Trends in functional limitations among middle-aged and older adults in the Asia-Pacific: survey evidence from 778,507 observations across six countries

Abstract

Background: There are few studies comparing health status trends among middle-aged and older adults in countries currently experiencing a rapid demographic and economic transition in the Asia-Pacific, relative to their high-income regional counterparts. This study investigates trends in functional limitations among individuals aged 45 years and above in six major Asia-Pacific countries, ranging from middle- to high-income, from 2001 to 2019 and examines disparities across socioeconomic and demographic sub-groups.

Methods: Data on 778,507 individuals from seven surveys in three high-income countries (Australia, Japan, South Korea) and three middle-income countries (China, Indonesia, and India) were used. Activities of daily living (ADL), instrumental activities of daily living (IADL), and mobility measures served as indicators of functional limitations. Age-standardized prevalence was used to assess prevalence trends in functional limitations and their distribution across sex and age. Multivariate linear probability models were used to examine whether the patterns still hold when controlling for birth cohorts and socioeconomic and demographic factors.

Findings: People aged 45 years and above in Australia, Japan, and South Korea experienced declines in functional limitations, whereas increases were observed in India and Indonesia. The findings for China were unclear and varied depending on the indicator. Changes in prevalence of functional limitations over time were more pronounced among people aged over 60 years. Higher prevalence of functional limitations was observed for respondents with lower education and among those are not currently married across countries.

Interpretation: Study findings highlight the potential for cross-national learning to address functional limitations among older populations in low- and middle-income countries.

Funding: Not applicable.

Keywords: ADL; Asia-Pacific; Disability; Functional limitations; Population ageing.

Fig. 1

Share of the population aged 60 years and above in selected countries from the Asia-Pacific. Source: United Nations, Department of Economic and Social Affairs, Population Division (2024). World Population Prospects 2024, Data Sources. UN DESA/POP/2024.

Fig. 2

Age-standardized prevalence of functional limitations by sex. (a) Difficulty in dressing and bathing (ADL limitations commonly available across surveys). (b) Difficulty in shopping and preparing meals (IADL limitations commonly available across surveys). (c) Difficulty in walking 1 km (mobility limitation commonly available across surveys). Note: Population was adjusted using 2020 UN population data, ADL = Activities of daily living, IADL = instrumental activities of daily living. HILDA = The Household, Income, and Labour Dynamics in Australia, CSLC = Comprehensive Survey of Living Conditions, KLoSA = Korean Longitudinal Study of Aging, CHARLS = China Health and Retirement Longitudinal Study, CLHLS = The Chinese Longitudinal Healthy Longevity Survey, IFLS = The Indonesia Family Life Survey, IHDS = India Human Development Survey. Those aged 65 years and above. Due to the sample availability, age-standardized prevalence for KLoSA is based on those aged 55 years and above and CLHLS is based on those aged 65 years and above.

Fig. 2

Age-standardized prevalence of functional limitations by sex. (a) Difficulty in dressing and bathing (ADL limitations commonly available across surveys). (b) Difficulty in shopping and preparing meals (IADL limitations commonly available across surveys). (c) Difficulty in walking 1 km (mobility limitation commonly available across surveys). Note: Population was adjusted using 2020 UN population data, ADL = Activities of daily living, IADL = instrumental activities of daily living. HILDA = The Household, Income, and Labour Dynamics in Australia, CSLC = Comprehensive Survey of Living Conditions, KLoSA = Korean Longitudinal Study of Aging, CHARLS = China Health and Retirement Longitudinal Study, CLHLS = The Chinese Longitudinal Healthy Longevity Survey, IFLS = The Indonesia Family Life Survey, IHDS = India Human Development Survey. Those aged 65 years and above. Due to the sample availability, age-standardized prevalence for KLoSA is based on those aged 55 years and above and CLHLS is based on those aged 65 years and above.

Fig. 2

Age-standardized prevalence of functional limitations by sex. (a) Difficulty in dressing and bathing (ADL limitations commonly available across surveys). (b) Difficulty in shopping and preparing meals (IADL limitations commonly available across surveys). (c) Difficulty in walking 1 km (mobility limitation commonly available across surveys). Note: Population was adjusted using 2020 UN population data, ADL = Activities of daily living, IADL = instrumental activities of daily living. HILDA = The Household, Income, and Labour Dynamics in Australia, CSLC = Comprehensive Survey of Living Conditions, KLoSA = Korean Longitudinal Study of Aging, CHARLS = China Health and Retirement Longitudinal Study, CLHLS = The Chinese Longitudinal Healthy Longevity Survey, IFLS = The Indonesia Family Life Survey, IHDS = India Human Development Survey. Those aged 65 years and above. Due to the sample availability, age-standardized prevalence for KLoSA is based on those aged 55 years and above and CLHLS is based on those aged 65 years and above.

Fig. 3

Prevalence of difficulty in physical functioning by age in selected survey years. (a) Difficulty in dressing and bathing (commonly available ADL across surveys). (b) Difficulty in shopping and preparing meals (commonly available IADL across surveys). (c) Difficulty in walking 1 km (commonly available mobility across surveys). Note: ADL = Activities of daily living, IADL = instrumental activities of daily living. HILDA = The Household, Income, and Labour Dynamics in Australia, CSLC = Comprehensive Survey of Living Conditions, KLoSA = Korean Longitudinal Study of Aging, CHARLS = China Health and Retirement Longitudinal Study, CLHLS = The Chinese Longitudinal Healthy Longevity Survey, IFLS = The Indonesia Family Life Survey, IHDS = India Human Development Survey. Analysis based on data from HILDA, CLSC, KLoSA, CHARLS, IFLS, and IHDS. X axis is age group and y axis is prevalence of functional limitations (%). All prevalence were weighted according to survey weight.

Fig. 3

Prevalence of difficulty in physical functioning by age in selected survey years. (a) Difficulty in dressing and bathing (commonly available ADL across surveys). (b) Difficulty in shopping and preparing meals (commonly available IADL across surveys). (c) Difficulty in walking 1 km (commonly available mobility across surveys). Note: ADL = Activities of daily living, IADL = instrumental activities of daily living. HILDA = The Household, Income, and Labour Dynamics in Australia, CSLC = Comprehensive Survey of Living Conditions, KLoSA = Korean Longitudinal Study of Aging, CHARLS = China Health and Retirement Longitudinal Study, CLHLS = The Chinese Longitudinal Healthy Longevity Survey, IFLS = The Indonesia Family Life Survey, IHDS = India Human Development Survey. Analysis based on data from HILDA, CLSC, KLoSA, CHARLS, IFLS, and IHDS. X axis is age group and y axis is prevalence of functional limitations (%). All prevalence were weighted according to survey weight.

Fig. 3

Prevalence of difficulty in physical functioning by age in selected survey years. (a) Difficulty in dressing and bathing (commonly available ADL across surveys). (b) Difficulty in shopping and preparing meals (commonly available IADL across surveys). (c) Difficulty in walking 1 km (commonly available mobility across surveys). Note: ADL = Activities of daily living, IADL = instrumental activities of daily living. HILDA = The Household, Income, and Labour Dynamics in Australia, CSLC = Comprehensive Survey of Living Conditions, KLoSA = Korean Longitudinal Study of Aging, CHARLS = China Health and Retirement Longitudinal Study, CLHLS = The Chinese Longitudinal Healthy Longevity Survey, IFLS = The Indonesia Family Life Survey, IHDS = India Human Development Survey. Analysis based on data from HILDA, CLSC, KLoSA, CHARLS, IFLS, and IHDS. X axis is age group and y axis is prevalence of functional limitations (%). All prevalence were weighted according to survey weight.