Determining Factors Associated with Loss of Independence Among Ethnic Minority Older Adults: A 10-year Longitudinal Study Using NHATS Study - Decreased independence with disability in later life is a pervasive and growing challenge both nationally and individually. More than 41% of Americans with disabilities are older than 65. Two in five older adults, age 65+, live with at least one disability such as a mobility limitation, visual impairment, and/or dependent activities of daily living. As life expectancy increases, the number of individuals acquiring a disability in later life is likely to increase. Loss of independence (LoI) and support of unmet needs in performing daily activities are significant burdens to the individual as well as a growing public health challenge. In recent decades, U.S. health indicators have revealed a notable rise in late-life disability, evidenced by a decline in the country's life expectancy international ranking from 20th in 1960 to 40th in 2015, with a projected further decrease to 43rd by 2060. In the U.S, mobility disability, a major contributing factor to LoI, is more prevalent among individuals of advanced age, women, those living below the poverty level, Latinix, and those living alone. Functional decline and late-life disability represent complex and multidimensional challenges that are preventable. The World Health Organization (WHO) developed the International Classification of Functioning, Disability and Health (ICF) model, a comprehensive framework for better understanding and developing solutions for delaying disability and LoI in later life. However, research utilizing the ICF model in the U.S. is limited, hindering lack of understanding of mobility and disability, and development of successful early strategies to prolong independence.
The overall objective of this proposed study, employing a population-based cohort longitudinal design, is to determine factors contributing to loss of independence among multiethnic populations in the U.S., utilizing the WHO's comprehensive multi-dimensional ICF model. This research will leverage the National Health and Aging Trends Study (NHATS) dataset.
Our specific aims are: #1) To Identify predictors of LoI longitudinally using the ICF domains of personal (demographics and health conditions), body function/structure, activity performance, participation limitation and environment over the period from 2011 to 2020;
#2) To investigate how the impact of ICF domains on LoI differs across gender and race/ethnicity subgroups over the period from 2011 to 2020 (interaction effect).
Innovative methods proposed for this study include: a) Utilizing a comprehensive standardized ICF model, not previously used in the U.S. to identify risk factors associated with loss of independence (LoI) among older adults and examining subgroups based on gender and ethnic groups; b) Employing a Vulnerability of Elder Survey (VES) tool to measure the outcome variable of LoI; and c) Analyzing the model using data from the NHATS, which includes a nationally representative sample of Medicare beneficiaries aged 65 and older.
The identified risk factors for LoI will enhance evidence-based knowledge and validate the model for evaluating functional decline, benefiting future research efforts. This study is crucial for understanding disparities among ethnic minority older groups that will serve as a roadmap for future research efforts. It could play a key role in reducing disability levels and improving health outcomes through early screening, thereby leading to a subsequent decrease in health disparities.
Budget amount: $250,800
Use of funds: The budget will be allocated for salaries and wages for PIs and staff, cost for dissemination of results, and purchasing equipment and devices.
