Skip to main content
NCBI home page
American Journal of Public Health logoLink to American Journal of Public Health
. 1997 Mar;87(3):378–383. doi: 10.2105/ajph.87.3.378

Disability in activities of daily living: patterns of change and a hierarchy of disability.

D D Dunlop 1, S L Hughes 1, L M Manheim 1
PMCID: PMC1381008  PMID: 9096537

Abstract

OBJECTIVES: This paper examines longitudinal data over 6 years to evaluate incidence rates of disability and the pattern of dependency in activities of daily living. METHODS: The Longitudinal Study of Aging (n = 5151) was used to evaluate incidence of disability in activities of daily living; biennial interview data from 1984 through 1990 were used. The median age to disability onset for individual activities was estimated from survival analysis. A prevalent ordering of incident disability was identified from patterns of disability onset within individuals. RESULTS: The progression of incident disability among the elderly supported by longitudinal data, based on both the ordering of median ages to disability onset and patterns of incident disability, was as follows: walking, bathing, transferring, dressing, toileting, feeding. Gender differences were found in disability incidence rates. CONCLUSIONS: This study provides a mathematical picture of physical functioning as people age. These findings, based on longitudinal data, indicate a different hierarchical structure of disability than found in previous reports using cross-sectional data. Furthermore, the study documents gender differences in incident impairment, which indicate that although women outlive men, they spend more time in a disabled state.

Full text

PDF
378

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Branch L. G., Jette A. M. A prospective study of long-term care institutionalization among the aged. Am J Public Health. 1982 Dec;72(12):1373–1379. doi: 10.2105/ajph.72.12.1373. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Branch L. G., Katz S., Kniepmann K., Papsidero J. A. A prospective study of functional status among community elders. Am J Public Health. 1984 Mar;74(3):266–268. doi: 10.2105/ajph.74.3.266. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Branch L., Jette A., Evashwick C., Polansky M., Rowe G., Diehr P. Toward understanding elders' health service utilization. J Community Health. 1981 Winter;7(2):80–92. doi: 10.1007/BF01323227. [DOI] [PubMed] [Google Scholar]
  4. Dunlop D. D., Tamhane A. C., Chmiel J. S., Phair J. P. A model-based approach to estimate the AIDS-free time distribution in homosexual men using longitudinal data. J Biopharm Stat. 1994 Jul;4(2):129–146. doi: 10.1080/10543409408835078. [DOI] [PubMed] [Google Scholar]
  5. Jette A. M., Branch L. G. The Framingham Disability Study: II. Physical disability among the aging. Am J Public Health. 1981 Nov;71(11):1211–1216. doi: 10.2105/ajph.71.11.1211. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. KATZ S., FORD A. B., MOSKOWITZ R. W., JACKSON B. A., JAFFE M. W. STUDIES OF ILLNESS IN THE AGED. THE INDEX OF ADL: A STANDARDIZED MEASURE OF BIOLOGICAL AND PSYCHOSOCIAL FUNCTION. JAMA. 1963 Sep 21;185:914–919. doi: 10.1001/jama.1963.03060120024016. [DOI] [PubMed] [Google Scholar]
  7. Katz S., Branch L. G., Branson M. H., Papsidero J. A., Beck J. C., Greer D. S. Active life expectancy. N Engl J Med. 1983 Nov 17;309(20):1218–1224. doi: 10.1056/NEJM198311173092005. [DOI] [PubMed] [Google Scholar]
  8. Keller B. K., Potter J. F. Predictors of mortality in outpatient geriatric evaluation and management clinic patients. J Gerontol. 1994 Nov;49(6):M246–M251. doi: 10.1093/geronj/49.6.m246. [DOI] [PubMed] [Google Scholar]
  9. Kempen G. I., Suurmeijer T. P. The development of a hierarchical polychotomous ADL-IADL scale for noninstitutionalized elders. Gerontologist. 1990 Aug;30(4):497–502. doi: 10.1093/geront/30.4.497. [DOI] [PubMed] [Google Scholar]
  10. Lazaridis E. N., Rudberg M. A., Furner S. E., Cassel C. K. Do activities of daily living have a hierarchical structure? An analysis using the longitudinal study of aging. J Gerontol. 1994 Mar;49(2):M47–M51. doi: 10.1093/geronj/49.2.m47. [DOI] [PubMed] [Google Scholar]
  11. Manton K. G. A longitudinal study of functional change and mortality in the United States. J Gerontol. 1988 Sep;43(5):S153–S161. doi: 10.1093/geronj/43.5.s153. [DOI] [PubMed] [Google Scholar]
  12. Molander U. Urinary incontinence and related urogenital symptoms in elderly women. Acta Obstet Gynecol Scand Suppl. 1993;158:1–22. doi: 10.3109/00016349309156515. [DOI] [PubMed] [Google Scholar]
  13. Mor V., Wilcox V., Rakowski W., Hiris J. Functional transitions among the elderly: patterns, predictors, and related hospital use. Am J Public Health. 1994 Aug;84(8):1274–1280. doi: 10.2105/ajph.84.8.1274. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Prentice R. L., Gloeckler L. A. Regression analysis of grouped survival data with application to breast cancer data. Biometrics. 1978 Mar;34(1):57–67. [PubMed] [Google Scholar]
  15. Reuben D. B., Rubenstein L. V., Hirsch S. H., Hays R. D. Value of functional status as a predictor of mortality: results of a prospective study. Am J Med. 1992 Dec;93(6):663–669. doi: 10.1016/0002-9343(92)90200-u. [DOI] [PubMed] [Google Scholar]
  16. Severson M. A., Smith G. E., Tangalos E. G., Petersen R. C., Kokmen E., Ivnik R. J., Atkinson E. J., Kurland L. T. Patterns and predictors of institutionalization in community-based dementia patients. J Am Geriatr Soc. 1994 Feb;42(2):181–185. doi: 10.1111/j.1532-5415.1994.tb04949.x. [DOI] [PubMed] [Google Scholar]
  17. Siu A. L., Reuben D. B., Hays R. D. Hierarchical measures of physical function in ambulatory geriatrics. J Am Geriatr Soc. 1990 Oct;38(10):1113–1119. doi: 10.1111/j.1532-5415.1990.tb01374.x. [DOI] [PubMed] [Google Scholar]
  18. Strawbridge W. J., Kaplan G. A., Camacho T., Cohen R. D. The dynamics of disability and functional change in an elderly cohort: results from the Alameda County Study. J Am Geriatr Soc. 1992 Aug;40(8):799–806. doi: 10.1111/j.1532-5415.1992.tb01852.x. [DOI] [PubMed] [Google Scholar]
  19. Travis S. S., McAuley W. J. Simple counts of the number of basic ADL dependencies for long-term care research and practice. Health Serv Res. 1990 Jun;25(2):349–360. [PMC free article] [PubMed] [Google Scholar]
  20. Varekamp I., Smit C., Rosendaal F. R., Bröcker-Vriends A., Briët E., van Dijck H., Suurmeijer T. P. Employment of individuals with haemophilia in The Netherlands. Soc Sci Med. 1989;28(3):261–270. doi: 10.1016/0277-9536(89)90269-4. [DOI] [PubMed] [Google Scholar]
  21. Wetle T., Scherr P., Branch L. G., Resnick N. M., Harris T., Evans D., Taylor J. O. Difficulty with holding urine among older persons in a geographically defined community: prevalence and correlates. J Am Geriatr Soc. 1995 Apr;43(4):349–355. doi: 10.1111/j.1532-5415.1995.tb05806.x. [DOI] [PubMed] [Google Scholar]

Articles from American Journal of Public Health are provided here courtesy of American Public Health Association

RESOURCES