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. 2012 Nov;102(11):2157-63.
doi: 10.2105/AJPH.2011.300602. Epub 2012 Sep 20.

Trends in US older adult disability: exploring age, period, and cohort effects

Shih-Fan Lin  1 , Audrey N Beck, Brian K Finch, Robert A Hummer, Ryan K Masters
Affiliations

Trends in US older adult disability: exploring age, period, and cohort effects

Shih-Fan Lin et al. Am J Public Health. 2012 Nov.

Erratum in

  • Am J Public Health. 2013 Jan;103(1):e8. Master, Ryan K [corrected to Masters, Ryan K]

Abstract

Objectives: We elucidated how US late-life disability prevalence has changed over the past 3 decades.

Methods: We examined activities of daily living (ADL) and instrumental activities of daily living (IADL) disability trends by using age-period-cohort (APC) models among older adults aged 70 years or older who responded to the National Health Interview Survey between 1982 and 2009. We fitted logistic regressions for ADL and IADL disabilities and for each of the 3 APC trends with 2 models: unadjusted and fully adjusted for age, period, cohort, and sociodemographic variables.

Results: The unadjusted and adjusted period trends showed a substantial decline in IADL disability, and ADL disability remained stable across time. Unadjusted cohort trends for both outcomes also showed continual declines across successive cohorts; however, increasing cohort trends were evident in the adjusted models.

Conclusions: More recent cohorts of US older adults are becoming more disabled, net of aging and period effects. The net upward cohort trends in ADL and IADL disabilities remain unexplained. Further studies should explore cohort-specific determinants contributing to the increase of cohort-based disability among US older adults.

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Figures

FIGURE 1—
FIGURE 1—
Unadjusted period trends of ADL and IADL disability, (a) as originally provided and (b) as replicated: National Health Interview Survey 1982–2009. Note. ADL = activities of daily living; IADL = instrumental activities of daily living. Source. Figure 1a provided by Schoeni et al.
FIGURE 2—
FIGURE 2—
Period trends of ADL and IADL disability among US adults aged 70 years and older, with 95% confidence intervals, (a) unadjusted and (b) adjusted: National Health Interview Survey 1982–2009. Note. ADL = activities of daily living; IADL = instrumental activities of daily living. The adjusted model controlled for age, cohort, region, race, marital status, education, employment status, and Consumer Price Index–adjusted income.
FIGURE 3—
FIGURE 3—
Age trends of ADL and IADL disability among US adults aged 70–84 years, with 95% confidence intervals, (a) unadjusted and (b) adjusted: National Health Interview Survey 1982–2009. Note. ADL = activities of daily living; IADL = instrumental activities of daily living. The adjusted model controlled for period, cohort, region, race, marital status, education, employment status, and Consumer Price Index–adjusted income.
FIGURE 4—
FIGURE 4—
Cohort trends of ADL and IADL disability among US adults aged 70 years and older, (a) unadjusted and (b) adjusted: National Health Interview Survey 1982–2009. Note. ADL = activities of daily living; BMI = body mass index; IADL = instrumental activities of daily living. The adjusted model controlled for age, period, region, race, marital status, education, employment status, and Consumer Price Index–adjusted income. Dashed lines indicate models with an additional BMI control variable. Confidence intervals were placed only on the adjusted cohort trends without body mass index adjustment.
See this image and copyright information in PMC

References

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