Incidence of functional limitation in older adults: the impact of gender,race, and chronic conditions

OBJECTIVES: To evaluate the relation of chronic conditions, gender, and race to the incidence of activities of daily living (ADLs) limitation in older adults. DESIGN: The 2-year cumulative incidence of functional limitation was estimated from survival analysis methods by using elders without baseline functional limitations. SETTING: Longitudinal Study of Aging (LSOA). Initial interviews: 1984; reinterviews: 1986, 1988, and 1990. PARTICIPANTS: A total of 4205 elderly subjects from the LSOA. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Dependent variables: self-reported moderate (1-2 ADLs) and severe (> or =3 ADLs) functional limitation. Independent variables: sociodemographics, self-reported chronic conditions, and prior levels of functional limitation. RESULTS: Gender and race predicted moderate functional limitation onset, after controlling for age and education. Arthritis, diabetes, prior cerebrovascular disease (CVD), incontinence, and impaired vision were significant predictors of moderate functional limitation onset after controlling for demographics. Differences in the prevalence of chronic conditions appear to explain why moderate functional limitation incidence rates are higher in older women and blacks. Gender, but not race, predicted onset of severe functional limitation, after controlling for age and education. Prior moderate functional limitation, CVD, and vision impairment predicted onset of severe functional limitation after controlling for demographics. CONCLUSION: Prevention of functional decline should target chronic conditions and moderate functional limitation in older adults.