Bret T Howrey1, Soham Al Snih2, Kyu K Jana3, Mary Kristen Peek4, Kenneth J Ottenbacher2. 1. Department of Family Medicine, bthowrey@utmb.edu. 2. Division of Rehabilitation Sciences, and. 3. Department of Family Medicine. 4. Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston.
Abstract
BACKGROUND: Longitudinal studies of activities of daily living (ADL) in older adults have identified numerous factors associated with declining ability. Analyses based on population averages may not observe distinct subgroups whose ADL trajectories differ. METHODS: We used latent class models to identify subgroups of trajectories in a sample from the Hispanic Established Populations for Epidemiologic Study of the Elderly, a population-based study of noninstitutionalized Mexican Americans aged 65 and older from five Southwestern states (n = 2584). RESULTS: Three distinct trajectories of ADL limitations were identified and characterized as stable, delayed, and rapid ADL increase. Sex (female), diabetes, and arthritis were associated with increased odds of membership in the delayed and rapid groups compared with the stable group. Stroke had a differential magnitude of effect on ADL limitations across the stable (β = 1.11, p < .001), delayed (β = 0.52, p < .001), and rapid groups (β = 0.12, p < .05). Hip fracture was associated with increased limitations in the stable group (β = 1.27, p < .001) but not in the rapid group. Church attendance was associated with fewer limitations in all groups with a larger effect in the stable group (β = -0.87, p < .001) compared with the rapid group (β = -0.10, p < .05). CONCLUSIONS: Substantial heterogeneity exists in changes in ADL disability over time among older Mexican Americans. Attempts at maintaining function may benefit from targeting reductions in comorbidities and acute health events associated with disability.
BACKGROUND: Longitudinal studies of activities of daily living (ADL) in older adults have identified numerous factors associated with declining ability. Analyses based on population averages may not observe distinct subgroups whose ADL trajectories differ. METHODS: We used latent class models to identify subgroups of trajectories in a sample from the Hispanic Established Populations for Epidemiologic Study of the Elderly, a population-based study of noninstitutionalized Mexican Americans aged 65 and older from five Southwestern states (n = 2584). RESULTS: Three distinct trajectories of ADL limitations were identified and characterized as stable, delayed, and rapid ADL increase. Sex (female), diabetes, and arthritis were associated with increased odds of membership in the delayed and rapid groups compared with the stable group. Stroke had a differential magnitude of effect on ADL limitations across the stable (β = 1.11, p < .001), delayed (β = 0.52, p < .001), and rapid groups (β = 0.12, p < .05). Hip fracture was associated with increased limitations in the stable group (β = 1.27, p < .001) but not in the rapid group. Church attendance was associated with fewer limitations in all groups with a larger effect in the stable group (β = -0.87, p < .001) compared with the rapid group (β = -0.10, p < .05). CONCLUSIONS: Substantial heterogeneity exists in changes in ADL disability over time among older Mexican Americans. Attempts at maintaining function may benefit from targeting reductions in comorbidities and acute health events associated with disability.
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