffalo , Buffalo , New York , USA
| | - Tamara Cadet
- b Simmons College , School of Social Work , Boston , Massachusetts , USA
- c Oral Health Policy and Epidemiology, HSDM-Oral Health Policy and Epidemiology , Harvard School of Dental Medicine , Boston , Massachusetts , USA
| | - Laura Lien
- d Chief Education Office, State of Oregon , Salem , Oregon , USA
| | - Angela Smalley
- e Department of Rehabilitation Science, School of Public Health and Health Professions , University at Buffalo , Buffalo , New York , USA
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Kang L, Jia L, Han P, Zhang W, Ma Y, Fu L, Yu H, Chen X, Wang L, Hou L, Yu X, Song J, He R, Li H, Miao T, Yang X, Niu K, Wang L, Guo Q. Combined Effect of Obesity and Mobility Limitation with Incidence of Type 2 Diabetes and Mortality in Chinese Elderly. Rejuvenation Res 2017; 20:375-382. [PMID: 28398133 DOI: 10.1089/rej.2017.1936] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
This article aims to examine the effect of mobility limitation and obesity on the risk of new incidence of type 2 diabetes mellitus (T2DM) and mortality. The design was a cohort study (n = 1075) among adults aged 60 years and older. Obesity was defined as body-mass index greater than or equal to 28 kg/m2. Mobility limitation was defined as participants scoring in the top 20% on the timed up and go test or in the slowest 20% for the 4-m walking test. The mean age of the study population was 67.4 ± 5.4 years (age range: 60-86 years), and 57.4% were women. Overall, 5.1% of women and 1.9% of men had both obesity and mobility limitations. During 3-year follow-up, the new incidence of T2DM was 2.98% and the adjusted risk of the new incidence of T2DM was progressively greater in obese subjects without mobility limitation, but not greater in the single mobility limitation subjects. The combination of mobility limitation and obesity (odds ratio = 10.3, 95% confidence interval = 2.25-70.13) has a significantly higher risk than obesity only or mobility limitation only. What is more, obesity with mobility limitation could be an independent predictor of 3-year mortality compared with the other subjects. We demonstrated the associations between obesity and mobility limitation and thus the increased risk of developing, with the combination over time, T2DM and mortality.
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Affiliation(s)
- Li Kang
- 1 Department of Rehabilitation Medicine, TEDA International Cardiovascular Hospital, Cardiovascular Clinical College of Tianjin Medical University , Tianjin, China .,2 Department of Rehabilitation Medicine, Tianjin Medical University , Tianjin, China
| | - Liye Jia
- 2 Department of Rehabilitation Medicine, Tianjin Medical University , Tianjin, China
| | - Peipei Han
- 2 Department of Rehabilitation Medicine, Tianjin Medical University , Tianjin, China
| | - Wen Zhang
- 2 Department of Rehabilitation Medicine, Tianjin Medical University , Tianjin, China
| | - Yixuan Ma
- 2 Department of Rehabilitation Medicine, Tianjin Medical University , Tianjin, China
| | - Liyuan Fu
- 2 Department of Rehabilitation Medicine, Tianjin Medical University , Tianjin, China
| | - Hairui Yu
- 2 Department of Rehabilitation Medicine, Tianjin Medical University , Tianjin, China
| | - Xiaoyu Chen
- 2 Department of Rehabilitation Medicine, Tianjin Medical University , Tianjin, China
| | - Lu Wang
- 2 Department of Rehabilitation Medicine, Tianjin Medical University , Tianjin, China
| | - Lin Hou
- 2 Department of Rehabilitation Medicine, Tianjin Medical University , Tianjin, China
| | - Xing Yu
- 2 Department of Rehabilitation Medicine, Tianjin Medical University , Tianjin, China
| | - Jianing Song
- 2 Department of Rehabilitation Medicine, Tianjin Medical University , Tianjin, China
| | - Ruiming He
- 2 Department of Rehabilitation Medicine, Tianjin Medical University , Tianjin, China
| | - Hui Li
- 2 Department of Rehabilitation Medicine, Tianjin Medical University , Tianjin, China
| | - Tingting Miao
- 2 Department of Rehabilitation Medicine, Tianjin Medical University , Tianjin, China
| | - Xiaolong Yang
- 2 Department of Rehabilitation Medicine, Tianjin Medical University , Tianjin, China
| | - Kaijun Niu
- 3 Nutritional Epidemiology Institute, Tianjin Medical University , Tianjin, China .,4 School of Public Health, Tianjin Medical University , Tianjin, China
| | - Liancheng Wang
- 5 Department of Rehabilitation Medicine, Tianjin Hospital , Tianjin, China
| | - Qi Guo
- 1 Department of Rehabilitation Medicine, TEDA International Cardiovascular Hospital, Cardiovascular Clinical College of Tianjin Medical University , Tianjin, China .,2 Department of Rehabilitation Medicine, Tianjin Medical University , Tianjin, China
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Windham BG, Harrison KL, Lirette ST, Lutsey PL, Pompeii LA, Gabriel KP, Koton S, Steffen LM, Griswold ME, Mosley TH. Relationship Between Midlife Cardiovascular Health and Late-Life Physical Performance: The ARIC Study. J Am Geriatr Soc 2017; 65:1012-1018. [PMID: 28165626 PMCID: PMC5435564 DOI: 10.1111/jgs.14732] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To examine the association between midlife cardiovascular health and physical performance 25 years later. DESIGN Cohort study (Atherosclerosis Risk in Communities Study); multinomial logistic and logistic regression adjusted for demographic characteristics and clinical measures. SETTING Four U.S. communities: Forsyth County, North Carolina; Washington County, Maryland; Minneapolis, Minnesota; and Jackson, Mississippi. PARTICIPANTS Individuals aged 54.2 ± 5.8 at baseline (N = 15,744; 55% female, 27% black). MEASUREMENTS Cardiovascular health was measured at baseline using the American Heart Association's Life's Simple 7 (LS7) score (0-14) and LS7 component categories (poor, intermediate, ideal) for each risk factor. The Short Physical Performance Battery (SPPB) was used to quantify physical function as ordinal (0-12) and categorical (low (0-6), fair (7-9), good (10-12) outcomes. RESULTS Mean baseline LS7 score was 7.9 ± 2.4; 6,144 (39%) individuals returned 25 years later for the fifth ARIC examination, at which point the SPPB was administered. Of 5,916 individuals who completed the SPPB, 3,288 (50%) had good physical performance. Each 1-unit increase in LS7 score was associated with a 17% higher SPPB score (rate ratio (RR) = 1.17, 95% confidence interval (CI) = 1.15-1.19) and a 29% greater chance of having a late-life SPPB score of 10 or greater compared to SPPB score of less than 10 (RR = 1.29, 95% CI = 1.25-1.34). Ideal baseline glucose (RR = 2.53, 95% CI = 2.24-2.87), smoking (RR = 1.97, 95% CI = 1.81-2.15), blood pressure (RR = 1.70, 95% CI = 1.54-1.88), body mass index (RR = 1.51, 95% CI = 1.37-1.66), and physical activity (RR = 1.31, 95% CI = 1.20-1.43) had the strongest associations with late-life SPPB score, adjusting for other LS7 components. CONCLUSION Better cardiovascular health during midlife may lead better physical functioning in older age.
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Affiliation(s)
- B Gwen Windham
- Dept. of Medicine, Division of Geriatrics, University of Mississippi Medical Center
| | | | - Seth T Lirette
- Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center
| | | | - Lisa A Pompeii
- University of Texas Health Science Center at Houston School of Public Health
| | - Kelley Pettee Gabriel
- University of Texas Health Science Center at Houston School of Public Health Austin Campus
| | | | | | - Michael E Griswold
- Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center
| | - Thomas H Mosley
- Dept. of Medicine, Division of Geriatrics, University of Mississippi Medical Center
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Brenner AB, Clarke PJ. Understanding Socioenvironmental Contributors to Racial and Ethnic Disparities in Disability Among Older Americans. Res Aging 2016; 40:103-130. [PMID: 27909061 DOI: 10.1177/0164027516681165] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Our understanding of the mechanisms through which racial/ethnic disparities in disability in older adults develop and are maintained is limited. We examined the role of physical impairment, socioeconomic factors and health for racial/ethnic disparities in activities of daily living (ADL), and the modifying role of the indoor home environment. Data come from the National Health and Aging Trends Study ( N = 5,640), and negative binomial regression models were specified separately for men and women. Blacks and Hispanics reported more ADL difficulty than Whites. Living in homes with clutter was associated with higher rates of ADL difficulty, but it was not related to racial/ethnic disparities. Racial/ethnic differences were explained by physical impairment for men, but not for women. Socioeconomic factors and health accounted for remaining disparities for Black, but not for Hispanic women. Attention to individual and environmental factors is necessary to fully understand and address race/ethnic disparities in disability in older Americans.
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Affiliation(s)
- Allison B Brenner
- 1 Survey Research Center at the Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Philippa J Clarke
- 1 Survey Research Center at the Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
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Nascimento CFD, Duarte YAO, Lebrão ML, Chiavegatto Filho ADP. Individual and Neighborhood Factors Associated With Functional Mobility and Falls in Elderly Residents of São Paulo, Brazil: A Multilevel Analysis. J Aging Health 2016; 30:118-139. [DOI: 10.1177/0898264316669229] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: To identify socioeconomic and contextual factors associated with functional mobility and falls in elderly residents of São Paulo, Brazil. Method: We used data from the Health, Well-Being, and Aging ( Saúde, Bem-estare Envelhecimento [SABE]) Study. The dependent variables were falling in the last year and functional mobility impairment. Individual (marital status, race, education, and perception of income sufficiency) and contextual (green area and violence) factors were analyzed by multilevel logistic models. Results: Having 8 or more years of schooling was a protective factor for mobility impairment. Neighborhoods with moderate homicide rate were associated with higher odds of falling. Moderate green spaces were associated with higher odds of falling and lower odds to have mobility impairment for individuals 80 years and older. Discussion: Our findings support the concern that neighborhood characteristics are associated with falls and mobility impairment. Strategies to prevent these outcomes should consider contextual aspects.
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13
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Brenner AB, Burke JF, Skolarus LE. Moving Toward an Understanding of Disability in Older U.S. Stroke Survivors. J Aging Health 2016; 30:75-104. [PMID: 27605555 DOI: 10.1177/0898264316666125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES We test a comprehensive model of disability in older stroke survivors and determine the relative contribution of neighborhood, economic, psychological, and medical factors to disability. METHOD The sample consisted of 728 stroke survivors from the National Health and Aging Trends Study (NHATS), who were 65 years and older living in community settings or residential care. Confirmatory factor analysis and structural equation modeling were used to test relationships between neighborhood, socioeconomic, psychological, and medical factors, and disability. RESULTS Economic and medical context were associated with disability directly and indirectly through physical impairment. Neighborhood context was associated with disability, but was only marginally statistically significant ( p = .05). The effect of economic and neighborhood factors was small compared with that of medical factors. DISCUSSION Neighborhood and economic factors account for a portion of the variance in disability among older stroke survivors beyond that of medical factors.
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Buchman AS, Wilson RS, Yu L, Boyle PA, Bennett DA, Barnes LL. Motor Function Is Associated With Incident Disability in Older African Americans. J Gerontol A Biol Sci Med Sci 2015; 71:696-702. [PMID: 26525087 PMCID: PMC5007739 DOI: 10.1093/gerona/glv186] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 09/28/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Disability in older African American adults is common, but its basis is unclear. We tested the hypothesis that the level of motor function is associated with incident disability in older African Americans after adjusting for cognition. METHODS A prospective observational cohort study of 605 older community-dwelling African American adults without dementia was carried out. Baseline global motor score summarized 11 motor performances, cognition was based on 19 cognitive tests, and self-reported disability was obtained annually. We examined the association of motor function with incident disability (instrumental activities of daily living [IADL], activities of daily living [ADL], and mobility disability) with a series of Cox proportional hazards models which controlled for age, sex, and education. RESULTS Average follow-up was about 5 years. In proportional hazards models, a 1-SD increase in baseline level of global motor score was associated with about a 50% decrease in the risk of subsequent IADL, ADL, and mobility disability (all p values < .001). These associations were unchanged in analyses controlling for cognition and other covariates. Further, the association of global motor score and incident ADL disability varied with the level of cognition (estimate -5.541, SE 1.634, p < .001), such that higher motor function was more protective at higher levels of cognition. Mobility and dexterity components of global motor score were more strongly associated with incident disability than strength (all p values < .001). CONCLUSIONS Better motor function in older African Americans is associated with a decreased risk of developing disability. Moreover, the association of motor function and disability is stronger in individuals with better cognitive function.
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Affiliation(s)
- Aron S Buchman
- Rush Alzheimer's Disease Center, Department of Neurological Sciences, and
| | - Robert S Wilson
- Rush Alzheimer's Disease Center, Department of Neurological Sciences, and Department of Behavioral Sciences, Rush University Medical Center, Chicago, Illinois
| | - Lei Yu
- Rush Alzheimer's Disease Center, Department of Neurological Sciences, and
| | - Patricia A Boyle
- Rush Alzheimer's Disease Center, Department of Neurological Sciences, and Department of Behavioral Sciences, Rush University Medical Center, Chicago, Illinois
| | - David A Bennett
- Rush Alzheimer's Disease Center, Department of Neurological Sciences, and
| | - Lisa L Barnes
- Rush Alzheimer's Disease Center, Department of Neurological Sciences, and Department of Behavioral Sciences, Rush University Medical Center, Chicago, Illinois
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Dong R, Wang X, Guo Q, Wang J, Zhang W, Shen S, Han P, Ma Y, Kang L, Wang M, Fu L, Jia L, Wang L, Niu K. Clinical Relevance of Different Handgrip Strength Indexes and Mobility Limitation in the Elderly Adults. J Gerontol A Biol Sci Med Sci 2015; 71:96-102. [DOI: 10.1093/gerona/glv168] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 08/31/2015] [Indexed: 12/18/2022] Open
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