Variation in Thresholds for Reporting Mobility Disability Between National Population Subgroups and Studies

Melzer, David; Lan, Tzuo Yun; Tom, Brian D. M.; Deeg, Dorly J. H.; Guralnik, Jack M.

doi:10.1093/gerona/59.12.1295

Cited by 73 publications

(56 citation statements)

References 14 publications

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“…First, we have used a self-reported measure of disability. However, two studies comparing self-reported function with observed performance found no gender differences in the reporting of disability [46,47] . Second, we chose to use a categorical measure of disability rather than a continuous measure of functional status.…”

Section: Discussionmentioning

confidence: 97%

Explaining the Effect of Gender on Functional Transitions in Older Persons

et al. 2008

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Background: Women live longer but experience greater disability than men. The reasons for this gender difference in disability are not well understood. Objective: Our objectives were to determine if the higher prevalence of disability in women is due to greater incidence of disability, longer duration of disability, or both, and to identify factors that potentially explain these gender differences. Methods: 754 community-living persons aged 70 and older who were non-disabled (required no personal assistance) in four essential activities of daily living (ADLs) were assessed monthly for disability for up to 6 years. A multi-state extension of the proportional hazards model was used to determine the effects of gender on transitions between states of no disability, mild disability, severe disability, and death, and to evaluate potential mediators of these effects. Results: Women were more likely to make the transition from no disability to mild disability and less likely to make the transitions from mild to no disability and from both mild and severe disability to death. The gender difference in the transitions between no disability and mild disability was largely explained by differences in gait speed and physical activity, but gender difference in transitions to death persisted despite adjustment for multiple potential mediators. Conclusion: The higher prevalence of disability in women versus men is due to a combination of higher incidence and longer duration, resulting from lower rates of recovery and mortality among disabled women.

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Section: Discussionmentioning

confidence: 97%

Explaining the Effect of Gender on Functional Transitions in Older Persons

et al. 2008

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“…30 Our findings are also consistent with results from NHANES III in the US indicating that higher income people may have more lenient standards for their health, reporting physical difficulties or inabilities only when they reach a more severe level of tested limitation. 21,36 In our analysis, this type of 'index shift' would correspond to the fact that a person with more education or higher income would have to be in worse health, as measured by mortality risk, in order to rate themselves in a lower SRH category compared with someone with less education or less income. ref.…”

Section: Discussionmentioning

confidence: 99%

“…[14][15][16][17] Evidence of reporting heterogeneity for subjective health measures across SES groups within countries has been found in the UK, France, Canada, Israel and the US using a variety of benchmarks for 'objective' health. 9,13,[18][19][20][21] With respect to mortality, a number of recent studies have found significant race/ethnic and gender differences in the predictive effect of SRH in the US. [22][23][24][25] For instance, SRH is a weaker predictor of mortality for less-acculturated Hispanic adults, which some have suggested is due to a tendency to put a greater weight on non-life-threatening issues such as emotional and mental well-being in their health assessment, 22 though language and cultural differences in response styles are also plausible.…”

Section: Introductionmentioning

confidence: 99%

Does the predictive power of self-rated health for subsequent mortality risk vary by socioeconomic status in the US?

Dowd

Zajacova

2007

International Journal of Epidemiology

288

204

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Background The purpose of this study is to test whether the predictive power of an individual's self-rated health (SRH) on subsequent mortality risk differs by socioeconomic status (SES) in the United States. MethodsWe use the National Health Interview Survey 1986-94 linked to Multiple Cause of Death Files 1986-97 (NHIS-MCD). Analyses are based on non-Hispanic Black and White adults 25 and older (n ¼ 358 388). Cox proportional hazard models are used to estimate the effect of SRH on mortality risk during follow-up.Interactions of SRH and level of education and SRH and level of income are used to assess differences in the predictive power of SRH for subsequent mortality risk. ResultsThe effect of SRH on subsequent mortality risk differs by level of education and level of income. Lower health ratings are more strongly associated with mortality for adults with higher education and/or higher income relative to their lower SES counterparts.Conclusions Our findings suggest that individuals with different education or income levels may evaluate their health differently with respect to the traditional five-point SRH scale, and hence their subjective health ratings may not be directly comparable. These results have important implications for research that tries to quantify and explain socioeconomic inequalities in health based on self-rated health.

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“…There has been a longstanding debate within gerontology as to whether longer life is associated with a ''compression of morbidity'' (2), an ''expansion of morbidity'' (3,4), or a combination of both, with an increased prevalence of chronic diseases counterbalanced by a decrease in the severity and consequences of the same diseases (5). The evidence supporting these different perspectives is mixed, perhaps because of differences in research settings (e.g., cohorts, countries, and ethnicities) and methodology (e.g., response rates and assessment instruments) (6)(7)(8). Nonetheless, there are accumulating data that the prevalence of chronic disability is decreasing among the elderly (6,9).…”

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confidence: 99%

Exceptional longevity does not result in excessive levels of disability

Christensen

Petersen

Jeune

et al. 2008

Proc. Natl. Acad. Sci. U.S.A.

216

180

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Late-life loss of independence in daily living is a central concern for the aging individual and for society. The implications of increased survival to advanced age may be different at the population level than at the individual level. Here we used a longitudinal multiassessment survey of the entire Danish 1905 cohort from 1998 to 2005 to assess the loss of physical and cognitive independence in the age range of 92 to 100 years. Multiple functional outcomes were studied, including independence, which was defined as being able to perform basic activities of daily living without assistance from other persons and having a MiniMental State Examination (MMSE) score of 23 or higher. In the aggregate, the 1905 cohort had only a modest decline in the proportion of independent individuals at the 4 assessments between age 92 and 100 years: 39%, 36%, 32%, and 33%, with a difference between first and last assessment of 6% [95% confidence interval (CI), ؊1-14%]. For participants who survived until 2005, however, the prevalence of independence was reduced by more than a factor of 2, from 70% in 1998 to 33% in 2005 (difference, 37%; 95% CI, 28 -46%). Similar results were obtained for the other functional outcomes. Analyses of missing data resulting from nonresponse and death suggest that the discrepancy between the population trajectory and the individual trajectory is caused by increased mortality among dependent individuals. For the individual, long life brings an increasing risk of loss of independence. For society, mortality reductions are not expected to result in exceptional levels of disability in cohorts of the very old.centenarians ͉ nonagenarians ͉ survival ͉ independence T he oldest-old is the fastest growing segment of the population in the Western world, and the increase results mainly from a reduction in mortality rates among the oldest-old (1). There has been a longstanding debate within gerontology as to whether longer life is associated with a ''compression of morbidity'' (2), an ''expansion of morbidity'' (3, 4), or a combination of both, with an increased prevalence of chronic diseases counterbalanced by a decrease in the severity and consequences of the same diseases (5). The evidence supporting these different perspectives is mixed, perhaps because of differences in research settings (e.g., cohorts, countries, and ethnicities) and methodology (e.g., response rates and assessment instruments) (6-8). Nonetheless, there are accumulating data that the prevalence of chronic disability is decreasing among the elderly (6, 9). Although there is evidence that successive cohorts are living not only longer but also better (10-13), there still is considerable concern, both at the individual and societal level, that an extension of life into the highest ages in any birth cohort of elderly, now or in the future, will be accompanied by very high rates of loss of independence, with great personal and societal costs. Cross-sectional data indicate that dependency is considerably more prevalent in the oldest-old than in the ...

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Variation in Thresholds for Reporting Mobility Disability Between National Population Subgroups and Studies

Abstract: There is evidence of differences in thresholds for reporting mobility disability, especially across age and income groups in older Americans. Further work is needed to understand the perceptual, attitudinal, or environmental factors that cause these reporting differences.

Cited by 73 publications

References 14 publications

Explaining the Effect of Gender on Functional Transitions in Older Persons

Explaining the Effect of Gender on Functional Transitions in Older Persons

Does the predictive power of self-rated health for subsequent mortality risk vary by socioeconomic status in the US?

Exceptional longevity does not result in excessive levels of disability

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