Regional differences in functional status among the aged.

This study investigated regional differences in functional status among aged Medicare beneficiaries in the United States, and the degree to which population risk factors and certain geographic/environmental attributes of communities accounted for the regional differences. Four years of the Medicare Current Beneficiary Survey (1992-1995) were pooled together yielding 37,150 person-year observations of functional status for a sample of aged Medicare beneficiaries residing in the community or nursing homes. Multinomial logit models, estimated on a four-category functional status scale, produced strong empirical evidence of substantial regional differences in the prevalence of functional independence, functional limitations, IADL limitations, and ADL limitations, that could not be attributed to regional population composition, socio-demographic factors, lifestyle characteristics, and chronic medical conditions. Although such population risk factors accounted for much of the regional variations in functional status among older men, the notably higher prevalence of IADL and ADL limitations among older women residing in the Deep South could not be similarly attributed to such risk factors. Rather, the empirical results suggest that a significant portion of the harmful effects associated with residence in the Deep South among older women may be attributed to a higher prevalence of residence in counties characterized by lower population density and/or higher poverty concentration.