At a Glance
The Onset and Progression of Disability in Older Adults
Kieron Barclay, Carlos Diaz-Venegas, Christian Dudel; in Collaboration with Timothy A. Reistetter, Rebeca Wong, Alejandra Michaels-Obregon, Ickpyo Hong (all: The University of Texas System, The University of Texas Medical Branch at Galveston, USA), Sergio de la Vega (Universidad Autónoma Metropolitana, México City, Mexico), Ching-Yi Wang (Chung Shan Medical University, Taichung City, Taiwan), Maria Andrée López Gómez (Harvard University, Harvard T.H. Chan School of Public Health, Boston, USA), Fernando Benavides (Pompeu Fabra University, Barcelona, Spain)
Life expectancy has been increasing steadily over time. Many older people will spend time in disability, and this transition from a healthy status to having a disability or disabilities is no doubt a challenging one. Although a large body of research is examining disability among the aging, many dimensions of the onset and progression of physical limitations at older ages are poorly understood. Previous work indicates that sociodemographic and socioeconomic factors such as gender or socioeconomic status are important predictors for the onset of disability. The average onset and progression of physical limitations also seems to vary across contexts, moderated by levels of social and economic development, as well as the infrastructure and welfare systems, which may buffer against the rate of physical degradation.
In this project, we use data from longitudinal aging surveys such as the Health and Retirement Survey and the Mexican Health and Aging Survey to examine how gender, socioeconomic status, family circumstances, as well as health behaviors, affect the onset and progression of disability. The data have valuable information on individuals aged 50 or older, including their economic circumstances, living arrangements, marital status, health behaviors, social networks, and self-reports of functional capacities and chronic conditions. Our statistical analyses are based on multinomial or ordinal logistic regressions and mixed-effect models, which allow us to analyze the effects of socioeconomic and health-related outcomes on disability in different contexts. We also transform our estimates in order to understand how much time individuals can expect to spend in a healthy or in a disabled state.
Research conducted in this project has already led to a number of fascinating findings. One of these is the critical role that health behaviors play in the onset of disability. In the United States, almost 80% of the population has a history of smoking, obesity, or both by the time they reach age 50. We have found that men and women with healthier behavioral profiles experienced a delay in the onset of disability by six years compared to the average American, where we define a healthy behavioral profile as having no history of smoking or obesity and as having moderate alcohol consumption. This highlights the remarkable difference that modifiable behaviors can have on the experience of aging, even in a high-income country. Other work has suggested that Mexican adults aged over 50 have higher levels of physical functionality than Americans aged over 50 at the population level and that the average progression of disability is similar in Mexico and the United States, this despite the fact that the United States spends a far higher percentage of its national GDP on healthcare.
Aging, Mortality and Longevity
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