Disparities in self-reported activities of daily living and instrumental activities of daily living disability among Asian American subgroups in the United States: Results from the National Health Interview Survey 2001–2003 (original) (raw)
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Journal of Cross-cultural Gerontology, 2007
The objective of this paper is to examine short-term trends in the prevalence of limitation in Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL) and Nagi physical functioning tasks among persons age 60 years or older in five Asian settings: Indonesia, the Philippines, Singapore, Taiwan and the Beijing Municipality. The data come from recent panel surveys of older adults that span a period of 3–4 years during the mid to late 1990s. Results suggest a general trend toward an increase in functional limitation in four of the five settings, with the most pronounced increases occurring for the Nagi functioning tasks. Compositional differences in the population accounted for little of the increase. The paper discusses the potential implications of these results and places them in the context of past and current trends in functional limitation observed in the United States.
Predictors of ADL Disability in Culturally Diverse Older Adults
Medicine & Science in Sports & Exercise, 2008
Almost 42% of adults over 65 years of age live with at least one disability. Further, people of lower socioeconomic status and Blacks have greater risks for disability than Whites and individuals at higher socioeconomic status. The consequences of disability include loss of independence, decreased quality of life, increased chances of depression, consumption of health care services, and institutionalization. The purpose of this study was to utilize the disablement process framework to examine the contribution of physical function, dyspnea, and pain to disability in activities-of-daily-living (ADL) in culturally diverse older adults (i.e., diverse according to race, income, and education). Participants were 51 older adults (M age = 60.0 years, SD = 9.7) from an urban community center and an independent living housing facility for seniors with fixed incomes who completed the Functional Status Index (FSI), which provides ratings of need for assistance (FSIA) and pain (FSIP) with ADLs, the Continuous Scale Physical Functional Performance 10-item Test (CS-PFP10), and an analog dyspnea scale. Hierarchical multiple regression revealed that CS-PFP10 scores alone account for approximately 21% and 30% of the variance in FSIA scores of the participants from the community center and the housing facility, respectively. Adding FSIP and dyspnea ratings to the prediction model results in explaining an even higher portion of the variance in FSIA scores (36% in the community center and 53% in the housing facility). Based on this model, functional capacity improvement and pain and dyspnea prevention and management should be targeted when designing culturally appropriate strategies for delaying disability and maintaining independent life. 2003). This rate of disability actually reflects a slightly lower prevalence of disability in older adults over the past two decades; however, the absolute number of adults living with disabilities is rising as a result of the growth of this segment of the population. Data from the U.S. Department of Health and Human Services (2004) indicate that the absolute number of disabled seniors has increased from 26.9 million in 1982 to 34.4 million in 2004. Disability has detrimental consequences for the individual including loss of independence in activities of daily living (ADL) eroding feelings of esteem, increased chances of depression (Yang & George, 2005), overall mortality (Wolinsky, Stump, Callahan, & Johnson, 1996), and decreased quality of life (Wilson & Cleary, 1995). In addition to the major impact to the individual, the financial consequences of an increase in number of disabled older adults include added health care utilization, institutionalization, and excess burden for the families. The direct and indirect annual costs associated with disability in the American population are more than $300 billion, or four percent of the gross domestic product (U.S. Department of Health and Human Services, 2004). Consequently, prevention, delay, and treatment of disability have become a top priority for public health and aging research. Disability in Understudied Populations According to the US Census Current Reports "Americans with Disabilities 2002" (Steinmetz, 2006), the prevalence of disability in Black persons is 19.8%. When compared with the other races, Blacks have the highest prevalence rate for severe disability (14%) and need for assistance (4.7%). Furthermore, the US Census Current Reports 65+ (He et al., 2005) reported that people of lower socioeconomic status and Blacks have greater risks for disability than Whites and individuals at higher socioeconomic status.
The journals of gerontology. Series A, Biological sciences and medical sciences, 2014
A decline in prevalence of late-life disability in activities of daily living (ADLs) has been reported in Western countries. We investigate the time trend of disability in basic ADLs among Chinese older people in 1997-2006, and explore the potential contribution of cardiometabolic diseases to the trend. The study included 7,845 participants (age ≥ 60 years) in the China Health and Nutrition Survey who were examined in 1997, 2000, 2004, and 2006. Data on ADLs were collected through interviews. Disability in basic ADLs was defined as need of assistance or inability to perform at least one of the five self-care activities of bathing, dressing, toileting, feeding, and transferring. Generalized estimating equation models were used to test the time trend in ADL disability and its association with cardiometabolic diseases. Prevalence of ADL disability decreased from 13.2% in 1997 to 9.9% in 2006; the trend was statistically evident among people aged 60-69 years, women, and rural residents ...
International Journal of Environmental Research and Public Health
Introduction: This study aims to determine the cross-cultural measurement equivalence of the Washington Group General Measure of Disability for older adults. Materials and Methods: This study used the 2012 California Health Interview Survey. The sample included 14,115 non-Hispanic White, Black, Hispanic and Asian adults aged 65 and older. Analysis was conducted using multi-group confirmatory factor analysis (CFA), parallel and Tau-equivalent tests. Results: The results indicated that the measure was valid for use with older adults (Satorra Bentler χ2 = 13.27, df = 3, p = 0.005, GFI = 0.996). Multi-group CFA indicated comparisons were valid between Whites with Blacks, and Hispanics with Asians. Cognitive disability was associated with independent living disability for Whites and Blacks, and with sensory disability for Hispanics and Asians. Conclusions: Findings indicated the measure is valid for cross-cultural comparison for certain racial/ethnic groups. Further research is needed to...
The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 2006
Background. We sought to assess the validity of the physical and cognitive domains of Lawton and Brody's Instrumental Activities of Daily Living (IADL) scale and its cross-cultural applicability across ethnic groups in an Asian population of community-living older adults. Methods. Using data from a random population sample of noninstitutionalized Chinese, Malay, and Indian older adults 60 years old and older in Singapore (N ¼ 1072), we modeled the dimensional structure of the 8-item IADL Scale using exploratory and confirmatory factor analyses, and assessed its convergent and divergent validity using known group differences and strengths of association. Results. Factor analyses yielded two strong and reliable factors representing underlying physical and cognitive dimensions of IADL. The validity of the model was supported by the pattern of associations of the IADL with age, gender, education, self-reported health status, hospitalization, physical comorbidities, dementia and depression, and Mini-Mental State Examination (MMSE) scores. Notably, cognitive IADL showed a greater total effect on MMSE cognitive performance score than did physical IADL, with the effect of physical IADL on MMSE score mostly explained by cognitive IADL. Reasonably good cross-cultural validity was demonstrated among Chinese, Malays, and Indians, with strongest validity for Indians. Conclusion. The eight-item IADL Scale has physical and cognitive domains and is cross-culturally applicable. The cognitive IADL domain taps a set of activities directly related to cognitive functioning.
2009
Assistive technology has become increasingly important in facilitating independence among older Americans. It remains unclear, however, whether this trend has been experienced broadly. Using the 1992 to 2001 Medicare Current Beneficiary Survey, we provide evidence that among older people who have difficulty with daily activities, there were substantial increases in the independent use of assistive technology (without help from another person). Controlling for shifts in the composition of the older population reporting difficulty with daily activities, the independent use of assistive technology increased on average 4% to 5% per year, amounting to a 6 percentage point increase over the entire period. These increases were accompanied by declines in the use of any help and in unassisted difficulty, with larger declines in the latter. Substantial differentials in assistance-which favor the more highly educated in the case of technology and favor minorities in the case of help-persisted over this period. All else equal, 5-percentage point gaps were evident between more and less advantaged education groups with respect to the independent use of assistive technology for walking. Gaps in the independent use of assistive technology to bathe were even larger, amounting to 7 to 8 percentage points in 2001 by education and race. We discuss the implications of findings for the study of latelife disability trends and disparities therein. Hartke, R.J., T.R. Prohaska, and S.E. Furner. 1998. Older adults and assistive devices: Use, multiple-device use and need. Journal of Aging and Health 10(1): 99-116. Kemper, P. 1992. The use of formal and informal care by the disabled elder. Health Services Research 27(4):421-451. Kington R.S. and J.P. Smith. 1997. Socioeconomic status and racial and ethnic differences in functional status associated with chronic diseases. American Journal of Public Health. 87(5):805-10.
Item response bias was present in instrumental activity of daily living scale in Asian older adults
Journal of Clinical Epidemiology, 2007
Objective: Item response bias (also called differential item functioning, DIF) in Instrumental Activities of Daily Living (IADL) occurs when members of different groups possessing the same disability level do not have the same probability of responding positively for a given item(s). This study aimed to identify the extent of DIF by gender, age, ethnicity, and dementia groups in IADL estimates in Asian (Chinese, Malays, and Indian) elderly subjects. Methods: Data of 1,072 noninstitutionalized elderly subjects were analyzed using Multiple-Indicator Multiple-Cause (MIMIC) latent variable modeling. Results: Given the same functional level, older elderly were less likely to report needing help with preparing meals; men were more likely to report needing help with preparing meals, doing laundry, and taking medication; Malays and demented elderly were more likely to report needing help with using the telephone. The impact of DIF on group differences in cognitive IADL was highest for ethnicity (58%), followed by gender (50%), and dementia (23%); whereas 92% and 5% of group differences in physical IADL were for gender and age, respectively. Conclusion: Item-response bias in IADL scale by gender, age, ethnicity, and dementia should be considered in direct comparisons of disability status among population groups.
American Journal of Epidemiology, 1998
This study examined Hispanic versus non-Hispanic white patterns of needing assistance with instrumental activities of daily living (IADL). The authors interviewed 798 Hispanic and 614 non-Hispanic white residents of rural Colorado, who were aged 60 years and older between 1993 and 1995. Seventy-five participants were nursing home residents at the time of the interview. Community-dwelling Hispanics were 1.6 times as likely as non-Hispanic whites to need assistance with at least one IADL task (95% confidence interval 1.25-2.13). A larger proportion of disabled non-Hispanic whites were in nursing homes but, after including nursing home residents, Hispanics remained significantly more likely to need assistance on at least one IADL task (odds ratio = 1.49, 95% confidence interval 1.16-1.93). Hispanics were also more likely to have difficulty on observed performance tasks. The Hispanic excess was not removed by adjusting for chronic disease, reported difficulty walking, or income. English language proficiency adjustment lowered the Hispanic excess, but adjusting for years of education or Mini-Mental State Examination scores more completely removed the ethnic differences. Higher education was protective for both Hispanic and non-Hispanic white elderly. Efforts to further investigate what facets or correlates of education are operating may offer useful insights into limiting IADL difficulties in future cohorts.