From Disability to Death: A 20-Year Follow-Up from the Taiwan Longitudinal Study on Aging

Background

In this study, factors associated with the duration of a disability before death in older adults who are moderately to severely disabled in Taiwan are investigated.

Methods

A nationally representative sample of older adults (65+) in 1996 who died before 2016 (n = 1139) were analyzed to calculate their disability status and the length of time they were disabled before death.

Results

The mean period during which the participants experienced moderate to severe disability before death for older adults in Taiwan was 5.53 years (SD = 3.15). Men who were overweight had an average of 1.17 more survival years (β_overweight = 1.17, p < 0.05) as compared to those who were normal weight, and in the case of those who were cognitively impaired (SPMSQ ≤ 7), years of survival were decreased by an average of 1.70 years as compared to those who were cognitively intact before death (βcognition = −1.70, p < 0.01). The aforementioned effects were independent of age. In women, the number of diseases was the most dominant independent correlate for survival years (β_disease = −0.34, p < 0.05).

Conclusion

Disability distribution at various time points before death among the elderly in Taiwan was revealed in the study. At 10 years before death, 93% of the elderly were free from any ADL disabilities, and only 4% reported more than three ADL disabilities. At 6 years before death, an average of 10% of the participants had more than three ADL disabilities, and at one year before death, moderate to severe disability increased to 38%. Factors associated with the survival years among those who were moderately to severely disabled showed distinct gender differences.

Disability trajectories in activities of daily living of elderly Chinese before death

This study aims to analyze the changes in activities of daily living (ADL) of the Chinese elderly before death, and to explore the heterogeneity in this process. Using data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), we quantify disability trajectories of ADL using a group-based trajectory model and find that there are three types of disability trajectory for ADL. The elderly who differ by socioeconomic status, childhood experiences, health behaviors, ages and birth cohorts show significant differences in their disability trajectories. Long duration of disability is found to be more prevalent in older females and people with high socioeconomic status. Good and stable status of ADL is more common among males and people of low socioeconomic status, while the elderly in an early cohort who died at older ages were more likely to have experienced a long duration of disability. Selective and protective effects contribute to the observed differences in trajectories.

Aging With Disability for Midlife and Older Adults

This analysis brings “aging with disability” into middle and older ages. We study U.S. adults ages 51+ and ages 65+ with persistent disability (physical, household management, personal care; physical limitations, instrumental activities of daily living [IADLs], activities of daily living [ADLs]), using Health and Retirement Study data. Two complementary approaches are used to identify persons with persistent disability, one based directly on observed data and the other on latent classes. Both approaches show that persistent disability is more common for persons ages 65+ than ages 51+ and more common for physical limitations than IADLs and ADLs. People with persistent disability have social and health disadvantages compared to people with other longitudinal experiences. The analysis integrates two research avenues, aging with disability and disability trajectories. It gives empirical heft to government efforts to make aging with disability an age-free (all ages) rather than age-targeted (children and youths) perspective.

Predictors of ADL Disability Trajectories Among Low-Income Frail Elders in the Community

In this study, the author examined the effects of psychosocial and health factors on the ADL disability trajectory of low-income frail elders living in the community. She analyzed three-year longitudinal data with a maximum of 15 repeated observations from a cohort of elderly participants in Michigan’s Medicaid Waiver Program ( N=3,161), using the hierarchical linear modeling approach. Baseline data of this cohort were taken in 1999; a reassessment was conducted about every three months. The analysis shows that major risk factors for a poor activity of daily living (ADL) disability trajectory include being Black, older, living with nonspouse others, and no confidence in functional improvement. Presence of arthritis, cancer, and cognitive limitation had significant and modest effects on ADL disability trajectories. The findings have implications to community-based intervention programs for frail elderly persons in the community.

Reliability and Validity of the Brazilian Version of the Late-Life Function and Disability Instrument

OBJECTIVE

We evaluated the test-retest reliability, internal consistency, and construct validity of the Brazilian version of the Late-Life Function and Disability Instrument.

METHOD

A sample of 118 older adults provided data for testing construct validity and internal consistency, and 14 provided data for testing test-retest reliability. Factor analysis with varimax rotation was used to assess construct validity.

RESULTS

The Function component had excellent test-retest and total internal consistency reliability. Factor analysis revealed that the Upper Extremity Function and Advanced Lower Extremity Function domains were similar to the original analysis. The Disability component showed adequate to excellent test-retest reliability, except in the Management role; total internal consistency was excellent. Factor analysis revealed that its domains were similar to the original analysis, except for some items.

CONCLUSION

The Late-Life Function and Disability Instrument is recommended for assessment of Brazilian community-dwelling older adults who are functionally independent and who do not require mobility assistance.

Trajectories of limitations in activities of daily living among older adults in Mexico, 2001-2012

BACKGROUND

Trajectories of disability are an essential component to understand the burden of disability at the societal level. Longitudinal studies, compared to cross-national studies, enable a better analysis of the progression of physical limitations among the elderly. However, information on disability dynamics in developing countries is limited.

OBJECTIVES

This paper examines the changes in activities of daily living (ADLs) in an 11-yr. period in the Mexican elderly population aged 60 or older and identifies how sociodemographic variables alter these trajectories.

METHODS

The data come from the Mexican Health and Aging Study (MHAS), a national sample of adults born in 1951 or earlier, including a baseline survey in 2001 and follow-ups in 2003 and 2012.

RESULTS

The ADL score increased on average by 0.03 for every year respondents aged after 60. In contrast, the ADL score was reduced by 0.06 for every additional year of education.

CONCLUSIONS

Age, gender, and years of education were confirmed to influence the trajectories of ADL limitations. Understanding the patterns of deterioration of functional limitations will help public health policies to better serve the population.

Examining late-life functional limitation trajectories and their associations with underlying onset, recovery, and mortality

OBJECTIVES

Identify common trajectories of physical functional limitation and mortality among Taiwanese 50 and older as they age, link these to underlying transitions in onset, recovery, and mortality, and assess associations between trajectories and a set of risk factors.

METHOD

Longitudinal data from 4 waves of the Survey of Health and Living Status of the Middle-Aged and Elderly in Taiwan, collected between 1996 and 2007, are analyzed using a summary measure indicating difficulty with one or more of 7 physical functions. A group-based trajectory model identifies common trajectories. Shorter term transition probabilities that underlie multiperiod trajectories are examined. Multinomial regression associates risk factors with trajectory group membership.

RESULTS

Best fitting the data is a model with 3 groups characterized as early, mid, and late onset of limitation. Roughly half the population follows the trajectory of mid onset and a quarter each of the other 2. Females and those least educated are most likely to belong to the early-onset group.

DISCUSSION

The analysis advances understanding of late-life functioning by focusing on the heterogeneity of functional limitation experience, appropriately accounting for the relation between functional limitation and mortality and linking long-term patterns with short-term changes in functional limitation.

Modeling disability trajectories and mortality of the oldest-old in China

This article uses a group-based modeling approach to jointly estimate disability and mortality trajectories over time based on data from the population aged 80 and older in China, and explores relations of demographic, socioeconomic, and early-life characteristics to membership in gender-specific trajectory groups. A three-group model best fits the data for both males and females. For most groups, predicted numbers of limitations in activities of daily living (ADLs) increase with age, but the pace is gradual in some cases and rapid in others. For each gender, the estimated mortality probability trajectories for the three groups follow a hierarchy that is related to the predicted ADL counts at age 80. Only a few characteristics predict trajectory-group membership. Prior nonagricultural occupation is associated with less favorable disability trajectories for both genders. For females, rural residence, a greater number of children ever born, and having a father who did not work in agriculture are associated with more favorable trajectories. For a small group of males who received education, disability is moderate but changes little with age. Findings may reflect heterogeneity of survival among the least advantaged, as well as a possible expansion of morbidity among a small advantaged group.

Nursing Home Stays and the Pace of Severe Disability Onset

Severe disability is an important predictor of nursing home admissions. The purpose of this study is to examine the role of severe disability pacing on risk of short- and long-term nursing home stays. Respondents who developed severe disability were assigned into one of two pacing trajectories: catastrophic or progressive disability. The author analyzed seven waves of data from the Health and Retirement Study and created a series of discrete-time event history models. The analysis showed that the risk associated with severe disability and nursing home stays varied based on severe disability pacing. Progressive and catastrophic disability were associated with increased risk of short- and long-term stays; however, the risk of nursing home stays was much greater for respondents with catastrophic disability for short- and long-term stays. The findings have implications for policy and research. The author suggests that future research focus on interventions aimed at slowing the pace of severe disability.

End-of-life care in the oldest old

Objective:

The aim of this study was to describe the last year of life of a sample of the oldest old, focusing on care trajectories, health, social networks, and function in daily life activities.

Method:

Data originated from the NONA study, a longitudinal study of 193 individuals among the oldest old living in a Swedish municipality. During this longitudinal study, 109 participants died. Approximately one month after their death, a relative was asked to participate in a telephone interview concerning their relative's last year of life. One hundred two relatives agreed to participate.

Results:

Most of the elderly in this sample of the oldest old (74.5%) died at an institution and the relatives were mostly satisfied with the end-of-life care. The oldest old relatives estimated that the health steadily declined during the last year of life, and that there was a decline in performing of daily life activities. They also estimated that those dying in institutions had fewer social contacts than those dying in a hospital or at home.

Significance of results:

Care at end of life for the oldest old is challenged by problems with progressive declines in ability to perform activities of daily living and health. The findings also highlight the need to support social networks at eldercare institutions.

Health Trajectories Among Older Movers

Objective: To examine health trajectories among older migrants by reason for move. Method: Data from the 1992 to 2006 Health and Retirement Study (HRS) are used to model trajectories of self-rated health and activity of daily living (ADL) limitations that occurred prior seven types of moves. Results: There are substantial differences across the reason-for-move groups in initial levels of self-rated health. Declines in self-rated health among nursing home movers are more than two times steeper than the other reason-for-move groups. Employment, comfort, economic security, life crisis, and affiliation movers have low initial levels of ADL limitations and slow increases in ADL limitations. Health and nursing home movers have higher initial ADL limitations and increases in ADL limitations that are three and seven times higher respectively than the other groups. Discussion: The results are consistent with the predictions of Litwak and Longino’s (1987) typology of later-life migration and the extant literature on later-life migration. Implications for communities are considered.

Religiousness and Longitudinal Trajectories in Elders' Functional Status

The purpose of this study was to examine the effects of religiousness on the trajectories of difficulties with activities of daily living (ADLs) and instrumental ADLs (IADLs) in community-dwelling older adults over a three-year period. Seven waves of data from the University of Alabama at Birmingham Study of Aging were analyzed using a hierarchical linear modeling method. The study was based on the 784 participants who completed interviews every six months between December 1999 and February 2004. Frequent religious service attendance was associated with fewer ADL difficulties and IADL difficulties at baseline. Furthermore, religious service attendance predicted slower increases for frequent churchgoers and steeper increases for less frequent churchgoers in IADL difficulties, controlling for variables related to demographics and resources. Religious service attendance was independently associated with ADL and IADL difficulties cross-sectionally. However, significant protective effects of religious service attendance were identified longitudinally only for the IADL trajectory.