Longer lives, sicker lives? Increased longevity and extended disability among Mexican-origin elders

Abstract

Objectives: (a) To identify factors associated with different patterns of functional decline in a longitudinal sample of older Mexican-origin individuals, and (b) to determine the proportions of life after age 65 characterized by serious functional impairment.

Methodology: We use the Hispanic Established Populations for Epidemiologic Studies of the Elderly to examine changes in objective Performance Oriented Mobility Assessments in a cohort of 3,050 Mexican-origin elders initially interviewed in 1993/1994 and recontacted 6 times over 17 years. This sample combined with an additional cohort of 902 individuals 75 and older added at wave 4 in 2004/2005 (combined sample = 3,952) is used in life table analyses to estimate the number of years after 65 characterized by serious functional impairment.

Results: Three distinct patterns of functional decline emerge: (a) high initial functioning followed by decline, but not to the level of disability (48%); (b) moderate initial functioning followed by decline to the level of disability (37.5%); and (c) initial disability followed by continued poor functioning (14.5%). Life table analyses reveal that subjects spent over half of the period after 65 with serious functional limitations. Significant gender and nativity differentials emerge.

Discussion: Protracted morbidity that accompanies increases in life expectancy has serious implications for the physical, social, and economic well-being of older individuals and their families, as well as for health and long-term care policy.

Keywords: Active life expectancy; Disability trajectory; Functional capacity; H-EPESE; Hispanic; Longevity..

Figure 1.

Performance oriented mobility assessment (POMA) classes, 1993–2011.