Foundations of Activity of Daily Living Trajectories of Older Americans

Abstract

Objectives: The disablement process can be viewed conceptually as a progression from disease to impairment to functional limitation and finally disability (frequently operationalized as activity limitation). This article assesses the extent to which early phases of the process are associated with individual-level disability trajectories by age.

Method: We use data from seven waves of the Health and Retirement Study, 1998 to 2010, to investigate for individuals aged 65-84 years how baseline sociodemographic characteristics and self-reported disease, pain, and functional limitation (physical, cognitive, or sensory) are related to the dynamics of limitations in activities of daily living (ADLs). Our modeling approach jointly estimates multiperiod trajectories of ADL limitation and mortality and yields estimates of the number of, shapes of, and factors associated with the most common trajectories.

Results: Individual probability of ADL limitation can best be described by three common trajectories. In comparison with disease, pain, and functional limitation, sociodemographic characteristics have weak associations with trajectory group membership. Notably, neither sex nor education is strongly associated with group membership in multivariate models.

Discussion: The analysis confirms the importance of the early phases of the disablement process and their relationships with subsequent trajectories of activity limitation.

Keywords: Disability; Functional health status; Health disparities; Mortality; Transition models.

Figure 1.

Disablement process.

Figure 2.

Predicted probability of any activity of daily living limitation by age and group.

Figure 3.

Predicted probability of mortality by age at previous survey wave and group.