Trends in Functional and Activity Limitations among Chinese Oldest‐Old, 1998 to 2008

China has the world's largest oldest‐old population, but information on trends in late‐life disability is lacking. We use data from the Chinese Longitudinal Healthy Longevity Survey for 1998 to 2008 to determine whether prevalence of limitations with physical functions and daily activities has changed recently among the Chinese population aged 80 to 105 and, if so, to investigate the factors associated with the change. We find that prevalence of need for assistance with activities of daily living and inability to independently conduct instrumental activities of daily living declined substantially. Males did not experience improvement in ability to carry out underlying physical functions over the same period, but females did. Variables associated with trends in one or more of these outcomes were adequacy of medical care as a child, childhood hunger, father's occupation in agriculture, main occupation before age 60 in agriculture, adequacy of current medical care, and body weight.     

Gender differences in activity of daily living of the elderly in rural China: evidence from Chaohu

Using data from a sample survey, Well-being of the elderly in Anhui province, China, this paper studies the effects of health, economic and family factors on the activities of daily living (ADLs) as measures of disability for elderly men and women. The objective is to explore reasons for gender differences in ADLs in rural China. Our results suggest that higher incidence rates of chronic diseases, lower cognitive ability, as well as heavier household and daily care burdens of females, are the main factors leading to a higher prevalence of ADL disability for the female elderly.     

Gender Differences in Activity of Daily Living of the Elderly in Rural China: Evidence from Chaohu

ABSTRACT

Using data from a sample survey, “Well-being of the elderly in Anhui province, China,” this paper studies the effects of health, economic and family factors on the activities of daily living (ADLs) as measures of disability for elderly men and women. The objective is to explore reasons for gender differences in ADLs in rural China. Our results suggest that higher incidence rates of chronic diseases, lower cognitive ability, as well as heavier household and daily care burdens of females, are the main factors leading to a higher prevalence of ADL disability for the female elderly.     

Modeling Disability Trajectories and Mortality of the Oldest-Old in China

This article uses a group-based modeling approach to jointly estimate disability and mortality trajectories over time based on data from the population aged 80 and older in China, and explores relations of demographic, socioeconomic, and early-life characteristics to membership in gender-specific trajectory groups. A three-group model best fits the data for both males and females. For most groups, predicted numbers of limitations in activities of daily living (ADLs) increase with age, but the pace is gradual in some cases and rapid in others. For each gender, the estimated mortality probability trajectories for the three groups follow a hierarchy that is related to the predicted ADL counts at age 80. Only a few characteristics predict trajectory-group membership. Prior nonagricultural occupation is associated with less favorable disability trajectories for both genders. For females, rural residence, a greater number of children ever born, and having a father who did not work in agriculture are associated with more favorable trajectories. For a small group of males who received education, disability is moderate but changes little with age. Findings may reflect heterogeneity of survival among the least advantaged, as well as a possible expansion of morbidity among a small advantaged group.     

Trends in health of older adults in the United States: Past,present, future

The decline in late-life disability prevalence in the United States was one of the most important developments in the well-being of older Americans in the 1980s and 1990s, but there is no guarantee that it will continue into the future. We review the past literature on trends in disability and other health indicators and then estimate the most recent trends in biomarkers and limitations for both the population aged 65 and older and those aged 40 to 64, the future elderly. We then investigate the extent to which trends in education, smoking, and obesity can account for recent trends in limitations and discuss how these three factors might influence future prospects for late-life health. We find that improvements in the health of the older population generally have continued into the first decade of the twenty-first century. The recent increase in the proportion of the younger population needing help with activities of daily living is concerning, as is the doubling of obesity in the last few decades. However, the increase in obesity has recently paused, and favorable trends in education and smoking are encouraging.     

Obesity, disease, and functional limitation in later life

Little is known about the effects of obesity late in life. Using data from the Longitudinal Study of Aging and the Assets and Health Dynamics of the Oldest Old Survey, this study finds an increased prevalence of obesity, over time, among those 70 and older. Obesity is related most strongly to limitations in activities of daily living (ADLs) for women and to activities related to mobility. One ADL, eating, has a negative association to obesity. Obesity is associated with an increased prevalence of arthritis, diabetes, and hypertension. These results are cross-sectional and are based on self-reports of height and weight; they must be interpreted cautiously.     

Was there compression of disability for older Americans from 1992 to 2003?

Medical advances and the growth of the elderly population have focused interest on trends in the health of the elderly. Three theories have been advanced to describe these trends: compression of morbidity, expansion of morbidity, and dynamic equilibrium. We applied multistate life table methods to the Medicare Current Beneficiary Survey to estimate active and disabled life expectancy from 1992 to 2003, defining disability as having difficulty with instrumental activities of daily living or activities of daily living. We found increases in active life expectancy past age 65 and decreases in life expectancy with severe disability. These trends are consistent with elements of both the theory of compression of morbidity and the theory of dynamic equilibrium.     

Well-Being in Older Gays and Lesbians: A Comparison of Predictors

This study aims to examine the predictors of subjective well-being and their variations between older gays and older lesbians. Participants were 143 gays and 66 lesbians aged 56–80 who reside in Israel. Assessments included subjective well-being, hope, health, participation, activities of daily living (ADL), instrumental ADLs, environment and living conditions, and accessibility and availability of community services. In the fully-adjusted models, hope and health were the most potent predictors of subjective well-being, respectively, among gays and lesbians. Additional significant predictors, among gays, were community availability and accessibility and satisfaction with one’s environment and living conditions. Findings suggest that while primary predictors of subjective well-being are similar among gays and lesbians, communal and residential factors are unique significant contributors to the subjective well-being of gays. It may be that among older lesbians, but not among older gays, personal resources are more important contributors to subjective well-being in comparison to community-based resources.     

Visual Capacity,Out-of-home Activities and Emotional Well-being in Old Age: Basic Relations and Contextual Variation

This work examined the role of visual capacity in connection with psychological, social network related, and socio-structural predictors of out-of-home everyday functioning and emotional well-being. The results are based on a sample of 1519 community dwelling elderly (55–98 years; mean age 70.8 years), 757 of them were living in urban, and 762 were living in rural regions, half-and-half from East and West Germany. Structural equation modeling supported the hypothesis of robust relations among age, vision, intellectual functioning, out-of-home everyday functioning, and emotional well-being that are largely independent of the regional and societal macro context. In detail, vision mediated the effect of age on out-of-home activities of daily living (ADL/IADL) and leisure activities, while intellectual functioning mediated the effect of vision on out-of-home leisure activities. All effects on emotional well-being were mediated by out-of-home leisure activities. Enriching the micro level model with psycho-social variables (i.e., outdoor motivation and social resources) and an indication of the socio-economic situation (i.e., financial resources) revealed some contextual variations: At this meso level of analysis, social resources contributed less and outdoor motivation contributed more to out-of-home leisure activities in the urban than in the rural sample. Second, outdoor motivation was significantly related to social resources in the urban, but not in the rural sample. Third, financial resources contributed modestly but significantly to out-of-home leisure activities in the East German, but not in the West German urban and rural samples. It is concluded that visual capacity plays a substantial role in a robust micro level model able to predict everyday functioning and well-being. If additional resources adding to the prediction of these outcomes are also taken into consideration in a meso level analysis model, the whole variable interplay becomes more strongly affected by macro contextual variation.     

Resolving inconsistencies in trends in old-age disability: Report from a technical working group

In September 2002, a technical working group met to resolve previously published inconsistencies across national surveys in trends in activity limitations among the older population. The 12-person panel prepared estimates from five national data sets and investigated methodological sources of the inconsistencies among the population aged 70 and older from the early 1980s to 2001. Although the evidence was mixed for the 1980s and it is difficult to pinpoint when in the 1990s the decline began, during the mid- and late 1990s, the panel found consistent declines on the order of 1%-2.5% per year for two commonly used measures in the disability literature: difficulty with daily activities and help with daily activities. Mixed evidence was found for a third measure: the use of help or equipment with daily activities. The panel also found agreement across surveys that the proportion of older persons who receive help with bathing has declined at the same time as the proportion who use only equipment (but not personal care) to bathe has increased. In comparing findings across surveys, the panel found that the period, definition of disability, treatment of the institutionalized population, and age standardizing of results were important to consider. The implications of the findings for policy, national survey efforts, and further research are discussed.     

Out of Sight,Out of Mind: Including Group Quarters Residents With Household Residents Can Change What We Know About Working-Age People With Disabilities

Information about residents of institutional and noninstitutional group quarters (GQ), particularly those with disabilities, has been limited by gaps in survey data, and statistics based on data that exclude some or all GQ residents are biased as estimates of total population statistics. We used the 2006 and 2007 American Community Survey (ACS) to identify the distribution of working-age populations with and without disabilities by major residence type and to assess the sensitivity of disability statistics to GQ residence. Our findings show that (1) of those with disabilities, about 1 in 13 males and 1 in 33 females live in GQ; (2) GQ rates are higher for individuals reporting mental, self-care, or go-outside-the-home disabilities than for those reporting sensory, physical, or employment disabilities; (3) younger males with disabilities are more likely to reside there, particularly at institutional GQ, reflecting their relatively high incarceration rate; (4) individuals with and without disabilities who are black, American Indian, were never married, or have less than a high school education have higher GQ residence rates; (5) 40% of male and 62% of female GQ residents have a disability; (6) adding GQ residents to household residents increases estimated disability prevalence for males by 6%, and the estimated difference between disability prevalence rates by gender nearly disappears; and (7) inclusion of the GQ population substantially lowers employment rate estimates for young males, blacks, and American Indians.     

1992~2002年中国老年人生活自理能力变化研究

基于1992年中国老年人供养体系调查和2002年中国老年人健康长寿第三期调查,本文对中国老年人1992~2002年生活自理能力的变化进行了探讨。结果显示1992~2002年十年间中国老年人生活自理能力失能率平均年下降l%。其平均年下降率具有如下特点:高龄老人高于中低龄老人;城镇老人高于农村老人;男性老人高于女性老人;非文盲老人高于文盲老人;有配偶老人高于无配偶老人。     

中国老年人临终前 生活自理能力的衰退轨迹

本文以老年人为研究对象,以基本生活自理能力(ADL)为测量指标,使用"中国老年健康长寿影响因素跟踪调查"(CLHLS)数据,分析在1998-2014年期间去世的老年人群临终前的生活自理能力的变化轨迹。作者利用组基轨迹模型对男性和女性老年人的生活自理能力变化过程分别进行拟合,发现老年人在临终前的生活自理能力存在显著差异并归纳出三种变化轨迹:生活自理能力完好型、快速发展型和缓慢下降型。研究发现生命历程早期阶段的经历、所处的社会经济状况、年龄效应和队列效应都会对生活自理能力的衰退轨迹产生显著影响。增龄带来的生活自理能力下降使老年人临终前的失能风险及其持续时间增加,而较晚的出生队列在临终前出现长时间失能的可能性较低。在三类轨迹中,自理能力缓慢下降型轨迹受到各种因素的影响最为显著,而该类型的出现概率是影响失能老年人照料负担的主要因素,由此也证明了除去年龄效应与性别差异之外,由社会经济状况、健康行为习惯、生活环境等因素合力产生的健康保护作用将会在失能老年人照料负担增长过程中发挥主导作用。研究还发现老年女性在临终前会面临更高的失能风险和更长时间的失能存活期,其生活自理能力变化过程受到更多因素的影响。     

Common Factors That Enhance the Quality of Life for Women Living in Their Own Homes or in Aged Care Facilities

A qualitative study of older women living in their own homes and older women living in aged care facilities found that the concerns of the women living in their own homes were the realities of life for the residents in the aged care facilities. Twenty-five female residents across two facilities and 11 older women living in their own homes were interviewed. The positive outcomes of aging at home are relevant and desirable for residents of aged care facilities. A smooth transition from community living to residential aged care involves retaining some of these positive aspects of their lives.     

Disability pathways preceding death in England by socio-economic status

The role of socio-economic status (SES) in the last years of life is an under-researched aspect of health inequalities. This study examines disability patterns preceding death using data from the English Longitudinal Study of Ageing. We use repeated measures latent class analysis to identify the most common pathways preceding death in terms of walking ability and limitations in activities of daily living. Three pathways emerge: one characterized by consistently low disability; a second by a constant high level of functional limitations; and a third by medium impairment. We examine how different SES indicators predict belonging to each disability pathway. Conditional on income, higher wealth is associated with a lower likelihood of belonging to the high disability pathway. Contrary to our expectations, we find no educational gradient in the pathways preceding death. Health inequalities in the last years of life seem to exist especially between individuals with different levels of wealth.     

城市老年人社会活动参与对其健康的影响--基于CHARLS 2011年数据

基于2011年“中国健康与养老追踪调查”全国基线调查数据,研究城市老年人社会活动参与对其健康的影响。研究结果发现社会活动参与对老年人日常生活活动能力、抑郁情绪均有显著影响。社会活动参与越多的老年人,在日常生活活动能力方面表现得越好;抑郁情绪也越少。可见,社会活动参与能有效改善老年人的健康水平。本文的研究结论支持了活动理论的观点,即老年人参与社会活动,可以增进他们的身体和心理健康水平。此外,本文还发现性别、年龄、婚姻状况、医疗保险、吸烟、喝酒等变量均对老年人健康有显著影响。     

Time and Money: A New Look at Poverty and the Barriers to Physical Activity in Canada

The relationship between time, money, and regular participation in physical activities, especially at the intensities and durations required to improve one’s health, is an important public health and social policy issue. The objective of this research is to develop a better understanding of the extent to which income poverty and time poverty act as barriers to regular participation in moderate or higher intensity physical activities. This study uses Canadian time use data collected in 2005 in order to measure income poverty, time poverty, and active living. Objective measures of physical activity engagement (participation rates, daily occurrences, and daily time budgets) are used to explore differences between the rich and poor categories of both income and time wealth. The income and time wealth categories are corroborated using subjective assessments of stress and perceived barriers to regular participation in sports. The results illustrate the multidimensional nature of poverty, but from a public health and social policy perspective, time poverty may be more important than income poverty as a barrier to regular physical activity engagement.     

A comparison of the environmental attitudes, concern, and behaviors of native-born and foreign-born U.S. Residents

This research offers an examination of environmental attitudes, concern, and behaviors among individuals presently living within the context producing contemporary American environmental awareness, but who originated from contexts socially, environmentally, and economically distinct. More specifically, data from the 1993 environmental module of the General Social Survey are used to examine variations in environmental awareness across native-and foreign-born individuals. Results suggest that immigrants living in the U.S. do, indeed, express similarattitudes toward environmental issues as compared to native-born residents. However, shorter-term immigrants (those residing abroad at age 16) in particular express significantly higher levels ofconcern with regard to environmental problems as compared to native-born residents. In addition, shorter-term immigrants are more likely to engage in “environmentally friendly” behaviors as compared to native-born residents, although they appear less likely to have signed an environmentally oriented petition.     

Trends in old-age functioning and disability in Japan, 1993-2002

Disability is a burden to individuals and society. Population ageing, combined with the fact that disability is most common among the elderly, has focused attention on trends in old-age disability. This study estimates trends in functioning and disability among Japanese elderly from 1993 to 2002 and contrasts the patterns with those found in the USA. Japan is an especially interesting country because its age structure is relatively old, and it currently has the highest life expectancy in the world despite the fact that just 50 years ago its life expectancy was in the bottom half of all countries. As in the USA, disability rates have fallen. If it were not for the gains in disability between 1993 and 2002, there would have been 1.1 million more disabled elderly in 2002. The reductions were experienced broadly across socio-demographic and economic groups. Increases in education across cohorts are associated with the declines in disability.     

Exposure to Violence,Coping Strategies,and Diagnosed Mental Health Problems Among Adults in a Migrant-Sending Community in Central Mexico

Deadly violence has spread throughout Mexico, affecting the well-being of citizens. What is the impact of this violence on the daily lives of Mexican adults? Building upon the stress process model, we used a mixed-methods approach to examine relationships between multiple indicators of exposure to and fear of violence and four diagnosed mental health outcomes, as well as self-rated mental health, in a Mexican community using the Survey of Health and Mexican Migration (456 surveys; 49 interviews). The multivariate models provide evidence that perceptions of insecurity are associated with diagnosed depressive episode, agoraphobia, alcohol abuse, a total count of mental health conditions, and poor self-rated mental health. Past victimization is associated with anxiety. Stress and coping behaviors did not formally mediate these violence–mental illness associations. The qualitative results confirm that residents fear violence and cope by adjusting their personal behaviors. These results foreshadow the emergence of mental health conditions as a critical public health concern for Mexicans living under the threat of violence.