When Do Older Adults Become “Disabled”? Social and Health Antecedents of Perceived Disability in a Panel Study of the Oldest Old

Abstract

Disability carries negative social meaning, and little is known about when (or if), in the process of health decline, persons identify themselves as "disabled." We examine the social and health criteria that older adults use to subjectively rate their own disability status. Using a panel study of older adults (ages 72+), we estimate ordered probit and growth curve models of perceived disability over time. Total prevalent morbidity, functional limitations, and cognitive impairment are predictors of perceived disability. Cessation of driving and receipt of home health care also influence older adults 'perceptions of their own disability. A dense social network slowed the rate of labeling oneself disabled, while health anxiety accelerated the process over time, independent of health status. When considering perceived disability, the oldest old use multidimensional criteria capturing function, recent changes in health status and social networks, and anxiety about their health.

The Impact of DSM-IV Symptom and Clinical Significance Criteria on the Prevalence Estimates of Subthreshold and Threshold Anxiety in the Older Adult Population

“…Since older adults are generally less likely than younger adults to consider themselves as disabled, 15 reporting impairment in at least one area of social functioning was considered as a significant disability (i.e., meeting the clinical significance criterion).…”

“…[12][13][14] However, the use of this criterion with older adults may conversely increase the number of false-negative cases, since they are usually less active and less likely to perceive themselves as disabled than younger adults. 15 In addition, because older adults are more likely to somatize their distress and to report less emotional disturbances, 8,[16][17][18] the symptom criteria may be harder to satisfy in this population.Knowing that the symptom and the clinical significance criteria may pose problems in the older adult population, the aim of the current study was to answer the following questions: (a) how these criteria affect the prevalence estimates of anxiety problems in this population and (b) do these criteria identify a group of older adults presenting a more severe condition needing psychiatric help? To answer these questions, respondents with a full anxiety disorder were compared with respondents presenting different patterns of subthreshold anxiety on their sociodemographic, health, and health behavior characteristics.…”

“…[12][13][14] However, the use of this criterion with older adults may conversely increase the number of false-negative cases, since they are usually less active and less likely to perceive themselves as disabled than younger adults. 15 In addition, because older adults are more likely to somatize their distress and to report less emotional disturbances, 8,[16][17][18] the symptom criteria may be harder to satisfy in this population.…”

The Social Connectedness of Older Adults: A National Profile

“…Higher-density networks (in which one's network members know each other) constitute close knit social contexts in which one's contacts can triangulate information, share caregiving duties, and pool resources. Network density is associated with greater access to and more frequent activation of informal support, and therefore may have unique health benefits (Haines, Hurlbert, and Beggs 1996;Hurlbert, Haines, and Beggs 2000;Kelley-Moore et al 2006). …”

Functional capability and violence situations against the elderly

“…The functional capability would be the potential to perform the activities of daily living or a certain action without needing the help of others, which is determinant to maintain quality of life and independence. (2) The results obtained in evaluating functional capability allow to learn the profile of the elderly, regarding their functionality in everyday activities, which allows to identify situations that need an intervention for health promotion, in order to postpone the disabilities inherent to aging. (3) Violence and abuse against the elderly can be defined as a single and repeated act, or the lack of appropriate measures in abuse situations, which occur in any relationship where there is an expectation of trust and causes harm or distress to an elder person.…”