# Presentation: 496216

## Trends in Functional Status and Disability among the Elderly

**Ellen Kramarow**
**Jennifer Akerblom**
** ****NCHS Data Users Conference**
**July 2004**

## 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, self-report 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

## Slide 10

## Slide 11

## Slide 12

## Slide 13

## Slide 14

## 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?

## Slide 17

## Slide 18

## Slide 19

## Slide 20

## Community Residents Age 65 and over 

**Community**** ****Residents Age 65 and over **

## Slide 22

## 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
- 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

## 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?

## Slide 26

## Slide 27

## Slide 28

## 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

## Slide 30

## 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

## Slide 32

## 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

## Slide 35

## 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

## Slide 37

## 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.