Trajectory of functional status among older Taiwanese: Gender and age variations

Abstract

Current findings on gender and age differences in health trajectories in later life are equivocal and largely based upon data derived from Western developed nations. This study examines gender and age variations in the trajectory of functional status among older adults in Taiwan, a non-Western newly industrialized society. Data came from a sample of some 3500 Taiwanese aged 60 and over, initially surveyed in 1989 and subsequently followed in 1993, 1996, 1999, and 2003. Hierarchical linear models with time-varying covariates were employed in depicting the dynamics of functional status across gender and age. Women and the old–old experienced higher levels of disability and rates of increase than their male and young–old counterparts. Moreover, older women bore a disproportionately larger burden of disability. There are therefore significant gender and age variations in the trajectory of functional status among older Taiwanese. These findings provide evidence for the generalizability of prior observations to a non-Western society.

Social support and mortality among the aged people with major diseases or ADL disabilities in Taiwan: A national study

“…First, all data in this TLSA study were self-reported; no objective measures were utilized. As with all self-reported data, misclassification or confounding effects may be present, although the instruments utilized in this study have been verified in previous studies (Gottlieb, 1985;Liang et al, 2010;Pu et al, 2011). Although, we did not use the validated instruments of CCI as severity of comorbidity for major diseases, we used the top 10 leading causes of death in Taiwan as our covariate diseases instead.…”

“…With very high response rates for both survey cohorts in the 1996 survey (89% for the first cohort and 82% for the supplemental sample) both survey cohorts retain their high sample representativeness. Details of the TLSA study design have been described elsewhere (Liang et al, 2010;Martin, Zimmer, & Hurng, 2011;Pu, Tang, Huang, & Chou, 2011).…”

Disability trajectories and associated disablement process factors among older adults in Taiwan

“…Predisposing factors are those features of individuals that exist at or before the outset of the disablement process, such as demographic and biological characteristics. Evidence has shown that younger age, male, and more educational attainment are likely to be found in functionally independent older adults (Beckett et al, 1996;Chen, Covinsky, Stijacic Cenzer, Adler, & Williams, 2012;Liang, Wang, et al, 2010), whereas living with comorbidities and depressive symptoms are common in older adults with functional disabilities (Barry, Murphy, & Gill, 2011;Dalle Carbonare et al, 2009;Hung, Ross, Boockvar, & Siu, 2012). As for the intra-and extra-individual factors, the disablement process asserts that these factors serve as buffers, which may increase the individual's capacity or decrease environmental demands in an attempt to retard or reverse the progression of disablement.…”

“…From comparisons of two points of time to multiple-wave observations, the evidence has indicated that disability in older adults is not only a reversible condition but also a time-dependent process (Gill, Allore, Hardy, & Guo, 2006;Hardy & Gill, 2004;Seidel, Jagger, Brayne, Matthews, & Cfas, 2009). Patterns of disability change over time; in other words, the concept of the disability trajectory and identifying subgroups of older adults with different trajectories has gained recognition as ever more evidence supporting it is published in literatures (Chen, Mullan, et al, 2012;Chiu, Wray, & Ofstedal, 2011;Dodge, Du, Saxton, & Ganguli, 2006;Han et al, 2013;Hsu, 2009Hsu, , 2013Liang, Wang, et al, 2010;Liang, Xu, Bennett, Ye, & Quinones, 2010;Rajan et al, 2012;Taylor, 2010;Zimmer, Martin, Jones, & Nagin, 2014). The disability trajectory provides information on both the level of disability and the patterns of functional change over time.…”

“…One is age and gender differences; the older-old and females experience a higher level of disability initially and a faster rate of decline on the disability trajectory than the younger-old and males do (Liang, Wang, et al, 2010). Chronic diseases, such as diabetes-related comorbidities, appear to be associated with a relatively high speed of functional deterioration for Taiwanese older adults (Chiu et al, 2011).…”