Long-term declines in ADLs, IADLs, and mobility among older Medicare beneficiaries

Abstract

BackgroundMost prior studies have focused on short-term (≤ 2 years) functional declines. But those studies cannot address aging effects inasmuch as all participants have aged the same amount. Therefore, the authors studied the extent of long-term functional decline in older Medicare beneficiaries who were followed for varying time lengths, and the authors also identified the risk factors associated with those declines.MethodsThe analytic sample included 5,871 self- or proxy-respondents who had complete baseline and follow-up survey data that could be linked to their Medicare claims for 1993-2007. Functional status was assessed using activities of daily living (ADLs), instrumental ADLs (IADLs), and mobility limitations, with declines defined as the development of two of more new difficulties. Multiple logistic regression analysis was used to focus on the associations involving respondent status, health lifestyle, continuity of care, managed care status, health shocks, and terminal drop.ResultsThe average amount of time between the first and final interviews was 8.0 years. Declines were observed for 36.6% on ADL abilities, 32.3% on IADL abilities, and 30.9% on mobility abilities. Functional decline was more likely to occur when proxy-reports were used, and the effects of baseline function on decline were reduced when proxy-reports were used. Engaging in vigorous physical activity consistently and substantially protected against functional decline, whereas obesity, cigarette smoking, and alcohol consumption were only associated with mobility declines. Post-baseline hospitalizations were the most robust predictors of functional decline, exhibiting a dose-response effect such that the greater the average annual number of hospital episodes, the greater the likelihood of functional status decline. Participants whose final interview preceded their death by one year or less had substantially greater odds of functional status decline.ConclusionsBoth the additive and interactive (with functional status) effects of respondent status should be taken into consideration whenever proxy-reports are used. Encouraging exercise could broadly reduce the risk of functional decline across all three outcomes, although interventions encouraging weight reduction and smoking cessation would only affect mobility declines. Reducing hospitalization and re-hospitalization rates could also broadly reduce the risk of functional decline across all three outcomes.

Chiropractic Use in the Medicare Population: Prevalence, Patterns, and Associations With 1-Year Changes in Health and Satisfaction With Care

“…These variables were included because (1) the claims experience of persons in managed care would be different than those in fee-for-service (under-represented), and (2) the assessments of change in function and health are affected by whom (self-respondent vs. proxy respondent) is answering the survey questions. 18 …”

Inflammation Partially Mediates the Association of Multimorbidity and Functional Limitations in a National Sample of Middle-Aged and Older Adults

“…We also adjust for two health behaviors, smoking and regular exercise. Epidemiological studies have shown that adults who smoke are at increased risk of disability whereas those who exercise regularly have a reduced risk (d'Orsi et al, 2014; Hardy, McGurl, Studenski, & Degenholtz, 2010; Wolinsky et al, 2011). Moreover, smoking is predictive of higher circulating levels of inflammatory proteins whereas physical activity is linked to lower levels (Colbert et al, 2004; Jousilahti, Salomaa, Rasi, Vahtera, & Palosuo, 2003; Krabbe, Pedersen, & Bruunsgaard, 2004).…”

Functional Independence of Community-Dwelling Older Adults in China and South Korea

“…Although differences were identified within a country and across China and South Korea, given the nature of this comparative study, the discussion focuses on cross-country differences. By and large, the functional status of East Asian community-dwelling older adults is similar to the functional status of those in Western societies, which are relatively healthy and present few functional limitations (Wolinsky et al, 2011).…”