@article {13745, title = {The Prevalence of Cognitive Impairment Among Medicare Beneficiaries Who Use Outpatient Physical Therapy.}, journal = {Physical Therapy}, volume = {104}, year = {2024}, abstract = {

OBJECTIVE: The objective of this study was to estimate the prevalence of cognitive impairment (including cognitive impairment no dementia [CIND] and dementia) among Medicare fee-for-service beneficiaries who used outpatient physical therapy and to estimate the prevalence of cognitive impairment by measures that are relevant to rehabilitation practice.

METHODS: This cross-sectional analysis included 730 Medicare fee-for-service beneficiaries in the 2016 wave of the Health and Retirement Study with claims for outpatient physical therapy. Cognitive status, our primary variable of interest, was categorized as normal, CIND, or dementia using a validated approach, and population prevalence of cognitive impairment (CIND and dementia) was estimated by sociodemographic variables and Charlson comorbidity index score. Age-, gender- (man/woman), race-/ethnicity-adjusted population prevalence of CIND and dementia were also calculated for walking difficulty severity, presence of significant pain, self-reported fall history, moderate-vigorous physical activity (MVPA) <=1{\texttimes}/week, and sleep disturbance frequency using multinomial logistic regression.

RESULTS: Among Medicare beneficiaries with outpatient physical therapist claims, the prevalence of any cognitive impairment was 20.3\% (CIND:15.2\%, dementia:5.1\%). Cognitive impairment was more prevalent among those who were older, Black, had lower education attainment, or higher Charlson comorbidity index scores. The adjusted population prevalence of cognitive impairment among those who reported difficulty walking across the room was 29.8\%, difficulty walking 1 block was 25.9\%, difficulty walking several blocks was 20.8\%, and no difficulty walking was 16.3\%. Additionally, prevalence of cognitive impairment among those with MVPA <=1{\texttimes}/week was 27.1\% and MVPA >1{\texttimes}/week was 14.1\%. Cognitive impairment prevalence did not vary by significant pain, self-reported fall history, or sleep disturbance.

CONCLUSION: One in 5 older adults who use outpatient physical therapist services have cognitive impairment. Furthermore, cognitive impairment is more common in older physical therapist patients who report worse physical function and less physical activity.

IMPACT: Physical therapists should consider cognitive screening for vulnerable older adults to inform tailoring of clinical practice toward a patient{\textquoteright}s ability to remember and process rehabilitation recommendations.

}, keywords = {Aged, Cognitive Dysfunction, Cross-Sectional Studies, Dementia, Female, Humans, Male, Medicare, Mobility Limitation, Outpatients, pain, Physical Therapy Modalities, Prevalence, United States}, issn = {1538-6724}, doi = {10.1093/ptj/pzad115}, author = {Miller, Matthew J and Cenzer, Irena and Barnes, Deborah E and Kelley, Amy S and Covinsky, Kenneth E} } @article {12276, title = {Associations Between Midlife Functional Limitations and Self-Reported Health and Cognitive Status: Results from the 1998-2016 Health and Retirement Study.}, journal = {Journal of Alzheimer{\textquoteright}s Disease}, volume = {85}, year = {2022}, pages = {1621-1637}, abstract = {

BACKGROUND: Life-course approaches to identify and help improve modifiable risk factors, particularly in midlife, may mitigate cognitive aging.

OBJECTIVE: We examined how midlife self-rated physical functioning and health may predict cognitive health in older age.

METHODS: We used data from the Health and Retirement Study (1998-2016; unweighted-N = 4,685). We used survey multinomial logistic regression and latent growth curve models to examine how midlife (age 50-64 years) activities of daily living (ADL), physical function, and self-reported health affect cognitive trajectories and cognitive impairment not dementia (CIND) and dementia status 18 years later. Then, we tested for sex and racial/ethnic modifications.

RESULTS: After covariates-adjustment, worse instrumental ADL (IADL) functioning, mobility, and self-reported health were associated with both CIND and dementia. Hispanics were more likely to meet criteria for dementia than non-Hispanic Whites given increasing IADL impairment.

CONCLUSION: Midlife health, activities limitations, and difficulties with mobility are predictive of dementia in later life. Hispanics may be more susceptible to dementia in the presence of midlife IADLs. Assessing midlife physical function and general health with brief questionnaires may be useful for predicting cognitive impairment and dementia in later life.

}, keywords = {Activities of Daily Living, Age Factors, Cognitive Dysfunction, ethnicity, Female, Health Status, Humans, Male, Middle Aged, Mobility Limitation, Neuropsychological tests, Psychomotor Performance, Retirement, Risk Factors, Self Report, Surveys and Questionnaires}, issn = {1875-8908}, doi = {10.3233/JAD-215192}, author = {Wu, Benson and Toseef, Mohammad Usama and Stickel, Ariana M and Gonz{\'a}lez, Hector M and Tarraf, Wassim} } @article {12144, title = {Peripheral edema: A common and persistent health problem for older Americans.}, journal = {PLoS One}, volume = {16}, year = {2021}, pages = {e0260742}, abstract = {

Peripheral edema (i.e., lower limb swelling) can cause pain, weakness, and limited range of motion. However, few studies have examined its prevalence in the U.S. or its association with demographics, comorbidities, activity, or mobility. This study used data from the Health and Retirement Study, a nationally representative longitudinal survey of U.S. adults (age 51+/ N = 19,988 for 2016), to evaluate time trends and correlates of peripheral edema using weighted descriptive statistics and logistic regressions, respectively. Peripheral edema was assessed with the question "Have you had{\textellipsis} // Persistent swelling in your feet or ankles?" The weighted prevalence of edema among older U.S. adults was 19\% to 20\% between 2000 and 2016. Peripheral edema was associated with older age, female sex, non-white race, low wealth, obesity, diabetes, hypertension, pain, low activity levels, and mobility limitations (odds ratios ranging from 1.2-5.6; p-values <=0.001). This study provides the first estimates of national prevalence and correlates of peripheral edema among older Americans. Peripheral edema is common and strongly associated with comorbidities, pain, low activity levels, and mobility limitations, and disproportionately affects poorer and minority groups. Peripheral edema should be a focus of future research in order to develop novel and cost-effective interventions.

}, keywords = {Aged, Aged, 80 and over, Cross-Sectional Studies, Edema, ethnicity, Female, Follow-Up Studies, Humans, Longitudinal Studies, Lower Extremity, Male, Middle Aged, Mobility Limitation, Prognosis, Surveys and Questionnaires, United States}, issn = {1932-6203}, doi = {10.1371/journal.pone.0260742}, author = {Besharat, Soroush and Grol-Prokopczyk, Hanna and Gao, Shan and Feng, Changyong and Akwaa, Frank and Gewandter, Jennifer S} } @article {10445, title = {CHRONIC KIDNEY DISEASE, MUSCLE WEAKNESS, AND MOBILITY LIMITATION}, journal = {Innovation in Aging}, volume = {3}, year = {2019}, month = {2019/11/08}, pages = {S523 - S523}, abstract = {Objectives: Chronic kidney disease (CKD) is associated with increased mobility limitation. Prior research has documented that peripheral nerve abnormalities occur early in CKD and progressively worsen. Loss of balance, impaired muscle strength, and slow gait predispose older adults to falls and frailty. However, the current literature is limited by a lack of nationally representative data that includes objective measures of kidney disease and physical functioning. Thus, this research examines whether CKD is associated with muscle strength, balance, gait, and self-reported mobility limitations. Methods: Data come from the 2016 Health and Retirement Study (HRS). Estimated GFR, a measure of kidney functioning derived from creatinine levels in the blood, was used to classify CKD (i.e, eGFR<45 or Stage 3b CKD). Logistic and linear regression models were generated to examine the association of CKD with physical functioning, net of demographic characteristics (i.e., age, sex, race, and education) and comorbidities (i.e., obesity, pain, and number of diagnosed medical conditions). Results: In unadjusted models, CKD was significantly associated (p<0.05) with more mobility limitations, slower walking speeds, stronger grip strengths, and non-participation in balance tests. After adjusting for covariates, CKD (β=-1.43, p=0.01) was negatively associated with grip strength. In sex-stratified models, CKD was associated with slower walking speeds among men, whereas CKD was associated with more mobility limitations among women. Discussion: In a nationally representative sample of older adults, CKD was associated with poorer physical functioning on multiple measures. After adjusting for demographic characteristics and comorbidities, CKD was associated with increased muscle weakness.}, keywords = {Chronic disease, chronic kidney disease, Kidney disease, mobility, Mobility Limitation, Muscle Strength, Muscle Weakness}, isbn = {2399-5300}, url = {https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6841557/}, author = {Kenzie Latham-Mintus and Doshi, Simit and Ranjani N Moorthi} } @article {10.1093/geroni/igz038.1928, title = {MOBILITY TRAJECTORIES, HEALTHCARE SATISFACTION, AND PERCEIVED DISABILITY DISCRIMINATION AMONG OLDER ADULTS}, journal = {Innovation in Aging}, volume = {3}, year = {2019}, month = {11}, pages = {S523-S524}, abstract = {Although functional mobility limitations are associated with increased healthcare needs in later life, little research explores how older adults with varying functional mobility trajectories experience healthcare quality. To this end, we explore the effects of functional mobility trajectories on differences in healthcare treatment satisfaction, perceived disability discrimination in healthcare settings, and perceived everyday disability discrimination. We analyzed 9 waves of the Health and Retirement Study (n=29,284, 1998-2014, ages 50-84). First, we estimate age-specific group-based trajectories of functional mobility across age using finite mixture models. Second, we use multinomial logistic regression to identify sociodemographic factors that place individuals at elevated risk of membership in each group. Third, we explore how membership in one disability trajectory group over another affects healthcare satisfaction, perceptions of everyday discrimination in the context of healthcare treatment settings, and perceived discrimination in everyday life. Regression models include clustered standard errors to account for heteroscedasticity across repeated observations of individuals over time. We identify six group-based trajectories of functional mobility limitation among aging Americans. Black, female, and less-educated Americans are at higher risk of membership in disadvantaged trajectories, characterized by more rapidly increasing counts of functional mobility limitations, than their counterparts. Disadvantaged functional limitation trajectories are associated with lower levels of healthcare satisfaction, higher levels of perceived physical disability discrimination in healthcare treatment settings, and higher levels of perceived physical discrimination in other contexts of everyday life. The present study advances our knowledge of how older adults experience healthcare settings and discrimination across functional mobility status trajectories.}, keywords = {Disabilities, disability discrimination, Discrimination, Healthcare, healthcare satisfaction, Mobility Limitation}, issn = {2399-5300}, doi = {10.1093/geroni/igz038.1928}, url = {https://doi.org/10.1093/geroni/igz038.1928}, author = {Mueller, Collin and Jessica S West} } @article {8598, title = {"Taking a Turn for the Better": Does Self-reported Recovery From Walking Limitation Improve Disability and Mortality Outcomes?}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {73}, year = {2018}, month = {2018 09 20}, pages = {1278-1291}, chapter = {1278-1291}, abstract = {

Objectives: Recovery from self-reported walking limitation may be a turning point in an individual{\textquoteright}s health trajectory and may lead to better physical and mental health in the future. This research examines whether recovery from walking limitation is associated with onset of mobility disability, activities of daily living (ADLs) disability, or mortality among a national sample of older Americans.

Data and Methods: Using Waves 4 through 11 (1998-2012) of the Health and Retirement Study (HRS), discrete-time event history models (N = 12,579 person-intervals) with multiple competing events were estimated using multinomial logistic regression. The risk group was defined as respondents with walking limitation, but free of disability. A lagged measure of recovery was created using 2 adjacent waves, and disability and mortality outcomes were assessed in the subsequent wave (i.e., 2 years later).

Results: Recovery from walking limitation (i.e., difficulty walking one or several blocks) was associated with lower odds of mobility disability (i.e., difficulty walking across the room) onset, ADL with mobility disability onset, ADL without mobility disability onset, and mortality. Recovery from walking limitation was not only predictive of mobility-related outcomes, but also nonmobility-related ADLs and mortality-suggesting that the predictive capacity of recovery extends to multiple physical health outcomes.

Discussion: This research suggests that self-reported recovery from walking limitation may be a turning point in the disabling process and signals a meaningful change in an older adult{\textquoteright}s functional health trajectory.

}, keywords = {Age Factors, Aged, Disabled Persons, Female, Humans, Logistic Models, Male, Mobility Limitation, Mortality, Recovery of Function, Risk Factors, Self Report, Sex Factors, Socioeconomic factors, Walking}, issn = {1758-5368}, doi = {10.1093/geronb/gbw113}, url = {http://psychsocgerontology.oxfordjournals.org/lookup/doi/10.1093/geronb/gbw113}, author = {Kenzie Latham} } @article {8698, title = {Hierarchy and Speed of Loss in Physical Functioning: A Comparison Across Older U.S. and English Men and Women.}, journal = {J Gerontol A Biol Sci Med Sci}, volume = {72}, year = {2017}, month = {2017 Aug 01}, pages = {1117-1122}, abstract = {

Background: We aimed to identify the hierarchy of rates of decline in 16 physical functioning measures in U.S. and English samples, using a systematic and integrative coordinated data analysis approach.

Methods: The U.S. sample consisted of 13,612 Health and Retirement Study participants, and the English sample consisted of 5,301 English Longitudinal Study of Ageing participants. Functional loss was ascertained using self-reported difficulties performing 6 activities of daily living and 10 mobility tasks. The variables were standardized, rates of decline were computed, and mean rates of decline were ranked. Mann-Whitney U tests were performed to compare rates of decline between studies.

Results: In both studies, the rates of decline followed a similar pattern; difficulty with eating was the activity that showed the slowest decline and climbing several flights of stairs and stooping, kneeling, or crouching the fastest declines. There were statistical differences in the speed of decline in all 16 measures between countries. American women had steeper declines in 10 of the measures than English women. Similar differences were found between American and English men.

Conclusions: Reporting difficulties climbing several flights of stairs without resting, and stooping, kneeling, or crouching are the first indicators of functional loss reported in both populations.

}, keywords = {Activities of Daily Living, Aged, Aging, Cross-Cultural Comparison, Disability Evaluation, Female, Geriatric Assessment, Health Status Disparities, Humans, Longitudinal Studies, Male, Middle Aged, Mobility Limitation, Self Report, Statistics, Nonparametric, United Kingdom, United States}, issn = {1758-535X}, doi = {10.1093/gerona/glw209}, author = {Bendayan, Rebecca and Cooper, Rachel and Elizabeth G Wloch and Scott M Hofer and Andrea M Piccinin and Graciela Mu{\~n}iz Terrera} } @article {8678, title = {Rates of Recovery to Pre-Fracture Function in Older Persons with Hip Fracture: an Observational Study.}, journal = {J Gen Intern Med}, volume = {32}, year = {2017}, month = {2017 Feb}, pages = {153-158}, abstract = {

BACKGROUND: Knowledge about expected recovery after hip fracture is essential to help patients and families set realistic expectations and plan for the future.

OBJECTIVES: To determine rates of functional recovery in older adults who sustained a hip fracture based on one{\textquoteright}s previous function.

DESIGN: Observational study.

PARTICIPANTS: We identified subjects who sustained a hip fracture while enrolled in the nationally representative Health and Retirement Study (HRS) using linked Medicare claims. HRS interviews subjects every 2~years. Using information from interviews collected during the interview preceding the fracture and the first interview 6 or more months after the fracture, we determined the proportion of subjects who returned to pre-fracture function.

MAIN MEASURES: Functional outcomes of interest were: (1) ADL dependency, (2) mobility, and (3) stair-climbing ability. We examined baseline characteristics associated with a return to: (1) ADL independence, (2) walking one block, and (3) climbing a flight of stairs.

KEY RESULTS: A total of 733 HRS subjects >=65~years of age sustained a hip fracture (mean age 84 {\textpm} 7~years, 77~\% female). Thirty-one percent returned to pre-fracture ADL function, 34~\% to pre-fracture mobility function, and 41~\% to pre-fracture climbing function. Among those who were ADL independent prior to fracture, 36~\% returned to independence, 27~\% survived but needed ADL assistance, and 37~\% died. Return to ADL independence was less likely for those >=85~years old (26~\% vs. 44~\%), with dementia (8~\% vs. 39~\%), and with a Charlson comorbidity score >2 (23~\% vs. 44~\%). Results were similar for those able to walk a block and for those able to climb a flight of stairs prior to fracture.

CONCLUSIONS: Recovery rates are low, even among those with higher levels of pre-fracture functional status, and are worse for patients who are older, cognitively impaired, and who have multiple comorbidities.

}, keywords = {Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Comorbidity, Dementia, Female, Geriatric Assessment, Hip Fractures, Humans, Longitudinal Studies, Male, Mobility Limitation, Recovery of Function, Walking}, issn = {1525-1497}, doi = {10.1007/s11606-016-3848-2}, author = {Victoria L. Tang and Rebecca L. Sudore and Irena Cenzer and W John Boscardin and Alexander K Smith and Christine S Ritchie and Margaret Wallhagen and Finlayson, Emily and Petrillo, Laura and Kenneth E Covinsky} } @article {8333, title = {Antidepressant use and functional limitations in U.S. older adults.}, journal = {J Psychosom Res}, volume = {80}, year = {2016}, month = {2016 Jan}, pages = {31-6}, publisher = {80}, abstract = {

OBJECTIVE: The upsurge in prevalence and long-term use of antidepressants among older adults might have profound health implications beyond depressive symptom management. This study examined the relationship between antidepressant use and functional limitation onset in U.S. older adults.

METHODS: Study sample came from 2006 and 2008 waves of the Health and Retirement Study, in combination with data from 2005 and 2007 Prescription Drug Study. Self-reported antidepressant use was identified based on the therapeutic classification of Cerner Multum{\textquoteright}s Lexicon. Functional limitations were classified into those pertaining to physical mobility, large muscle function, activities of daily living, gross motor function, fine motor function, and instrumental activities of daily living. Cox proportional hazard models were performed to assess the effects of antidepressant use on future functional limitation onset by limitation category, antidepressant type, and length of use, adjusted by depression status and other individual characteristics.

RESULTS: Antidepressant use for one year and longer was associated with an increase in the risk of functional limitation by 8\% (95\% confidence interval=4\%-12\%), whereas the relationship between antidepressant use less than a year and function limitation was statistically nonsignificant. Antidepressant use was associated with an increase in the risk of functional limitation by 8\% (3\%-13\%) among currently nondepressed participants but not currently depressed participants.

CONCLUSION: Long-term antidepressant use in older adults should be prudently evaluated and regularly monitored to reduce the risk of functional limitation. Future research is warranted to examine the health consequences of extended and/or off-label antidepressant use in absence of depressive symptoms.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Antidepressive Agents, depression, Drug Utilization, Female, Health Surveys, Humans, Longitudinal Studies, Male, Mobility Limitation, Muscle, Skeletal, Prevalence, Risk Factors, Socioeconomic factors, United States}, issn = {1879-1360}, doi = {10.1016/j.jpsychores.2015.11.007}, url = {http://www.sciencedirect.com/science/article/pii/S0022399915300167}, author = {An, Ruopeng and Lu, Lingyun} } @article {6513, title = {Are self-reported neighbourhood characteristics associated with onset of functional limitations in older adults with or without memory impairment?}, journal = {J Epidemiol Community Health}, volume = {70}, year = {2016}, month = {2016 Oct}, pages = {1017-23}, abstract = {

BACKGROUND: Neighbourhood resources may preserve functional independence in older adults, but little is known about whether benefits differ for individuals with normal and impaired memory. We evaluated the extent to which neighbourhood context was related to onset of instrumental and basic activities of daily living (I/ADL) limitations and whether relationships were modified by memory impairment.

METHODS: Health and Retirement Study participants 50+ years of age without baseline I/ADL limitations (n=8726 for IADL and n=8345 for ADL models) were interviewed biennially for up to 8 years. Self-reported neighbourhood characteristics were scaled from 0 (worst) to 1 (best). Memory, assessed by direct and proxy cognitive assessments, was dichotomised at the 20th centile. We used pooled logistic regression models, adjusted for demographics and individual characteristics.

RESULTS: Low neighbourhood physical disorder (OR=0.51 (95\% CI: 0.37 to 0.69)), high social cohesion (OR=0.46 (0.34 to 0.62)), and high safety (OR=0.59 (0.46 to 0.76)) were associated with reduced incidence of IADL limitations. These neighbourhood characteristics were also associated with lower incidence of ADL limitations (disorder OR=0.59 (0.43 to 0.81)); social cohesion OR=0.60 (0.45 to 0.81)); safety OR=0.74 (0.58 to 0.93)). High social ties were not related to ADLs (OR=1.01(0.80 to 1.28)) or IADLs (OR=0.93(0.74 to 1.17)). The benefits of these neighbourhood characteristics for ADLs were similar among those with and without memory impairment but primarily observed among those without memory impairment for IADLs.

CONCLUSIONS: Older adults living in neighbourhoods with low physical disorder, high social cohesion and high safety experience lower incidence of IADL and ADL limitations. Memory status modified the estimated effects of neighbourhood characteristics on IADL but not ADL limitations.

}, keywords = {Activities of Daily Living, Aged, Female, Humans, Independent Living, Interviews as Topic, Longitudinal Studies, Male, Memory Disorders, Middle Aged, Mobility Limitation, Residence Characteristics, Risk Factors, United States}, issn = {1470-2738}, doi = {10.1136/jech-2016-207241}, url = {http://jech.bmj.com/content/early/2016/05/06/jech-2016-207241.abstract}, author = {Thu T Nguyen and Rist, Pamela M and M. Maria Glymour} } @article {6495, title = {Combinations of Chronic Conditions, Functional Limitations, and Geriatric Syndromes that Predict Health Outcomes.}, journal = {J Gen Intern Med}, volume = {31}, year = {2016}, month = {2016 Jun}, pages = {630-7}, chapter = {630}, abstract = {

BACKGROUND: The strategic framework on multiple chronic conditions released by the US Department of Health and Human Services calls for identifying homogeneous subgroups of older adults to effectively target interventions aimed at improving their health.

OBJECTIVE: We aimed to identify combinations of chronic conditions, functional limitations, and geriatric syndromes that predict poor health outcomes. DESIGN, SETTING AND PARTICIPANTS Data from the 2010-2012 Health and Retirement Study provided a representative sample of U.S. adults 50~years of age or older (n = 16,640).

MAIN MEASURES: Outcomes were: Self-reported fair/poor health, self-rated worse health at 2~years, and 2-year mortality. The main independent variables included self-reported chronic conditions, functional limitations, and geriatric syndromes. We conducted tree-based classification and regression analysis to identify the most salient combinations of variables to predict outcomes.

KEY RESULTS: Twenty-nine percent and 23~\% of respondents reported fair/poor health and self-rated worse health at 2~years, respectively, and 5~\% died in 2~years. The top combinations of conditions identified through our tree analysis for the three different outcome measures (and percent respondents with the outcome) were: a) for fair/poor health status: difficulty walking several blocks, depressive symptoms, and severe pain (> 80~\%); b) for self-rated worse health at 2~years: 68.5~years of age or older, difficulty walking several blocks and being in fair/poor health (60~\%); and c) for 2-year mortality: 80.5~years of age or older, and presenting with limitations in both ADLs and IADLs (> 40~\%).

CONCLUSIONS: Rather than chronic conditions, functional limitations and/or geriatric syndromes were the most prominent conditions in predicting health outcomes. These findings imply that accounting for chronic conditions alone may be less informative than also accounting for the co-occurrence of functional limitations and geriatric syndromes, as the latter conditions appear to drive health outcomes in older individuals.

}, keywords = {Activities of Daily Living, Age Distribution, Aged, Aged, 80 and over, Chronic disease, Comorbidity, Female, Geriatric Assessment, Health Status, Health Status Indicators, Humans, Longitudinal Studies, Male, Middle Aged, Mobility Limitation, Prognosis, Risk Factors, Self Report, Sex Distribution, Socioeconomic factors, Syndrome, United States}, issn = {1525-1497}, doi = {10.1007/s11606-016-3590-9}, url = {http://dx.doi.org/10.1007/s11606-016-3590-9}, author = {Siran M Koroukian and Nicholas K Schiltz and David F Warner and Jiayang Sun and Paul M Bakaki and Kathleen A Smyth and Kurt C Stange and Charles W Given} } @article {8397, title = {Functional status in older women diagnosed with pelvic organ prolapse.}, journal = {Am J Obstet Gynecol}, volume = {214}, year = {2016}, month = {2016 May}, pages = {613.e1-7}, publisher = {214}, abstract = {

BACKGROUND: Functional status plays an important role in the comprehensive characterization of older adults. Functional limitations are associated with an increased risk of adverse treatment outcomes, but there are limited data on the prevalence of functional limitations in older women with pelvic floor disorders.

OBJECTIVE: The aim of the study was to describe the prevalence of functional limitations based on health status in older women with pelvic organ prolapse (POP).

STUDY DESIGN: This pooled, cross-sectional study utilized data from the linked Health and Retirement Study and Medicare files from 1992 through 2008. The analysis included 890 women age >=65 years with POP. We assessed self-reported functional status, categorized in strength, upper and lower body mobility, activities of daily living (ADL), and instrumental ADL (IADL) domains. Functional limitations were evaluated and stratified by respondents self-reported general health status. Descriptive statistics were used to compare categorical and continuous variables, and logistic regression was used to measure differences in the odds of functional limitation by increasing age.

RESULTS: The prevalence of functional limitations was 76.2\% in strength, 44.9\% in upper and 65.8\% in lower body mobility, 4.5\% in ADL, and 13.6\% in IADL. Limitations were more prevalent in women with poor or fair health status than in women with good health status, including 91.5\% vs 69.9\% in strength, 72.9\% vs 33.5\% in upper and 88.0\% vs 56.8\% in lower body mobility, 11.6\% vs 0.9\% in ADL, and 30.6\% vs 6.7\% in IADL; all P < .01. The odds of all functional limitations also increased significantly with advancing age.

CONCLUSION: Functional limitations, especially in strength and body mobility domains, are highly prevalent in older women with POP, particularly in those with poor or fair self-reported health status. Future research is necessary to evaluate if functional status affects clinical outcomes in pelvic reconstructive and gynecologic surgery and whether it should be routinely assessed in clinical decision-making when treating older women with POP.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Aging, Cross-Sectional Studies, Female, Health Status, Health Surveys, Humans, Medicare, Middle Aged, Mobility Limitation, Muscle Strength, Pelvic Organ Prolapse, United States, Upper Extremity}, issn = {1097-6868}, doi = {10.1016/j.ajog.2015.11.038}, url = {http://www.sciencedirect.com/science/article/pii/S0002937815024783}, author = {Tatiana V D Sanses and Nicholas K Schiltz and Bruna M. Couri and Sangeeta T Mahajan and Holly E Richter and David F Warner and Jack M. Guralnik and Siran M Koroukian} } @article {8228, title = {Explaining Disability Trends in the U.S. Elderly and Near-Elderly Population.}, journal = {Health Serv Res}, volume = {50}, year = {2015}, note = {Times Cited: 1 0 1}, month = {2015 Oct}, pages = {1528-49}, publisher = {50}, abstract = {

OBJECTIVE: To examine disability trends among U.S. near-elderly and elderly persons and explain observed trends.

DATA SOURCE: 1996-2010 waves of the Health and Retirement Study.

STUDY DESIGN: We first examined trends in Activities of Daily Living and Instrumental Activities of Daily Living limitations, and large muscle, mobility, gross motor, and fine motor indexes. Then we used decomposition analysis to estimate contributions of changes in sociodemographic composition, self-reported chronic disease prevalence and health behaviors, and changes in disabling effects of these factors to disability changes between 1996 and 2010.

PRINCIPAL FINDINGS: Disability generally increased or was unchanged. Increased trends were more apparent for near-elderly than elderly persons. Sociodemographic shifts tended to reduce disability, but their favorable effects were largely offset by increased self-reported chronic disease prevalence. Changes in smoking and heavy drinking prevalence had relatively minor effects on disability trends. Increased obesity rates generated sizable effects on lower-body functioning changes. Disabling effects of self-reported chronic diseases often declined, and educational attainment became a stronger influence in preventing disability.

CONCLUSIONS: Such unfavorable trends as increased chronic disease prevalence and higher obesity rates offset or outweighed the favorable effects with the result that disability remained unchanged or increased.

}, keywords = {Activities of Daily Living, Age Distribution, Aged, Aged, 80 and over, Alcohol Drinking, Chronic disease, Disabled Persons, Female, Health Behavior, Health Surveys, Humans, Male, Middle Aged, Mobility Limitation, Obesity, Prevalence, Sex Distribution, Smoking, Socioeconomic factors, United States}, issn = {1475-6773}, doi = {10.1111/1475-6773.12284}, author = {Chen, Yiqun and Frank A Sloan} } @article {8156, title = {Incident Diabetes and Mobility Limitations: Reducing Bias Through Risk-set Matching.}, journal = {J Gerontol A Biol Sci Med Sci}, volume = {70}, year = {2015}, month = {2015 Jul}, pages = {860-5}, publisher = {70}, abstract = {

BACKGROUND: Increased prevalence of diabetes in the U.S. population could contribute substantially to increases in disability at older ages. Previous studies have examined the association between prevalent diabetes and various impairments and disabilities. Methods considering incident, rather than prevalent, diabetes as the exposure of interest can reduce bias in estimates of these associations.

METHODS: Risk-set matching, a type of propensity score matching meant to handle time-varying exposures, was used to estimate the relationship between incident diabetes and mobility limitations among adults in the Health and Retirement Study. This approach ensures that covariates precede diabetes onset rather than follow it.

RESULTS: Individuals who were diagnosed with diabetes during the study period accumulated more subsequent mobility limitations than were accumulated by matched controls. Among observationally similar pairs of individuals, those who developed diabetes reported an average of 24.9\% more mobility limitations at study exit than those who did not.

CONCLUSIONS: The magnitude of the relationship between diabetes and limitations estimated in this article is smaller than that presented in previous studies, but the method presented here is likely to provide a less-biased estimate of the association between diabetes and accumulation of mobility limitations.

}, keywords = {Bias, Diabetes Mellitus, Female, Humans, Incidence, Longitudinal Studies, Male, Middle Aged, Mobility Limitation, Propensity Score, Risk Assessment, Risk Factors, Socioeconomic factors, United States}, issn = {1758-535X}, doi = {10.1093/gerona/glu212}, url = {http://biomedgerontology.oxfordjournals.org/content/early/2014/11/19/gerona.glu212.abstract}, author = {Ezra I. Fishman} } @article {8229, title = {Increase in Disability Prevalence Before Hip Fracture.}, journal = {J Am Geriatr Soc}, volume = {63}, year = {2015}, note = {Times Cited: 0 0}, month = {2015 Oct}, pages = {2029-35}, publisher = {63}, abstract = {

OBJECTIVES: To establish the prevalence and correlates of disability during the 2 years before hip fracture.

DESIGN: Data from participants who experienced hip fracture in the Health and Retirement Study (HRS) with hip fracture identified using linked Medicare claims. Each participant was interviewed at varying time points in the 2 years before hip fracture. Disability was defined as self-report of the need for assistance in any activity of daily living (walking across the room, eating, bathing, dressing, using the toilet, transferring). Based on the timing between interview and hip fracture, prevalence of disability was calculated in the cohort as a whole over the 2 years before hip fracture and in subgroups defined according to demographic and clinical characteristics.

SETTING: The HRS is a nationally representative longitudinal study (1992-2010).

PARTICIPANTS: HRS participants aged >=65 with hip fracture (mean age at fracture 84, 77\% female).

RESULTS: The adjusted prevalence of disability was 20\% (95\% confidence interval (CI) = 14-25\%) 2 years before hip fracture, with little change until approximately 10 months before fracture, when it started to rise, reaching 44\% (95\% CI = 33-55\%) in the month before hip fracture. The prevalence of disability was highest in the last month before fracture for persons aged 85 and older (53\%) and for those with dementia (60\%).

CONCLUSION: Care models for hip fracture need to consider not only the acute medical and surgical needs, but also the high level of need for supportive care and caregiver assistance that chronically disabled individuals require.

}, keywords = {Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Dementia, Disability Evaluation, Disabled Persons, Educational Status, Female, Health Surveys, Hip Fractures, Humans, Income, Male, Mobility Limitation, Prevalence, United States}, issn = {1532-5415}, doi = {10.1111/jgs.13658}, author = {Irena Cenzer and W John Boscardin and Christine S Ritchie and Margaret Wallhagen and Kenneth E Covinsky} } @article {8154, title = {Multimorbidity redefined: prospective health outcomes and the cumulative effect of co-occurring conditions.}, journal = {Prev Chronic Dis}, volume = {12}, year = {2015}, note = {Times Cited: 0 0}, month = {2015 Apr 23}, pages = {E55}, publisher = {12}, abstract = {

INTRODUCTION: Multimorbidity is common among middle-aged and older adults; however the prospective effects of multimorbidity on health outcomes (health status, major health decline, and mortality) have not been fully explored. This study addresses this gap in the literature.

METHODS: We used self-reported data from the 2008 and 2010 Health and Retirement Study. Our study population included 13,232 adults aged 50 or older. Our measure of baseline multimorbidity in 2008 was based on the occurrence or co-occurrence of chronic conditions, functional limitations, and/or geriatric syndromes, as follows: MM0, no chronic conditions, functional limitations, or geriatric syndromes; MM1, occurrence (but no co-occurrence) of chronic conditions, functional limitations, or geriatric syndromes; MM2, co-occurrence of any 2 of chronic conditions, functional limitations, or geriatric syndromes; and MM3, co-occurrence of all 3 of chronic conditions, functional limitations, and geriatric syndromes. Outcomes in 2010 included fair or poor health status, major health decline, and mortality.

RESULTS: All 3 outcomes were significantly associated with multimorbidity. Compared with MM0 (respectively for fair or poor health and major health decline), the adjusted odds ratios (AORs) and 95\% confidence intervals were as follows: 2.61 (1.79-3.78) and 2.20 (1.42-3.41) for MM1; 7.49 (5.20-10.77) and 3.70 (2.40-5.71) for MM2; and 22.66 (15.64-32.83) and 4.72 (3.03-7.37) for MM3. Multimorbidity was also associated with mortality: an adult classified as MM3 was nearly 12 times (AOR, 11.87 [5.72-24.62]) as likely as an adult classified as MM0 to die within 2 years.

CONCLUSION: Given the strong and significant association between multimorbidity and prospective health status, major health decline, and mortality, multimorbidity may be used - both in clinical practice and in research - to identify older adults with heightened vulnerability for adverse outcomes.

}, keywords = {Aged, Aged, 80 and over, Alcohol Drinking, Body Mass Index, Chronic disease, Cognition Disorders, Comorbidity, Cross-Sectional Studies, Data Interpretation, Statistical, ethnicity, Female, Health Status Indicators, Humans, Interviews as Topic, Male, Middle Aged, Mobility Limitation, Outcome Assessment, Health Care, Prospective Studies, Recurrence, Retirement, Self Report, Smoking, Social Class, Syndrome, United States, Vulnerable Populations}, issn = {1545-1151}, doi = {10.5888/pcd12.140478}, author = {Siran M Koroukian and David F Warner and Owusu, Cynthia and Charles W Given} } @article {8240, title = {Social Relationships, Gender, and Recovery From Mobility Limitation Among Older Americans.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {70}, year = {2015}, month = {2015 Sep}, pages = {769-81}, publisher = {70}, abstract = {

OBJECTIVES: Evidence suggests social relationships may be important facilitators for recovery from functional impairment, but the extant literature is limited in its measurement of social relationships including an over emphasis on filial social support and a paucity of nationally representative data.

METHODS: Using data from Waves 4-9 (1998-2008) of the Health and Retirement Study (HRS), this research examines the association between social relationships and recovery from severe mobility limitation (i.e., difficulty walking one block or across the room) among older Americans. Using a more nuanced measure of recovery that includes complete and partial recovery, a series of discrete-time event history models with multiple competing recovery outcomes were estimated using multinomial logistic regression.

RESULTS: Providing instrumental support to peers increased the odds of complete and partial recovery from severe mobility limitation, net of numerous social, and health factors. Having relatives living nearby decreased the odds of complete recovery, while being engaged in one{\textquoteright}s neighborhood increased the odds of partial recovery. The influence of partner status on partial and complete recovery varied by gender, whereby partnered men were more likely to experience recovery relative to partnered women. The effect of neighborhood engagement on partial recovery also varied by gender. Disengaged women were the least likely to experience partial recovery compared with any other group.

DISCUSSION: The rehabilitative potential of social relationships has important policy implications. Interventions aimed at encouraging older adults with mobility limitation to be engaged in their neighborhoods and/or provide instrumental support to peers may improve functional health outcomes.

}, keywords = {Aged, Aged, 80 and over, Cohort Studies, Family, Female, Humans, Interpersonal Relations, Male, Middle Aged, Mobility Limitation, Peer Group, Recovery of Function, Residence Characteristics, Sex Factors, Social Support, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbu181}, url = {http://psychsocgerontology.oxfordjournals.org/content/early/2015/01/11/geronb.gbu181.abstract}, author = {Kenzie Latham and Philippa J Clarke and Gregory Pavela} } @article {8095, title = {Cohort differences in the marriage-health relationship for midlife women.}, journal = {Soc Sci Med}, volume = {116}, year = {2014}, note = {Times Cited: 0 0}, month = {2014 Sep}, pages = {64-72}, publisher = {116}, abstract = {

The present study aimed to identify potential cohort differences in midlife women{\textquoteright}s self-reported functional limitations and chronic diseases. Additionally, we examined the relationship between marital status and health, comparing the health of divorced, widowed, and never married women with married women, and how this relationship differs by cohort. Using data from the Health and Retirement Study (HRS), we examined potential differences in the level of functional limitations and six chronic diseases in two age-matched cohorts of midlife women in the United States: Pre-Baby Boomers, born 1933-1942, N~=~4574; and Early Baby Boomers, born 1947-1956, N~=~2098. Linear and logistic regressions tested the marital status/health relationship, as well as cohort differences in this relationship, controlling for age, education, race, number of marriages, length of time in marital status, physical activity, and smoking status. We found that Early Baby Boom women had fewer functional limitations but higher risk of chronic disease diagnosis compared to Pre-Baby Boom women. In both cohorts, marriage was associated with lower disease risk and fewer functional limitations; however, never-married Early Baby Boom women had more functional limitations, as well as greater likelihood of lung disease than their Pre-Baby Boom counterparts (OR~=~0.28). Results are discussed in terms of the stress model of marriage, and the association between historical context and cohort health (e.g., the influence of economic hardship vs. economic prosperity). Additionally, we discuss cohort differences in selection into marital status, particularly as they pertain to never-married women, and the relative impact of marital dissolution on physical health for the two cohorts of women.

}, keywords = {Age Factors, Aged, Chronic disease, Cohort Studies, Female, Health Status, Health Surveys, Humans, Marital Status, Marriage, Middle Aged, Mobility Limitation, Risk Factors, Socioeconomic factors, United States}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2014.06.040}, author = {Nicky J Newton and Lindsay H Ryan and Rachel T King and Jacqui Smith} } @article {7968, title = {Predictors of older adults{\textquoteright} personal and community mobility: using a comprehensive theoretical mobility framework.}, journal = {Gerontologist}, volume = {54}, year = {2014}, month = {2014 Jun}, pages = {398-408}, publisher = {54}, abstract = {

PURPOSE OF THE STUDY: Forty-six percent of older adults report limitations in their mobility, and maintaining mobility is considered an important factor in keeping adults independent and active in later life. This study tests a comprehensive theoretical framework of mobility (Webber, S. C., Porter, M. M., \& Menec, V. H. [2010]. Mobility in older adults: A comprehensive framework. The Gerontologist, 50[4], 443-450. doi:10.1093/geront/gnq013) identifying multiple determinants that additively influence mobility (financial, psychosocial, environmental, physical, and cognitive), as well as cross-cutting influences of gender, culture, and biography.

DESIGN AND METHODS: Structural equation modeling was used to examine several models of mobility using data from 6,112 respondents in the Health and Retirement Study (mean age: 74.74, 85\% white, 41\% male, 57\% married).

RESULTS: The original measurement model fit the data well. When both personal and community mobility were simultaneously predicted, only the physical, cognitive, psychosocial, and environmental determinants were retained in the independent models. Age and marital status also predicted personal and community mobility. Although most of these relationships were in the expected direction, interestingly when both forms of mobility were included in the model, poorer cognitive ability was associated with greater personal mobility in the final model.

IMPLICATIONS: Results indicate the importance of accounting for and examining comprehensive models of mobility. The factors affecting older adults{\textquoteright} mobility are complex, and these relationships need to be explored in more depth to ensure the maintenance of individuals{\textquoteright} independence and quality of life.

}, keywords = {Aged, Female, Humans, Male, Mobility Limitation, Models, Theoretical}, issn = {1758-5341}, doi = {10.1093/geront/gnt054}, author = {M. Ren{\'e}e Umstattd Meyer and Megan C Janke and Beaujean, A. Alexander} } @article {10279, title = {Chiropractic use and changes in health among older medicare beneficiaries: a comparative effectiveness observational study.}, journal = {J Manipulative Physiol Ther}, volume = {36}, year = {2013}, month = {2013 Nov-Dec}, pages = {572-84}, abstract = {

OBJECTIVE: The purpose of this study was to investigate the effect of chiropractic on 5 outcomes among Medicare beneficiaries: increased difficulties performing activities of daily living (ADLs), instrumental ADLs (IADLs), and lower body functions, as well as lower self-rated health and increased depressive symptoms.

METHODS: Among all beneficiaries, we estimated the effect of chiropractic use on changes in health outcomes among those who used chiropractic compared with those who did not, and among beneficiaries with back conditions, we estimated the effect of chiropractic use relative to medical care, both during a 2- to 15-year period. Two analytic approaches were used--one assumed no selection bias, whereas the other adjusted for potential selection bias using propensity score methods.

RESULTS: Among all beneficiaries, propensity score analyses indicated that chiropractic use led to comparable outcomes for ADLs, IADLs, and depressive symptoms, although there were increased risks associated with chiropractic for declines in lower body function and self-rated health. Propensity score analyses among beneficiaries with back conditions indicated that chiropractic use led to comparable outcomes for ADLs, IADLs, lower body function, and depressive symptoms, although there was an increased risk associated with chiropractic use for declines in self-rated health.

CONCLUSION: The evidence in this study suggests that chiropractic treatment has comparable effects on functional outcomes when compared with medical treatment for all Medicare beneficiaries, but increased risk for declines in self-rated health among beneficiaries with back conditions.

}, keywords = {Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Cohort Studies, Databases, Factual, Disability Evaluation, Female, Geriatric Assessment, Humans, Low Back Pain, Male, Manipulation, Chiropractic, Medicare, Mobility Limitation, Musculoskeletal Diseases, Patient Satisfaction, Quality of Life, Risk Assessment, Sex Factors, Treatment Outcome, United States}, issn = {1532-6586}, doi = {10.1016/j.jmpt.2013.08.008}, url = {https://www.ncbi.nlm.nih.gov/pubmed/24636108}, author = {Paula A Weigel and Jason Hockenberry and Suzanne E Bentler and Frederic D Wolinsky} } @article {7819, title = {Trends in late-life activity limitations in the United States: an update from five national surveys.}, journal = {Demography}, volume = {50}, year = {2013}, month = {2013 Apr}, pages = {661-71}, publisher = {50}, abstract = {

This article updates trends from five national U.S. surveys to determine whether the prevalence of activity limitations among the older population continued to decline in the first decade of the twenty-first century. Findings across studies suggest that personal care and domestic activity limitations may have continued to decline for those ages 85 and older from 2000 to 2008, but generally were flat since 2000 for those ages 65-84. Modest increases were observed for the 55- to 64-year-old group approaching late life, although prevalence remained low for this age group. Inclusion of the institutional population is important for assessing trends among those ages 85 and older in particular.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Disabled Persons, Female, Health Surveys, Humans, Male, Mobility Limitation, Models, Statistical, United States}, issn = {0070-3370}, doi = {10.1007/s13524-012-0167-z}, author = {Vicki A Freedman and Brenda C Spillman and Patricia Andreski and Jennifer C. Cornman and Eileen M. Crimmins and Kramarow, Ellen and Lubitz, James and Linda G Martin and Sharon S. Merkin and Robert F. Schoeni and Teresa Seeman and Timothy A Waidmann} } @article {7714, title = {Association of chronic diseases and impairments with disability in older adults: a decade of change?}, journal = {Med Care}, volume = {50}, year = {2012}, month = {2012 Jun}, pages = {501-7}, publisher = {50}, abstract = {

BACKGROUND: Little is known about how the relationship between chronic disease, impairment, and disability has changed over time among older adults.

OBJECTIVE: To examine how the associations of chronic disease and impairment with specific disability have changed over time.

RESEARCH DESIGN: Repeated cross-sectional analysis, followed by examining the collated sample using time interaction variables, of 3 recent waves of the Health and Retirement Study.

SUBJECTS: The subjects included 10,390, 10,621 and 10,557 community-dwelling adults aged 65 years and above in 1998, 2004, and 2008.

MEASUREMENTS: : Survey-based history of chronic diseases including hypertension, heart disease, heart failure, stroke, diabetes, cancer, chronic lung disease, and arthritis; impairments, including cognition, vision, and hearing; and disability, including mobility, complex activities of daily living (ADL), and self-care ADL.

RESULTS: Over time, the relationship of chronic diseases and impairments with disability was largely unchanged; however, the association between hypertension and complex ADL disability weakened from 1998 to 2004 and 2008 [odds ratio (OR) = 1.24; 99\% confidence interval (CI), 1.06-1.46; OR = 1.07; 99\% CI, 0.90-1.27; OR = 1.00; 99\% CI, 0.83-1.19, respectively], as it did for hypertension and self-care disability (OR = 1.32; 99\% CI, 1.13-1.54; OR=0.97; 99\% CI, 0.82-1.14; OR = 0.99; 99\% CI, 0.83-1.17). The association between diabetes and self-care disability strengthened from 1998 to 2004 and 2008 (OR = 1.21; 99\% CI, 1.01-1.46; OR = 1.37; 99\% CI, 1.15-1.64; OR = 1.52; 99\% CI, 1.29-1.79), as it also did for lung disease and self-care disability (OR = 1.64; 99\% CI, 1.33-2.03; OR = 1.63; 99\% CI, 1.32-2.01; OR = 2.11; 99\% CI, 1.73-2.57).

CONCLUSIONS: Although relationships between diseases, impairments, and disability were largely unchanged, disability became less associated with hypertension and more with diabetes and lung disease.

}, keywords = {Activities of Daily Living, Aged, Aging, Cardiovascular Diseases, Chronic disease, Cognition Disorders, Cross-Sectional Studies, Diabetes Mellitus, Disabled Persons, Female, Health Surveys, Hearing loss, Humans, Hypertension, Male, Mobility Limitation, Residence Characteristics, Respiratory Tract Diseases, Self Care, Socioeconomic factors, United States, Vision Disorders}, issn = {1537-1948}, doi = {10.1097/MLR.0b013e318245a0e0}, author = {William W. Hung and Joseph S. Ross and Boockvar, Kenneth S and Albert L Siu} } @article {10933, title = {A comparison and cross-validation of models to predict basic activity of daily living dependency in older adults.}, journal = {Medical Care}, volume = {50}, year = {2012}, month = {2012 Jun}, pages = {534-9}, abstract = {

BACKGROUND: A simple method of identifying elders at high risk for activity of daily living (ADL) dependence could facilitate essential research and implementation of cost-effective clinical care programs.

OBJECTIVE: We used a nationally representative sample of 9446 older adults free from ADL dependence in 2006 to develop simple models for predicting ADL dependence at 2008 follow-up and to compare the models to the most predictive published model. Candidate predictor variables were those of published models that could be obtained from interview or medical record data.

METHODS: Variable selection was performed using logistic regression with backward elimination in a two-third random sample (n = 6233) and validated in a one-third random sample (n = 3213). Model fit was determined using the c-statistic and evaluated vis-a-vis our replication of a published model.

RESULTS: At 2-year follow-up, 8.0\% and 7.3\% of initially independent persons were ADL dependent in the development and validation samples, respectively. The best fitting, simple model consisted of age and number of hospitalizations in past 2 years, plus diagnoses of diabetes, chronic lung disease, congestive heart failure, stroke, and arthritis. This model had a c-statistic of 0.74 in the validation sample. A model of just age and number of hospitalizations achieved a c-statistic of 0.71. These compared with a c-statistic of 0.79 for the published model. Sensitivity analyses demonstrated model robustness.

CONCLUSIONS: Models based on a widely available data achieve very good validity for predicting ADL dependence. Future work will assess the validity of these models using medical record data.

}, keywords = {Accidental Falls, Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Aging, Body Mass Index, Chronic disease, Female, Humans, Male, Mobility Limitation, Models, Statistical, Risk Assessment, Sex Factors}, issn = {1537-1948}, doi = {10.1097/MLR.0b013e318245a50c}, author = {Daniel O. Clark and Timothy E. Stump and Tu, Wanzhu and Douglas K Miller} } @article {7680, title = {Subjective social status and functional decline in older adults.}, journal = {J Gen Intern Med}, volume = {27}, year = {2012}, month = {2012 Jun}, pages = {693-9}, abstract = {

BACKGROUND: It is unknown whether subjective assessment of social status predicts health outcomes in older adults.

OBJECTIVE: To describe the relationship between subjective social status and functional decline in older adults.

DESIGN: Longitudinal cohort study.

SETTING: The Health and Retirement Study, a nationally representative survey of community-dwelling older adults (2004-2008).

PARTICIPANTS: Two thousand five hundred and twenty-three community-dwelling older adults.

MAIN MEASURES: Self-report of social status (SSS), categorized into three groups, reported by participants who marked a 10-rung ladder to represent where they stand in society. Four-year functional decline (new difficulty in any of five activities of daily living, mobility decline and/or death)

KEY RESULTS: Mean age was 64; 46\% were male, 85\% were white. At baseline, lower SSS was associated with being younger, unmarried, of nonwhite race/ethnicity, higher rates of chronic medical conditions and ADL impairment (P < 0.01). Over 4~years, 50\% in the lowest SSS group declined in function, compared to the middle and highest groups (28\% and 26\%), P-trend <0.001. Those in the lowest rungs of SSS were at increased risk of 4-year functional decline (unadjusted RR = 1.91, CI 1.-9-2.46). The relationship between a subjective belief that one is worse off than others and functional decline persisted after serial adjustment for demographics, objective SES measures, and baseline health and functional status (RR 1.36, CI 1.08-1.73).

CONCLUSIONS: In older adults, the belief that one is in the lowest rungs of social status is a measure of socioeconomic distress and of significant risk for functional decline. These findings suggest that self-report of low subjective social status may give clinicians additional information about which older adults are at high risk for future functional decline.

}, keywords = {Activities of Daily Living, Aged, Aging, Female, Health Status Disparities, Humans, Longitudinal Studies, Male, Middle Aged, Mobility Limitation, Risk Factors, Self Report, Social Class}, issn = {1525-1497}, doi = {10.1007/s11606-011-1963-7}, author = {Bonnie Chen and Kenneth E Covinsky and Irena Cenzer and Nancy E Adler and Brie A Williams} } @article {7600, title = {Aging in a cultural context: cross-national differences in disability and the moderating role of personal control among older adults in the United States and England.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {66}, year = {2011}, month = {2011 Jul}, pages = {457-67}, publisher = {66B}, abstract = {

OBJECTIVES: We investigate cross-national differences in late-life health outcomes and focus on an intriguing difference in beliefs about personal control found between older adult populations in the U.K. and United States. We examine the moderating role of control beliefs in the relationship between physical function and self-reported difficulty with daily activities.

METHOD: Using national data from the United States (Health and Retirement Study) and England (English Longitudinal Study on Ageing), we examine the prevalence in disability across the two countries and show how it varies according to the sense of control. Poisson regression was used to examine the relationship between objective measures of physical function (gait speed) and disability and the modifying effects of control.

RESULTS: Older Americans have a higher sense of personal control than the British, which operates as a psychological resource to reduce disability among older Americans. However, the benefits of control are attenuated as physical impairments become more severe.

DISCUSSION: These results emphasize the importance of carefully considering cross-national differences in the disablement process as a result of cultural variation in underlying psychosocial resources. This paper highlights the role of culture in shaping health across adults aging in different sociopolitical contexts.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Aging, Cross-Cultural Comparison, Culture, Disabled Persons, England, Female, Gait, Health Status, Humans, Internal-External Control, Longitudinal Studies, Male, Mobility Limitation, Politics, Social Values, Socioeconomic factors, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbr054}, author = {Philippa J Clarke and Jacqui Smith} } @article {7579, title = {Long-term declines in ADLs, IADLs, and mobility among older Medicare beneficiaries.}, journal = {BMC Geriatr}, volume = {11}, year = {2011}, month = {2011 Aug 16}, pages = {43}, publisher = {11}, abstract = {

BACKGROUND: Most prior studies have focused on short-term (<= 2 years) functional declines. But those studies cannot address aging effects inasmuch as all participants have aged the same amount. Therefore, the authors studied the extent of long-term functional decline in older Medicare beneficiaries who were followed for varying time lengths, and the authors also identified the risk factors associated with those declines.

METHODS: The analytic sample included 5,871 self- or proxy-respondents who had complete baseline and follow-up survey data that could be linked to their Medicare claims for 1993-2007. Functional status was assessed using activities of daily living (ADLs), instrumental ADLs (IADLs), and mobility limitations, with declines defined as the development of two of more new difficulties. Multiple logistic regression analysis was used to focus on the associations involving respondent status, health lifestyle, continuity of care, managed care status, health shocks, and terminal drop.

RESULTS: The average amount of time between the first and final interviews was 8.0 years. Declines were observed for 36.6\% on ADL abilities, 32.3\% on IADL abilities, and 30.9\% on mobility abilities. Functional decline was more likely to occur when proxy-reports were used, and the effects of baseline function on decline were reduced when proxy-reports were used. Engaging in vigorous physical activity consistently and substantially protected against functional decline, whereas obesity, cigarette smoking, and alcohol consumption were only associated with mobility declines. Post-baseline hospitalizations were the most robust predictors of functional decline, exhibiting a dose-response effect such that the greater the average annual number of hospital episodes, the greater the likelihood of functional status decline. Participants whose final interview preceded their death by one year or less had substantially greater odds of functional status decline.

CONCLUSIONS: Both the additive and interactive (with functional status) effects of respondent status should be taken into consideration whenever proxy-reports are used. Encouraging exercise could broadly reduce the risk of functional decline across all three outcomes, although interventions encouraging weight reduction and smoking cessation would only affect mobility declines. Reducing hospitalization and re-hospitalization rates could also broadly reduce the risk of functional decline across all three outcomes.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Cohort Studies, Disabled Persons, Female, Follow-Up Studies, Geriatric Assessment, Health Surveys, Humans, Insurance Benefits, Longitudinal Studies, Male, Medicare, Mobility Limitation, Prospective Studies, Time Factors, United States}, issn = {1471-2318}, doi = {10.1186/1471-2318-11-43}, author = {Frederic D Wolinsky and Suzanne E Bentler and Jason Hockenberry and Michael P Jones and Maksym Obrizan and Paula A Weigel and Kaskie, Brian and Robert B Wallace} } @article {7468, title = {Depressive symptoms in middle age and the development of later-life functional limitations: the long-term effect of depressive symptoms.}, journal = {J Am Geriatr Soc}, volume = {58}, year = {2010}, month = {2010 Mar}, pages = {551-6}, publisher = {58}, abstract = {

OBJECTIVES: To determine whether middle-aged persons with depressive symptoms are at higher risk for developing activity of daily living (ADL) and mobility limitations as they advance into older age than those without.

DESIGN: Prospective cohort study.

SETTING: The Health and Retirement Study (HRS), a nationally representative sample of people aged 50 to 61.

PARTICIPANTS: Seven thousand two hundred seven community living participants in the 1992 wave of the HRS.

MEASUREMENTS: Depressive symptoms were measured using the 11-item Center for Epidemiologic Studies Depression Scale (CES-D 11), with scores of 9 or more (out of 33) classified as significant depressive symptoms. Difficulty with five ADLs and basic mobility tasks (walking several blocks or up one flight of stairs) was measured every 2 years through 2006. The primary outcome was persistent difficulty with ADLs or mobility, defined as difficulty in two consecutive waves.

RESULTS: Eight hundred eighty-seven (12\%) subjects scored 9 or higher on the CES-D 11 and were classified as having significant depressive symptoms. Over 12 years of follow-up, subjects with depressive symptoms were more likely to reach the primary outcome measure of persistent difficulty with mobility or difficulty with ADL function (45\% vs 23\%, Cox hazard ratio (HR)=2.33, 95\% confidence interval (CI)=2.06-2.63). After adjusting for age, sex, measures of socioeconomic status, comorbid conditions, high body mass index, smoking, exercise, difficulty jogging 1 mile, and difficulty climbing several flights of stairs, the risk was attenuated but still statistically significant (Cox HR=1.44, 95\% CI=1.25-1.66).

CONCLUSION: Depressive symptoms independently predict the development of persistent limitations in ADLs and mobility as middle-aged persons advance into later life. Middle-aged persons with depressive symptoms may be at greater risk for losing their functional independence as they age.

}, keywords = {Activities of Daily Living, depression, Female, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Mobility Limitation, Proportional Hazards Models, Prospective Studies, Risk Factors, United States}, issn = {1532-5415}, doi = {10.1111/j.1532-5415.2010.02723.x}, author = {Kenneth E Covinsky and Kristine Yaffe and Lindquist, Karla and Cherkasova, Elena and Yelin, Edward and Dan G. Blazer} } @article {7404, title = {Changes in functional status among persons over age sixty-five undergoing total knee arthroplasty.}, journal = {Med Care}, volume = {47}, year = {2009}, month = {2009 Jul}, pages = {742-8}, publisher = {47}, abstract = {

BACKGROUND: This study assessed changes in physical functional status following receipt of total knee arthroplasty (TKA) for patients diagnosed with osteoarthritis (OA) of the knee in a national sample of persons aged 65+ in the United States relative to a sample of similar OA patients who did not receive TKA.

METHODS: Data from the Health Retirement Survey (HRS) and linked Medicare claims from 1994 to 2006 were used to identify persons with diagnoses of OA of the lower leg who received a TKA (n = 516) and those who did not receive TKA (n = 1756). Predicted probabilities of receiving total knee arthroplasty from logit analysis were used for matching TKA and comparison groups on demographic, socioeconomic, and baseline functional status factors. Functional status measures were: mobility, gross motor function, large muscle, and limitations in activities of daily living (ADL). Average treatment effects of the treated (ATT), which compares changes in functional status between those who received TKA with similar individuals who did not receive TKA, were computed using propensity score matching.

RESULTS: Mobility (average treatment effect of the treated (ATT = 0.315; 95\% CI: 0.118-0.512), gross motor function (ATT = 0.314; 95\% CI: 0.156-0.472), and ADL limitations (ATT = 0.174; 95\% CI: 0.055-0.293), improved among persons receiving TKA relative to the comparison group. Relative to the mean values of the physical function at baseline, mobility, gross motor function, and ADL limitations persons receiving TKA had better functional outcomes than the comparison group by 17.5, 39.3, and 46.9 percent, respectively.

CONCLUSIONS: TKA is effective in improving functional status in elderly persons.

}, keywords = {Activities of Daily Living, Aged, Arthroplasty, Replacement, Knee, Attitude to Health, Geriatric Assessment, Health Care Surveys, Health Status, Health Surveys, Humans, Insurance Claim Reporting, Logistic Models, Longitudinal Studies, Medicare, Mobility Limitation, Multivariate Analysis, Muscle Weakness, Osteoarthritis, Knee, pain, Sensitivity and Specificity, Surveys and Questionnaires, Treatment Outcome, United States}, issn = {1537-1948}, doi = {10.1097/MLR.0b013e31819a5ae3}, author = {Frank A Sloan and Ruiz, David and Alyssa C Platt} } @article {7358, title = {Pain, functional limitations, and aging.}, journal = {J Am Geriatr Soc}, volume = {57}, year = {2009}, month = {2009 Sep}, pages = {1556-61}, publisher = {57}, abstract = {

OBJECTIVES: To examine the relationship between functional limitations and pain across a spectrum of age, ranging from mid life to advanced old age.

DESIGN: Cross-sectional study.

SETTING: The 2004 Health and Retirement Study (HRS), a nationally representative study of community-living persons aged 50 and older.

PARTICIPANTS: Eighteen thousand five hundred thirty-one participants in the 2004 HRS.

MEASUREMENTS: Participants who reported that they were often troubled by pain that was moderate or severe most of the time were defined as having significant pain. For each of four functional domains, subjects were classified according to their degree of functional limitation: mobility (able to jog 1 mile, able to walk several blocks, able to walk one block, unable to walk one block), stair climbing (able to climb several flights, able to climb one flight, not able to climb a flight), upper extremity tasks (able to do 3, 2, 1, or 0), and activity of daily living (ADL) function (able to do without difficulty, had difficulty but able to do without help, need help).

RESULTS: Twenty-four percent of participants had significant pain. Across all four domains, participants with pain had much higher rates of functional limitations than subjects without pain. Participants with pain were similar in terms of their degree of functional limitation to participants 2 to 3 decades older. For example, for mobility, of subjects aged 50 to 59 without pain, 37\% were able to jog 1 mile, 91\% were able to walk several blocks, and 96\% were able to walk one block without difficulty. In contrast, of subjects aged 50 to 59 with pain, 9\% were able to jog 1 mile, 50\% were able to walk several blocks, and 69\% were able to walk one block without difficulty. Subjects aged 50 to 59 with pain were similar in terms of mobility limitations to subjects aged 80 to 89 without pain, of whom 4\% were able to jog 1 mile, 55\% were able to walk several blocks, and 72\% were able to walk one block without difficulty. After adjustment for demographic characteristics, socioeconomic status, comorbid conditions, depression, obesity, and health habits, across all four measures, participants with significant pain were at much higher risk for having functional limitations (adjusted odds ratio (AOR)=2.85, 95\% confidence interval (CI)=2.20-3.69, for mobility; AOR=2.84, 95\% CI=2.48-3.26, for stair climbing; AOR=3.96, 95\% CI=3.43-4.58, for upper extremity tasks; and AOR=4.33; 95\% CI=3.71-5.06, for ADL function).

CONCLUSION: Subjects with pain develop the functional limitations classically associated with aging at much earlier ages.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Aging, Comorbidity, Cross-Sectional Studies, Disability Evaluation, Female, Geriatric Assessment, Health Behavior, Health Surveys, Humans, Life Style, Male, Middle Aged, Mobility Limitation, pain, Pain Measurement, Quality of Life, Risk Factors}, issn = {1532-5415}, doi = {10.1111/j.1532-5415.2009.02388.x}, author = {Kenneth E Covinsky and Lindquist, Karla and Dorothy D Dunlop and Yelin, Edward} } @article {7205, title = {Effect of arthritis in middle age on older-age functioning.}, journal = {J Am Geriatr Soc}, volume = {56}, year = {2008}, month = {2008 Jan}, pages = {23-8}, publisher = {56}, abstract = {

OBJECTIVES: To examine whether symptomatic arthritis in middle age predicts the earlier onset of functional difficulties (difficulty with activities of daily living (ADLs) and walking) that are associated with loss of independence in older persons.

DESIGN: Prospective longitudinal study.

SETTING: The Health and Retirement Study, a nationally representative sample of persons aged 50 to 62 at baseline who were followed for 10 years.

PARTICIPANTS: Seven thousand five hundred forty-three subjects with no difficulty in mobility or ADL function at baseline.

MEASUREMENTS: Arthritis was measured at baseline according to self-report. The primary outcome was time to persistent difficulty in one of five ADLs or mobility (walking several blocks or up a flight of stairs). Difficulty with ADLs or mobility was assessed according to subject interview every 2 years. Analyses were adjusted for other comorbid conditions, body mass index, exercise, and demographic characteristics.

RESULTS: Twenty-nine percent of subjects reported arthritis at baseline. Subjects with arthritis were more likely to develop persistent difficulty in mobility or ADL function over 10 years of follow-up (34\% vs 18\%, adjusted hazard ratio (HR)=1.63, 95\% confidence interval (CI)=1.43-1.86). When each component of the primary outcome was assessed separately, arthritis was also associated with persistent difficulty in mobility (30\% vs 16\%, adjusted HR=1.55, 95\% CI=1.41-1.71) and persistent difficulty in ADL function (13\% vs 5\%, adjusted HR=1.85, 95\% CI=1.58-2.16).

CONCLUSION: Middle-aged persons who report a history of arthritis are more likely to develop mobility and ADL difficulties as they enter old age. This finding highlights the need to develop interventions and treatments that take a life-course approach to preventing the disabling effect of arthritis.

}, keywords = {Activities of Daily Living, Arthritis, Chronic disease, Confidence Intervals, Female, Follow-Up Studies, Humans, Male, Middle Aged, Mobility Limitation, Prognosis, Prospective Studies, Risk Factors, Severity of Illness Index, Surveys and Questionnaires, Time Factors, Walking}, issn = {1532-5415}, doi = {10.1111/j.1532-5415.2007.01511.x}, author = {Kenneth E Covinsky and Lindquist, Karla and Dorothy D Dunlop and Thomas M Gill and Yelin, Edward} } @article {7256, title = {Racial/ethnic differences in the relationship between the use of health care services and functional disability: the health and retirement study (1992-2004).}, journal = {Gerontologist}, volume = {48}, year = {2008}, month = {2008 Oct}, pages = {659-67}, publisher = {48}, abstract = {

PURPOSE: The purpose of this study was to examine racial/ethnic differences in the relationship between functional disability and the use of health care services in a nationally representative sample of older adults by using the Andersen behavioral model of health services utilization.

DESIGN AND METHODS: The study used 12 years of longitudinal data from the Health and Retirement Study (1992-2004), a nationally representative sample of community-dwelling adults older than 50 in 1992 (N = 8,947). Nonlinear multilevel models used self-reported health care service utilization (physician visits and hospital admissions) to predict racial/ethnic differences in disability (activities of daily living and mobility limitations). The models also evaluated the roles of other predisposing (age and gender), health need (medical conditions and self-rated health), and enabling factors (health insurance, education, income, and wealth).

RESULTS: Blacks and Latinos utilizing physician visits and hospital admissions were associated with significantly more activity of daily living disability than Whites (p <.001). Blacks utilizing physician visits (p <.001) and hospital admissions (p <.05) and Latinos utilizing hospital admissions (p <.05) were associated with more mobility disability than Whites. Other predisposing, health need, and enabling factors did not account for these racial/ethnic differences.

IMPLICATIONS: Nationally, health care use for Blacks and Latinos was associated with more disabilities than for Whites after we accounted for predisposing, health need, and enabling factors. The findings suggest that improving health care quality for all Americans may supersede equal access to health care for reducing ethnic and racial disparities in functional health.

}, keywords = {Activities of Daily Living, Disabled Persons, ethnicity, Female, Health Services, Health Status Disparities, Healthcare Disparities, Humans, Longitudinal Studies, Male, Middle Aged, Mobility Limitation, Racial Groups, Retirement}, issn = {0016-9013}, doi = {10.1093/geront/48.5.659}, author = {Mary E Bowen and Hector M Gonz{\'a}lez} } @article {7246, title = {Spousal caregiving in late midlife versus older ages: implications of work and family obligations.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {63}, year = {2008}, month = {2008 Jul}, pages = {S229-S238}, publisher = {63B}, abstract = {

OBJECTIVES: This study examined life-stage differences in the provision of care to spouses with functional impairment.

METHODS: We examined 1,218 married adults aged 52 and older from the 2000 wave of the Health and Retirement Study who received impairment-related help with at least one activity of daily living. We examined the differential likelihood that spouses served as primary caregiver and the hours of care provided by spousal primary caregivers by life stage.

RESULTS: We found that late middle-aged care recipients were more likely than their older counterparts to receive the majority of their care from their spouse but received fewer hours of spousal care, mostly when spouses worked full time. Competing demands of caring for children or parents did not affect the amount of care provided by a spouse.

DISCUSSION: Late middle-aged adults with functional limitations are more likely than older groups to be married and cared for primarily by spouses; however, they may be particularly vulnerable to unmet need for care. As the baby boom generation ages, retirement ages increase, and federal safety nets weaken, people with health problems at older ages may soon find themselves in the same caregiving predicament as those in late middle age.

}, keywords = {Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Caregivers, Employment, Family Relations, Female, Gender Identity, Health Surveys, Humans, Longitudinal Studies, Male, Middle Aged, Mobility Limitation, Spouses, Time Factors, United States}, issn = {1079-5014}, doi = {10.1093/geronb/63.4.s229}, author = {Julie C Lima and Susan M Allen and Goldscheider, Frances and Intrator, Orna} } @article {7165, title = {Childhood social and economic well-being and health in older age.}, journal = {Am J Epidemiol}, volume = {166}, year = {2007}, month = {2007 Nov 01}, pages = {1059-67}, publisher = {166}, abstract = {

Childhood socioeconomic status (SES) acts over a lifetime to influence adult health outcomes. Whether the impact of childhood SES differs by age or race/ethnicity is unclear. The authors studied 20,566 community-living US adults aged > or =50 years. Parental education was the main predictor. Outcomes evaluated (1998-2002) included self-reported health and functional limitation. The influence of childhood SES on later-life health was also examined in groups stratified by age and race/ethnicity, with adjustment for demographic factors and current SES. Participants{\textquoteright} mean age was 67 years; 57\% were women. By race/ethnicity, 76\% were White, 14\% were Black, and 8\% were Latino. The relation between low parental education and fair/poor self-rated health declined with advancing age (age 50-64 years: adjusted odds ratio (AOR) = 1.42, 95\% confidence interval (CI): 1.24, 1.63; age > or =80 years: AOR = 1.14, 95\% CI: 0.96, 1.36). The relation between low parental education and fair/poor self-rated health differed across racial/ethnic groups and was significant in White (AOR = 1.33, 95\% CI: 1.21, 1.47) and Black (AOR = 1.37, 95\% CI: 1.14, 1.64) participants but not Latinos. These findings suggest that childhood SES affects health status through midlife but the effects may abate in late life; its effects also may be weaker in Latinos than in Whites or Blacks.

}, keywords = {Aged, Aged, 80 and over, Black or African American, Child, Confidence Intervals, Educational Status, Female, Frail Elderly, Health Status, Health Status Indicators, Hispanic or Latino, Humans, Male, Middle Aged, Mobility Limitation, Odds Ratio, Poverty, Retrospective Studies, Sampling Studies, San Francisco, Socioeconomic factors, Surveys and Questionnaires, White People}, issn = {0002-9262}, doi = {10.1093/aje/kwm185}, author = {Sandra Y. Moody-Ayers and Lindquist, Karla and Sen, Saunak and Kenneth E Covinsky} } @article {7128, title = {Does money buy better health? Unpacking the income to health association after midlife.}, journal = {Health (London)}, volume = {11}, year = {2007}, month = {2007 Apr}, pages = {199-226}, publisher = {11}, abstract = {

This article estimates the effect of household financial resources on health after midlife using models that minimize health-related selectivity and unobserved heterogeneity bias. I focus on the self-rated health and mobility limitations of adults transitioning into retirement over six panels of the Health and Retirement Study (1992-2002; age 51-61 at wave one; N = 7602). Standard regression models that adjust for health-related selection with prospective and retrospective controls suggest a significant influence of long-term income on health, but an insignificant influence of short-term income. Further adjustment for unobserved fixed effects also suggests that short-term income is insignificant. Sizable recent and long-term health feedbacks to income for a portion of the HRS respondents underscore the need to control for the confounding influence of health over the lifecourse. Together these results suggest that adults after midlife are heterogeneous with respect to the causal and selective processes generating the observed association between income and health.

}, keywords = {Aged, Attitude to Health, Employment, Health Status Indicators, Humans, Income, Middle Aged, Mobility Limitation, Models, Econometric, Retirement, Self Concept, Sociology, Medical, United States}, issn = {1363-4593}, doi = {10.1177/1363459307074694}, author = {Berry, Brent M.} } @article {7143, title = {Educational disparities in the prevalence and consequence of physical vulnerability.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {62}, year = {2007}, month = {2007 May}, pages = {S193-7}, publisher = {62B}, abstract = {

OBJECTIVES: The purpose of this study was to estimate educational differences in the prevalence and mortality consequence of physical vulnerability among older adults in the United States.

METHODS: Data came from the 1998 and 2000 waves of the Health and Retirement Study, a nationally representative cross-sectional and prospective cohort study of community-based adults aged 65 and older. We created a physical vulnerability score from age, gender, and self-reported disability measures and measured socioeconomic status via educational attainment. Mortality data came from the National Death Index.

RESULTS: In the 1998 cohort, high physical vulnerability was more than 3 times more prevalent in individuals with less than 12 years of education compared to those with 16 or more years of education. Although less educated older adults had a higher probability of death overall, evidence of educational differences in the mortality consequence of high physical vulnerability was limited. In 2000, 2.16 million older adults had high physical vulnerability, and more than one half (53\%) of these adults had less than 12 years of education.

DISCUSSION: In persons 65 years of age or older, educational differences are more apparent in the prevalence of physical vulnerability than in the mortality consequence of that vulnerability.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Chronic disease, Cohort Studies, Cross-Sectional Studies, Educational Status, Female, Geriatric Assessment, Health Surveys, Humans, Male, Mobility Limitation, Risk Factors, Socioeconomic factors, Survival Analysis, United States}, issn = {1079-5014}, doi = {10.1093/geronb/62.3.s193}, author = {Daniel O. Clark and Timothy E. Stump and Douglas K Miller and Long, J. Scott} } @article {7161, title = {An interpersonal continuity of care measure for Medicare Part B claims analyses.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {62}, year = {2007}, month = {2007 May}, pages = {S160-8}, publisher = {62B}, abstract = {

OBJECTIVES: This article presents an interpersonal continuity of care measure.

METHODS: We operationalized continuity of care as no more than an 8-month interval between any two visits during a 2-year period to either (a) the same primary care physician or (b) the same physician regardless of specialty. Sensitivity analyses evaluated two interval censoring algorithms and two alternative intervals. We linked Medicare Part A and B claims to baseline survey data for 4,596 respondents to the Survey on Asset and Health Dynamics Among the Oldest Old. We addressed the potential for selection bias by using propensity score methods, and we explored construct validity.

RESULTS: Interpersonal continuity with a primary care physician was 17.3\%, and interpersonal continuity of care with any physician was 26.1\%. Older participants; men; individuals who lived alone; people who had difficulty walking; and respondents with medical histories of arthritis, cancer, diabetes, heart conditions, hypertension, and stroke were most likely to have continuity. Individuals who had never married, were widowed, were working, or had low subjective life expectancy were least likely to have continuity.

DISCUSSION: Researchers can measure interpersonal continuity of care using Medicare Part B claims. Replication of these findings and further construct validation, however, are needed prior to widespread adoption of this method.

}, keywords = {Aged, Aged, 80 and over, Continuity of Patient Care, Disability Evaluation, Female, Health Services Accessibility, Health Surveys, Humans, Insurance Claim Review, Male, Medicare Part B, Mobility Limitation, Physician-Patient Relations, Primary Health Care, United States}, issn = {1079-5014}, doi = {10.1093/geronb/62.3.s160}, author = {Frederic D Wolinsky and Thomas R Miller and John F Geweke and Elizabeth A Chrischilles and An, Hyonggin and Robert B Wallace and Claire E Pavlik and Kara B Wright and Robert L. Ohsfeldt and Gary E Rosenthal} }