Trends in Functional Status and Disability among the Elderly

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Trends in Functional Status and Disability among
the Elderly
Ellen Kramarow Jennifer Akerblom NCHS Data
Users Conference July 2004
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Overview

• Disability and Functioning
• Definitions
• Trends
• Data Warehouse on Trends in Health and Aging
• Examples

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Definitions

• Conceptual Frameworks (Nagi, IOM, WHO)
• Pathology
• Impairment
• Functional Limitation
• Disability

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Definitions

• Disability is a complex concept
• Intersection of individuals capacity with
  environment
• Measurement in surveys does not necessarily
  capture all aspects of concept

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Definitions

• Disability Measurement
• Self-report vs. performance measures
• Survey design considerations (e.g.,
  institutionalized vs. noninstitutionalized, age
  groups, cross section vs. panel, self-report vs.
  proxy)

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Definitions

• Disability Measurement
• Activities of Daily Living (ADL)
• Instrumental Activities of Daily Living (IADL)
• Physical functioning (aka Nagi items)

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Definitions

• Disability Measurement
• Question wording
• Difficulty
• Needs/receives help
• Ability to perform with/without help or equipment

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Trends

• Recent review in JAMA (Freedman et al., 2002)
• Declines in IADL limitations
• Declines in physical functioning (Nagi)
  limitations
• Mixed evidence on ADLs (forthcoming paper shows
  decline in some measures from mid-1990s)

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Trends

• Data Warehouse on Trends in Health and Aging
• A collection of data tables providing information
  on trends of health and health care use by older
  Americans.  Viewable online or with Beyond
  20/20 software.
• Supported with funding from the National
  Institute on Aging (NIA)
• http//www.cdc.gov/nchs/agingact.htm

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Medicare Current Beneficiary Survey (MCBS)

• Began in 1991
• Survey sample
• N 12,000 (target sample size)
• community and facility dwelling Medicare
  beneficiaries
• Questions include
• health care use and cost
• sociodemographic characteristics
• health status
• physical functioning

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MCBS and ADLs

• Question
• Because of a health or physical problem, do you
  have any difficulty bathing/showering, dressing,
  eating, getting in/out of a bed/chair, walking,
  or using the toilet?

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Community Residents Age 65 and over
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Limitation of Activity Difficulty Performing
Activities of Daily Living, by Age, Residence,
Sex, Race and Ethnicity. MCBS, 1992-2002

• Among all individuals age gt65
• Decrease in reported ADL limitations between
  1992-2002
• Among individuals living in a facility
• Increasing trend in reported difficulty eating
  and/or using the toilet

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National Health Interview Survey(NHIS)

• Initiated in 1957
• Surveys the civilian non-institutionalized
  population, N approx. 100,000 persons from
  about 43,000 households
• Collects information on the amount, distribution
  and effects of illness and disability
• Survey redesigned in 1997

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NHIS and ADLs

• Question
• Because of a physical, mental, or emotional
  problem, do you need the help of other persons
  with personal care needs? If yes, do you need the
  help of other persons with bathing, dressing,
  eating, getting in/out of bed/chair, using the
  toilet, including getting to the toilet, and
  getting around inside the home?

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Needing Help with ADLs by Age, Sex, Race, and
Hispanic Origin. NHIS, 1997-2001

• From 1997-2001, a decreasing trend in reported
  need for help with bathing/showering was observed
• No significant change occurred in the percentage
  of people reporting they need help with other ADLs

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MCBS and Physical Functioning

• Question
• How much difficulty, if any, do you have
  stooping, lifting, reaching, grasping, and
  walking a quarter mile?
• Response Options
• No difficulty at all, A little difficulty, Some
  difficulty, A lot of difficulty, Not able to do,
  Refused, Dont know

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Limitation of Activity Difficulty in Physical
Functioning by Age, Residence, Sex and Race.
MCBS, 1992-2002

• Community dwelling individuals reported
• Increased difficulty stooping
• Decreased difficulty lifting, reaching and
  grasping
• Facility dwelling individuals reported
• Increased difficulty lifting

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NHIS and Physical Functioning

• Question
• By yourself, without using any special equipment,
  how difficult is it for you to walk a quarter
  mile, climb, stand, sit, stoop, reach, grasp,
  carry, and push?
• Response Options
• Not at all difficult, Only a little difficult,
  Somewhat difficult, Very difficult, Cant do at
  all, Do not do this activity

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Any Difficulty in Physical Functioning by Age,
Sex, Race, and Hispanic Origin. NHIS, 1997-2002

• 65 of the respondents reported any difficulty
  with at least 1 of 9 physical tasks
• Percentage reporting any difficulty has
  remained constant from 1997-2002

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Discrepancy in Stooping Measure

• MCBS asks about stooping, crouching, or
  kneeling
• NHIS asks about stooping, bending, or kneeling
• Percent unable to perform stooping is similar
  in both surveys
• Unclear why estimates are different

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Summary

• MCBS data from 1990s show decline in ADL
  limitation among noninstitutionalized older
  persons.
• NHIS shows a decline in percent needing help with
  bathing/showering only from 1997 to 2001.
• For many items, no change seen during time period
  covered by NHIS.

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Summary

• MCBS shows declining percent with difficulty in
  lifting, reaching, and grasping. Stooping
  measure is a puzzle.
• Data on institutionalized generally show increase
  in disability.

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Summary

• A lot of data on disability and functioning among
  the elderly are available.
• Estimates across sources may differ because of
  differences in question wording, sample design,
  and other factors.
• Making sense of the data takes work and attention
  to detail.