Transcript Trends in Functional Status and Disability among the Elderly Ellen Kramarow Jennifer Akerblom

Trends in Functional Status and
Disability among the Elderly
Ellen Kramarow
Jennifer Akerblom
NCHS Data Users Conference
July 2004
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Disease Control and Prevention
National Center for Health Statistics
Overview
Disability and Functioning
• Definitions
• Trends
Data Warehouse on Trends in
Health and Aging
• Examples
Definitions
Conceptual Frameworks (Nagi,
IOM, WHO)
• Pathology
• Impairment
• Functional Limitation
• Disability
Definitions
Disability is a complex concept
• Intersection of individual’s
capacity with environment
• Measurement in surveys does
not necessarily capture all
aspects of concept
Definitions
Disability Measurement
• Self-report vs. performance
measures
• Survey design considerations
(e.g., institutionalized vs.
noninstitutionalized, age groups,
cross section vs. panel, selfreport vs. proxy)
Definitions
Disability Measurement
• Activities of Daily Living (ADL)
• Instrumental Activities of Daily
Living (IADL)
• Physical functioning (aka Nagi
items)
Definitions
Disability Measurement
• Question wording
• Difficulty
• Needs/receives help
• Ability to perform with/without help
or equipment
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)
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
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
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?
Limitation of Activity: Any Difficulty Performing ADLs, MCBS 1992-2002
Community Residents Age 65 and over
30
Percent (age-adjusted)
25
20
15
10
5
0
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
Year
Bathing/Showering
Dressing
Eating
Getting in/out of bed/chairs
Walking
Using the toilet
2002
Difficulty Performing ADL - Bathing/Showering - by Race, MCBS 19922002, Community Residents Age 65 and over
Percent (age-adjusted)
25
20
15
10
5
0
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002
Year
White non-Hispanic
Black non-Hispanic
Hispanic
Limitation of Activity: Difficulty Performing
Activities of Daily Living, by Age, Residence,
Sex, Race and Ethnicity. MCBS, 1992-2002
•
Among all individuals age >=65:
•
•
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
National Health Interview Survey
(NHIS)
•
•
Initiated in 1957
•
Collects information on the amount, distribution
and effects of illness and disability
•
Survey redesigned in 1997
Surveys the civilian non-institutionalized
population, N = approx. 100,000 persons from
about 43,000 households
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?
Needing Help with Activities of Daily Living, NHIS, 1997-2001
Noninstitutionalized Persons, Age 65 and over
7
Percent (age-adjusted)
6
5
4
3
2
1
0
1997
1998
1999
2000
2001
Year
Bathing/Showering
Dressing
Eating
Getting in/out of bed/chair
Using/getting to toilet
Getting around inside home
Needing Help with Activities of Daily Living - Bathing/Showering,
NHIS 1997-2001 Noninstitutionalized Persons Age 65 and over
8
7
Percent (age-adjusted)
6
5
4
Both
sexes
Male
3
Female
2
1
0
1997
1998
1999
2000
2001
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
Limitations in Bathing, Noninstitutionalized Persons
Age 65 and over: MCBS and NHIS
14
Any
difficulty
Percent (age-adjusted)
12
10
8
Needs help
6
4
2
0
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002
Year
MCBS
NHIS
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, Don’t know
Any Difficulty in Physical Functioning - Community Residents
Age 65 and over, MCBS 1992-2002
Percent (age adjusted)
80
70
60
50
40
30
20
10
0
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
Years
Stooping
Lifting
Reaching
Grasping
Walking
2002
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
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, Can’t do at
all, Do not do this activity
Any Difficulty in Physical Functioning, Noninstitutionalized
Persons Age 65 and over, NHIS 1997-2002
70
Percent (age-adjusted)
60
50
40
30
20
10
0
1997-1998
1998-1999
1999-2000
2000-2001
2001-2002
Years
Walking
Reaching
Climbing
Grasping
Standing
Carrying
Sitting
Pushing
Stooping
Any limitation
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
Any Difficulty with Selected Physical Functioning
Measures Among Noninstitutionalized Persons Age 65
and over in MCBS and NHIS
80
70
Percent (age-adjusted)
60
50
40
30
20
MCBS - Stooping
MCBS - Walking
10
NHIS - Stooping
NHIS - Walking
0
1992
1993
1994
1995
1996
1997
Years
1998
1999
2000
2001
2002
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
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.
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.
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.