The progression of disability among older adults in Mexico

Effect of Autonomy and Physical Activity on Self-Rated Health of Older Adults in India: Gendered Analysis Using Structural Equation Models

The gendered expectations and responsibilities placed upon women can impede their ability to participate in social activities and engage in physical leisure pursuits, ultimately having a negative impact on their health. Our study investigates the mechanisms through which gender influences individuals' engagement with physical activity during free time and how this relates to self-rated health outcomes among adults aged 45 years or older living in India. Using cross-sectional analysis and Structural Equation Modelling, we analyzed data stratified by gender and age from the Longitudinal Ageing Study of India to examine these conceptual pathways. We found that compared to men, women face greater limitations related to decision-making autonomy, experience more functional impairments, have weaker social networks that provide less support for engaging in leisure-time physical activity, leading them to report lower levels of overall wellbeing than men. Further analyses demonstrated distinct pathways through which each gender's level of social network connectivity shapes behavior - strong connections increase opportunities for women specifically to engage positively with both peers and physically active pursuits supporting overall wellness goals.

The bidirectional relationship between activities of daily living and frailty during short-and long-term follow-up period among the middle-aged and older population: findings from the Chinese nationwide cohort study

Objective

Frailty and activities of daily living (ADL) disability are common conditions among older population. Studies on the bidirectional relationship between frailty and ADL are limited. The current study examined the cross-sectional and longitudinal associations between frailty and ADL in middle-aged and older Chinese individuals.

Methods

The data was collected through the China Health and Retirement Longitudinal Study (CHARLS), conducted in 2011, 2013, and 2015, encompassing 17,284 individuals aged ≥45 years. We excluded individuals without follow-up data. 2,631 participants finished the baseline survey. The definition of ADL disability encompasses difficulty in engaging in either basic activities of daily living (BADL) or instrumental activities of daily living (IADL). Frailty was assessed according to the Fried criteria. Logistic regression was utilized to examine odds ratios (ORs) and 95% confidence intervals (CIs) for assessing the cross-sectional relationships between ADL with frailty at baseline. The prediction effects were explored using Cox proportional hazards analysis, testing hazard ratios (HRs) and 95%CIs.

Results

In cross-sectional analysis, BADL [OR = 6.660 (4.519-9.815)], IADL [OR = 5.950 (4.490-7.866)], and ADL [OR = 5.658 (4.278-7.483)] exhibited significant associations with frailty; frailty demonstrated significant associations with BADL [OR = 6.741 (4.574-9.933)], IADL [OR = 6.042 (4.555-8.016)] and ADL [OR = 5.735 (4.333-7.591)]. In longitudinal analysis, IADL and ADL were significantly associated with frailty in participants without baseline frailty in the short-term period [IADL: HR = 1.971 (1.150-3.379), ADL: HR = 1.920 (1.146-3.215)], IADL exhibited a significant association with frailty in the long-term period [HR = 2.056 (1.085-3.895)]. There was no significant link observed between frailty and an elevated risk of disability onset in BADL, IADL and ADL during the short-term period. When considering the long-term perspective, frailty exhibited a significant association with an elevated risk of disability onset in BADL [HR= 1.820 (1.126-2.939)] and IADL [HR = 1.724 (1.103-2.694)].

Conclusion

In middle-aged and older adults, ADL and IADL disability predicted frailty after 2-year follow-up, IADL disability predicted frailty after 4-year follow-up. Moreover, frailty did not predict BADL, IADL and ADL disability after 2-year follow-up. However, frailty predicted BADL and IADL disability after 4-year follow-up.

A Scoping Review of Personal, Financial, and Environmental Determinants of Mobility Among Older Adults

OBJECTIVE

To synthesize available evidence of factors comprising the personal, financial, and environmental mobility determinants and their association with older adults' self-reported and performance-based mobility outcomes.

DATA SOURCES

PubMed, EMBASE, PsychINFO, Web of Science, AgeLine, Sociological Abstract, Allied and Complementary Medicine Database, and Cumulative Index to Nursing and Allied Health Literature databases search for articles published from January 2000 to December 2021.

STUDY SECTION

Using predefined inclusion and exclusion criteria, multiple reviewers independently screened 27,293 retrieved citations from databases, of which 422 articles underwent full-text screening, and 300 articles were extracted.

DATA EXTRACTION

The 300 articles' information, including study design, sample characteristics including sample size, mean age and sex, factors within each determinant, and their associations with mobility outcomes, were extracted.

DATA SYNTHESIS

Because of the heterogeneity of the reported associations, we followed Barnett et al's study protocol and reported associations between factors and mobility outcomes by analyses rather than by article to account for multiple associations generated in 1 article. Qualitative data were synthesized using content analysis. A total of 300 articles were included with 269 quantitative, 22 qualitative, and 9 mixed-method articles representing personal (n=80), and financial (n=1), environmental (n=98), more than 1 factor (n=121). The 278 quantitative and mixed-method articles reported 1270 analyses; 596 (46.9%) were positively and 220 (17.3%) were negatively associated with mobility outcomes among older adults. Personal (65.2%), financial (64.6%), and environmental factors (62.9%) were associated with mobility outcomes, mainly in the expected direction with few exceptions in environmental factors.

CONCLUSIONS

Gaps exist in understanding the effect of some environmental factors (eg, number and type of street connections) and the role of gender on older adults' walking outcomes. We have provided a comprehensive list of factors with each determinant, allowing the creation of core outcome set for a specific context, population, or other forms of mobility, for example, driving.

The Impact of Seguro Popular on the Progression of Disabilities Among Older Adults With Chronic Degenerative Diseases in Mexico

In a context of population aging, poverty, and inequalities including in the access to healthcare services, in 2004 Mexico initiated Seguro Popular (SP), a non-contributory health insurance providing coverage for informal sector workers excluded from social security. We analyze the impact of SP on the progression of functional limitations among adults aged over 50 with chronic degenerative diseases previously without stable health insurance. Panel data from the Mexican Health and Aging Study (MHAS) permit a difference-in-difference propensity score matching approach, comparing respondents before (2003) and after (2015) the implementation of SP. Findings suggest that SP affiliation in (or shortly before) 2012 has (weakly) slowed the progression of mobility, IADL, and ADL limitations, with a clearer effect in large urban centers. Reforms in the healthcare sector should address underlying structural barriers, reduce existing inequities, and provide effective access to high-quality services. with increased attention for long-term care needs, to guarantee healthy aging.

Prevalence and determinants of self-reported functional status among older adults residing in the largest refugee camp of the world

BACKGROUND

The older adults of refugee camps might be vulnerable to exhibiting limited functional abilities because of the limited resources available to create a supportive environment for older population in the camps. This study aims to explore the prevalence and determinants of self-reported functional status among the older adults residing in the Rohingya refugee camp in Bangladesh.

METHODS

This cross-sectional study was conducted on 864 older adults aged 60 years and above living in five selected sub-camps of Rohingya refugee camp in Cox's Bazar, Bangladesh. Data were collected through face-to-face interviews of the participants between November-December 2021. Functional status was measured using the Barthel Index. Information on participants' sociodemographic characteristics, self-reported chronic diseases and lifestyle characteristics were also collected. A multiple logistic regression model was used to assess the factors associated with self-reported functional abilities among the participants.

RESULTS

The overall percentage of people having limited self-reported functional ability was 26.5% (male: 22.6% and female: 31.5%) with inability most found in grooming (33.2%), bathing (31.8%), stair using (13.2%) and mobility (10.7%). In the final adjusted model, having age of 80 years or more (aOR = 2.01,95% CI: 1.08,3.75), being female (aOR = 1.44, 95% CI: 1.04,2.0), having low memory or concentration (aOR = 1.83, 95% CI: 1.30,2.56), loneliness (aOR = 2.89, 95% CI:1.74,4.80) and living with aid alone (aOR = 2.89, 95% CI: 1.74,4.80) were found to be associated with self-reported limited functional ability.

CONCLUSION

The findings of this study highlight the need for attention from policymakers and public health practitioners on addressing functional limitations among older adults residing in the Rohingya refugee camp. Our findings emphasize the need for the development of comprehensive interventions that can address the wider unmet needs (e.g., ensuring family/caregiver support, engaging in social and physical activities, providing nutritional support packages, etc.) to improve the health and well-being of older Rohingya adults.

Joint developmental trajectories and temporal precedence of physical function decline and cognitive deterioration: A longitudinal population-based study

Objectives

Previous studies primarily explored the unidirectional impact of cognition on physical function. However, the interplay between physical function and cognition and the temporal precedence in their predictive relationships have not been elucidated. We explored the bidirectional mechanism between physical function and cognition in a longitudinal dataset.

Materials and methods

A total of 1,365 participants in the Chinese Longitudinal Healthy Longevity Survey assessed physical function and cognition in 2011 (T1), 2014 (T2), and 2018 (T3) by the Katz scale and the Chinese version of the Mini-Mental State Examination scale, respectively. Changes in the trajectories of physical function and cognition were examined using the latent growth model. The correlational and reciprocal relationships between physical function and cognition were examined using the parallel process latent growth model and autoregressive cross-lagged (ARCL) models.

Results

Cognition and physical function decreased by an average of 0.096 and 0.017 points per year, respectively. Higher physical function was associated with better cognition at baseline (r = 0.237, p < 0.05), and longitudinal changes in physical function and cognition were positively correlated (r = 0.756, p < 0.05). ARCL analysis indicated that physical function at T1 positively predicted T2 cognitive function. However, this predictive relationship reversed between T2 and T3, whereby cognitive function at T2 predicted physical function at T3.

Conclusion

Both physical function and cognition declined over time. Early identification and intervention in physical dysfunction among older adults could be critical to prevent further cognitive impairment and maintain functional independence. Hence, regular functional assessment and individualized care plans are required to achieve healthy aging.

NonContributory Pensions, Functional Limitations, and Unpaid Family Care for Older Adults in Mexico

Objectives: We explore the effects of non-contributory pensions on functional limitations and receipt of unpaid family care by gender and frequency of pension payment. Methods: We employ a difference-in-differences estimator to identify the causal effects of non-contributory pension programs disbursed monthly or every two months for adults 70 years and older in the state of Yucatan, Mexico. Results:The monthly payment program led to lower difficulties in functional limitations and less receipt of help from family or relatives for older men and women as compared to the bimonthly program. We found a larger decline on receipt of family care for older women than for men. Discussion:Our results suggest that more frequent pension payments may have greater health benefits for recipients. They also highlight the need for greater understanding of policies that prevent or delay functional limitations and that could indirectly alleviate unpaid caregiver burden.

Development of a physical function outcome measure to harmonize comparisons between three Asian adult populations

PURPOSE

The purpose of this study was to use modern measurement techniques and create a precise functional status metric for Asian adults.

METHODS

The study subjects included Asian American adults from the 2012 Health and Retirement Study (n = 211), Chinese adults in the China Health and Retirement Longitudinal Study (n = 13,649), and Korean adults in the Korean Longitudinal Study of Aging (n = 7,486). The Rasch common-item equating method with nine self-care and mobility items from the three databases were used to create a physical function measure across the three Asian adult populations.

RESULTS

The created physical function measure included 23 self-care and mobility tasks and demonstrated acceptable psychometric properties (unidimensional, local independence, no misfit, no differential item functioning). A significant group difference in the estimated physical function across the three Asian adult populations ([Formula: see text] = 445.21, p < 0.0001) was identified. The American Asian adults (5.16 logits) had better physical function compared to the Chinese (4.15 logits) and Korean adults (3.32 logits).

CONCLUSION

Since the outcome measure was calibrated with the population-representative Asian samples, this derived physical function measure can be used for cross-national comparisons between the three countries. Using this precise functional status metric can help to identify factors that influence health outcomes in other Asian countries (China and Korea). This has the potential to generate numerous benefits, such as international disability monitoring and health-related policy development, improved shared decision making, and international syntheses of research findings.

Socio-economic inequality in functional disability and impairments with focus on instrumental activity of daily living: a study on older adults in India

Background

Studies have examined functional disability among older adults by combining Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL). This study adds another dimension to ADL and IADL by combining various impairments such as hearing, vision, walking, chewing, speaking, and memory loss among older adults. This study examines functional disability among older adults in India as measured by ADL, IADL, along with various impairments.

Methods

This study utilized data from Building a Knowledge Base on Population Aging in India (BKPAI), a national-level survey and conducted across seven states of India. The study utilized three outcome variables, namely, ADL, IADL, and Impairments. Descriptive and bivariate analyses were used along with multivariate analysis to fulfil the objectives of the study. The concentration index was calculated for ADL, IADL, and impairments, and further, decomposition analysis was carried out for IADL.

Results

The results observed that nearly 7.5% of older adults were not fully independent for ADL. More than half (56.8%) were not fully independent for IADL, and nearly three-fourths (72.6%) reported impairments. Overall, ADL, IADL, and impairments were higher among older adult’s aged 80+ years, older adults with poor self-rated health, and those suffering from chronic diseases. The likelihood of ADL (AOR = 6.42, 95% CI: 5.1–8.08), IADL (AOR = 5.08, 95% CI: 4.16–6.21), and impairment (AOR = 3.50, 95% CI: 2.73–4.48) were significantly higher among older adults aged 80+ years compared to 60–69 years. Furthermore, older adults who had poor self-rated health and suffered from chronic diseases were more likely to report ADL (AOR = 2.95, 95% CI: 2.37–3.67 and AOR = 2.70, 95% CI: 2.13–3.43), IADL (AOR = 1.74, 95% CI: 1.57–1.92 and AOR = 1.15, 95% CI: 1.04–1.15), and impairment (AOR = 2.36, 95% CI: 2.11–2.63 and AOR = 2.95, 95% CI: 2.65–3.30), respectively compared to their counterparts. Educational status and wealth explained most of the socio-economic inequality in the prevalence of IADL among older adults.

Conclusion

It is recommended that the government advise older adults to adopt health-promoting approaches, which may be helpful. Further, there is a pressing need to deliver quality care to older adults suffering from chronic conditions.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11591-1.

Transitions of disability, disability-free life expectancy and health insurance among adults aged 50 and older in Mexico: a multistate life table analysis

OBJECTIVES

To analyse the transitions of disability onset and recovery, estimate life expectancy (LE) with and without disability and explore the relation between insurance and disability patterns in the population aged 50+ in Mexico.

DESIGN

Multistate life table analysis of data from a longitudinal cohort survey.

SETTING

Data came from the Mexican Health and Aging Study, a longitudinal and representative survey of older adults in Mexico.

PARTICIPANTS

10 651 individuals aged 50+ interviewed in 2012 and 2015, including those who died between waves.

PRIMARY AND SECONDARY OUTCOME MEASURES

Disability is measured using the activities of daily living (ADL) scale. Transition rates between disability free, ADL disabled and death were employed to estimate total life expectancy (TLE) and disability-free life expectancy (DFLE).

RESULTS

46% of the individuals who reported an ADL limitation in 2012 recover from disability by 2015. TLE at age 60 for people without ADL limitations is 30 years (95% CI 28.9 to 31), out of which 4.7 years (95% CI 4.1 to 5.4) are lived with ADL limitations, while TLE at age 60 in the initially disabled is 18.7 years (95% CI 17.3 to 20), with 9.4 years (95% CI 8.4 to 10.3) lived with disability. DFLE at age 60 in people with social security is 24.2 years (95% CI 23.3 to 25.2), in people with public insurance is 24.6 years (95% CI 23.7 to 25.4) and in uninsured people is 26.9 years (95% CI 25.9 to 27.9).

CONCLUSIONS

In Mexico, a substantial proportion of ADL disabled individuals recover from disability. Nevertheless, initially disabled individuals have a considerably lower DFLE regardless of age when compared with initially active individuals. There appeared to be no differences in terms of disability and LEs between the individuals with social security and public insurance.

Effect of a Multicomponent Exercise Program (VIVIFRAIL) on Functional Capacity in Elderly Ambulatory: A Non-Randomized Clinical Trial in Mexican Women with Dynapenia

BACKGROUND

During aging, loss of muscle strength (dynapenia) combined with unhealthy lifestyles and sedentarism can lead to functional limitations and dependency; currently there is still limited evidence about multicomponent training as a treatment for dynapenia and dependence in ambulatory older women.

OBJECTIVE

To evaluate the effect of a multicomponent physical exercise program (VIVIFRAIL) on physical functionality in elderly ambulatory women with dynapenia.

DESIGN, SETTING AND PARTICIPANTS

A non-randomized clinical trial was realized in 61 ambulatory older women (65-80 years old) with dynapenia that belonged from two Integral Gerontological Centers (IGC) of Hidalgo, Mexico, from June to December 2019.

INTERVENTION

The control group (CG) received the physical daily training applied in the IGC (yoga, cardio-dance or tai chi) and the intervention group (IG) participated in a multicomponent program training (resistance, flexibility, balance and gait) called "VIVIFRAIL" for 12 weeks, minimum 3 weekly sessions of 45-60 minutes.

MEASURES

All participants were evaluated at baseline (0 weeks), intermediate (6 weeks) and final (12 weeks), evaluations included glucose, blood pressure (SBP and DBP), anthropometric test, body composition evaluation and functional performance test with Short Physical Performance Battery (SPPB), Timed Up and Go Test (TUGT), muscle strength and a falls risk short test.

RESULTS

52 older women completed the study, mean age was 71.9 ± 4.46. According to SPPB passport classification was 1 Type A, 1 Type B+, 9 Type C, 7 Type C+ and 9 Type D. After 12 weeks of intervention, statistical analysis showed that multicomponent exercise significantly improved strength (p=<0.001), gait speed (p<0.001), standing from a chair (p<0.001) and TUGT (p<0.001). About falls risk, intervention group went from 70% to 12.5% while control group went from 52.4% to 63.6% (p<0.05).

CONCLUSION

Older women who completed the 12 weeks multicomponent exercise program significantly improved their functionality in muscle strength, gait speed (3mt and 6mt), standing from a chair and TUGT tests. Also, it showed a significantly decrease in falls risk, therefore, this type of intervention can reduce the risk of frailty in the elderly.

Factors associated with functional loss among community-dwelling Mexican older adults

Introduction:

Functional status decline is related to many negative outcomes.

Objective:

To explore the relationship of sociodemographic, medical, and psychological factors with the incidence of functional status decline in Mexican older adults.

Materials and methods:

Data from the 2012 and 2015 waves of the Mexican Health and Aging Study (MHAS) survey were analyzed. Participants with previous functional status decline at baseline were excluded. We assessed functional status decline individually with activities of daily living (ADL) and instrumental ADL (IADLs) in an individual way.

Results:

Age was associated with functional limitations in ADL. Being male had an association with limitations for IADL. A poor financial situation and lower education related to higher limitations for ADL. Furthermore, pain, comorbidities, and depression were found to be independently associated with limitations in ADL. IADL limitation was associated with age, poor education, comorbidities, and depression, as well as cognitive impairment.

Conclusions:

We found that factors such as age, financial status, educational level, pain, and the number of comorbidities were associated with the incidence of functional status decline. Pain had a greater association in the 3-year functional ADL decline incidence when compared with cognitive impairment. Studying functional decline by domains allowed us to find more detailed information to identify factors susceptible to intervention with the aim to reduce the incidence of functional status decline and dependence.

Recovery from physical limitations among older Mexican adults

OBJECTIVES

This paper examines the key determinants of the likelihood of recovery from a physical disability among older adults.

METHODS

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, 2012 and 2015. At baseline, we divided our sample of older adults aged 60+ by dimensions of physical limitations (ADLs, IADLs, mobility) and classified respondents as having physical limitations in zero, one, two or three dimensions. Each respondent was then categorized as "same", "worse", "improved" or "died" depending on the number of physical dimensions with a limitation in a 2-year span (2001-2003) and again, separately, in a 3-year span (2012-2015). We then used a multinomial logistic regression to analyze the relative risk of transitioning from one category to another.

FINDINGS

Around 21 % of our sample exhibited some recovery in 2003 and around 20 % recovered in 2015. Age, gender, poor self-rated health, depression and some chronic conditions were significant for shifting the relative risk from staying the same to getting worse, dying or even improving.

CONCLUSIONS

Disability from a physical limitation is a reversible and dynamic process. Our results reflect the importance of considering the dimensions of physical ability while analyzing recovery, and illustrate that the presence of a chronic condition or depressive symptoms does not necessarily imply permanent disability.

Determinants of health expenditures during the last year of life of the Mexican population aged 50 or over

During the last year of life of the elderly health deteriorates the most, thus becoming the period of time when needs of medical services, personal care requirements and related costs are at highest. Using the Mexican Health and Aging Study, differences by sex in the determinants for out-of-pocket health expenditures during the last year of life of people 50 and over are discussed. Three levels of out-of-pocket expenses disbursement are contemplated: none, medium-low, and high. Controlling by sociodemographic variables, findings suggest that the number of hospital nights is the main determinant of health expenses, even above those related to diseases that are regarded as main causes of death. This fact impacts both out-of-pocket expences and the costs for medical institution. It is another issue in the over-hauling of the public health system.

Comparisons of the Association of Family and Social Factors With Functional Limitations Across the United States, Mexico, and South Korea: Findings From the HRS Family of Surveys

Objective: The association of family and social factors with the level of functional limitations was examined across the United States, Mexico, and Korea. Method: Participants included adults from the 2012 Health and Retirement Study (n = 10,017), Mexican Health and Aging Study (n = 6,367), and Korean Longitudinal Study of Aging (n = 4,134). A common functional limitation scale was created based on Rasch analysis with a higher score indicating better physical function. Results: The American older adults (3.65 logits) had better physical function compared with Mexican (2.81 logits) and Korean older adults (1.92 logits). There were different associations of family and social factors with functional limitations across the three countries. Discussion: The American older adults demonstrated less functional limitation compared with Mexican and Korean older adults at the population level. The findings indicate the need to interpret carefully the individual family and social factors associated with functional limitations within the unique context of each country.

Intersectional cohort change: Disparities in mobility limitations among older Singaporeans

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.

Socioeconomic inequality in functional deficiencies and chronic diseases among older Indian adults: a sex-stratified cross-sectional decomposition analysis

OBJECTIVES

Older adults with adverse socioeconomic conditions suffer disproportionately from a poor quality of life. Stratified by sex, income-related inequalities have been decomposed for functional deficiencies and chronic diseases among older adults, and the degree to which social and demographic factors contribute to these inequalities was identified in this study.

DESIGN

Cross-sectional study.

PARTICIPANTS

Data used for this study were retrieved from the WHO Study on Global AGEing and Adult Health Wave 1. A total of 3753 individuals (men: 1979, and women: 1774) aged ≥60 years were found eligible for the analysis.

MEASURES

Instrumental Activity of Daily Living (IADL) deficiency and presence of chronic diseases.

METHOD

The decomposition method proposed by Adam Wagstaff and his colleagues was used. The method allows estimating how determinants of health contribute proportionally to inequality in a health variable.

RESULTS

Compared with men, women were disproportionately affected by both functional deficiencies and chronic diseases. The relative contribution of sociodemographic factors to IADL deficiency was highest among those with poor economic status (38.5%), followed by those who were illiterate (22.5%), which collated to 61% of the total explained inequalities. Similarly, for chronic diseases, about 93% of the relative contribution was shared by those with poor economic status (42.3%), rural residence (30.5%) and illiteracy (20.3%). Significant difference in predictors was evident between men and women in IADL deficiency and chronic illness.

CONCLUSION

Pro-poor intervention strategies could be designed to address functional deficiencies and chronic diseases, with special attention to women.

Cross-national health comparisons using the Rasch model: findings from the 2012 US Health and Retirement Study and the 2012 Mexican Health and Aging Study

PURPOSE

Cross-national comparisons of patterns of population aging have emerged as comparable national micro-data have become available. This study creates a metric using Rasch analysis and determines the health of American and Mexican older adult populations.

METHODS

Secondary data analysis using representative samples aged 50 and older from 2012 U.S. Health and Retirement Study (n = 20,554); 2012 Mexican Health and Aging Study (n = 14,448). We developed a function measurement scale using Rasch analysis of 22 daily tasks and physical function questions. We tested psychometrics of the scale including factor analysis, fit statistics, internal consistency, and item difficulty. We investigated differences in function using multiple linear regression controlling for demographics. Lastly, we conducted subgroup analyses for chronic conditions.

RESULTS

The created common metric demonstrated a unidimensional structure with good item fit, an acceptable precision (person reliability = 0.78), and an item difficulty hierarchy. The American adults appeared less functional than adults in Mexico (β = - 0.26, p < 0.0001) and across two chronic conditions (arthritis, β = - 0.36; lung problems, β = - 0.62; all p < 0.05). However, American adults with stroke were more functional than Mexican adults (β = 0.46, p = 0.047).

CONCLUSIONS

The Rasch model indicates that Mexican adults were more functional than Americans at the population level and across two chronic conditions (arthritis and lung problems). Future studies would need to elucidate other factors affecting the function differences between the two countries.