Title: Sociodemographic Effects on Taskspecific ADL Functioning at the Oldestold Ages
1Sociodemographic Effects on Task-specific ADL
Functioning at the Oldest-old Ages
1. Public Policy, Duke University, 2. 3. China
Research Center on Aging
2Outline
- Introduction objectives
- Data and methodology
- Results
- Discussion
3I. Introduction objectives- Introduction
- ADL has a hierarchy Previous research has
suggested that Individual loses functioning of
each six task probably has ordering in that each
task involves different required capability to
perform (e.g., Dunlop et al. 1997Jagger et al.
2001 Katz et al. 1963) - Studies systematically examining the dynamic of
task-specific ADL and its associates are very
rare. - None of previous studies, which focus on ADL
task-specific, explore the correlations with
socio-demographic factors. - There is no study to examine the dynamics of each
ADL task-specific focusing on the oldest-old in
developing countries. - One of major limitations is the underestimation
of disability in the study of ADL functioning at
the old ages (Gill et al. 2002 Zeng, Gu, and
Land 2004) - The conventional method which does not include
the ADL change before dying overestimate effect
of age, gender, ethnicity, and living alone on
disability transitions while underestimates the
effects of SES (Gu Zeng 2004).
4I. Introduction objective- Objective
- By including the ADL information before dying,
this study tries to capture more robust effects
of sociodemographic factors on task-specific ADL
functioning over a two-year survey interval.
5II. Data source methodology - Data source
- The Chinese Longitudinal Healthy Longevity Survey
(CLHLS) in 1998, 2000, and 2002. All three waves
of data are pooled together. - Persons who reported age 106 or higher at Time 1
are excluded from this study. - Total 19,778
- Male 8,142
- Female 11,636
6II. Data source methodology- methodology
- Time 1 the start-point of each two-year
interval. - Time 2 the endpoint of each two-year interval.
7Measuring onset and recovery of disability in
each ADL task
Bathing
Toileting
Dressing
ADL
Indoor transferring
Eating
Continence
8II. Data source methodology-continue
not disabled(or no need help)
each ADL task
disabled (or need help)
9onset of task disability
the information of ADL changes before dying
task recovery
10- An individual is considered having an onset of
disability in one task - if he/she moved from not disabled (no need in
help) in that task at Time 1 to disabled (need in
help) in the same task at Time 2 or before dying - A person is classified as having a recovery
from disability in one task - if he/she moved from need in help in that task at
Time 1 to no need in help in the same task at
Time 2 or before dying
11six items into two categories
- requires both upper and low extremities
(high-level tasks/items ) - include bathing, toileting, dressing, indoor
transferring - requires upper extremities only or continence
(low-level tasks/items ) - include feeding, continence
- Factor analysis confirms this classification
12Sociodemographic factors
- Age 80-89, 90-99,100-106
- Sex Male, Female
- Residence urban, rural
- Ethnic group Han, other minorities
- Education 0 year (illiteracy), 1 years of
schooling - Economic independence
- economic independence mainly relying on
pension or own financial source - economic dependence namely relying on other
resources such as spouse, children or other
family members, or government subsidy and others
13Sociodemographic factors -continue
- Primary lifetime occupation
- for males agriculture, non-agriculture
- for females agriculture, housewife,
non-agriculture - Marital status
- currently not married (never married,
divorced, and widowed) - currently married
- Living arrangement living alone , not living
alone
14Control variables
- The confounders include
- (1) Family/social support and connection
Religious activities, proximity with children,
playing card, and who take care of the elder in
the daily life are considered as the proxy of
family and social supports/connections in this
study. - (2) Health practice alcoholic consumption,
smoking, diet, and doing exercise - (3) Health conditions cognitive function,
self-reported health, chronic disease conditions,
hearing and visual function, and functional
limitations. -
- (4) The length of surviving between Time 1 and
Time 2, and whether the respondent died or not
before Time 2 were also included in the model to
adjust their influence.
15Statistical models
- models for males and females separately
- those who lost to follow-up respondents at Time 2
are excluded - Random effect logit model after correcting
intra-person correlation was applied
16III. Results
17Table 1 Percentage distributions of
socio-demographic variables by gender ()
18Table 2 Dynamics changes of each ADL task by
gender
19- The functioning of the high level tasks declines
faster than the low level tasks. - The incidence rate for bathing is almost two
times more than that of continence. - The recovery rates present an opposite pattern,
and the recovery rate for bathing is 50 less
than that of continence.
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22Table 3 Odds ratios of gender and age on
the onset of disability and recovery from
disability of each ADL task
Notes (1) Male is the reference group. Age is
measured at the beginning of each two-year
interval. (2) N is the number of observations.
(3) The results are based on controlling other
confounders mentioned in the text. (4) Odds
ratios and their significant level were corrected
by intra-subject correlations due to some
subjects contributing two or threemore than one
observations to the pooled data set at a specific
time (Time 1or Time 2). (5) , plt0.1 , plt0.05
, plt0.01 , plt0.001.
23- Gender differential effect is significant among
nonagenarians and centenarians, and it reaches
the biggest among nonagenarians. The gender
differential patterns are similar across six
tasks. - The effect of increasing each additional age on
onset of and recovery from task-specific
disability is different both across tasks and
across age groups. - The effect of increasing each additional age on
onset of task disability is gradually diminishing
with the advancement of age.
24Table 4 Odds ratios of the onset of
disability of each ADL task
25Table 4 Odds ratios of the onset of
disability of each ADL task
Notes (1) Reference group of each covariate is
listed in the parentheses. (2) All variables are
measured at the beginning of each two-year
interval. (3) The results are based on
controlling other confounders mentioned in the
text. (4) Odds ratios and their significant
level were corrected by intra-subject
correlations due to some subjects contributing
two or threemore than one observations to the
pooled data set at a specific time (Time 1or Time
2). (5) , plt0.1 , plt0.05 , plt0.01 ,
plt0.001.
26Table 5 Odds ratios of the recovery of each
ADL task
27Table 5 Odds ratios of the recovery of each
ADL task
Notes (1) Reference group of each covariate is
listed in the parentheses. (2) All variables are
measured at the beginning of each two-year
interval. (3) The results are based on
controlling other confounders mentioned in the
text. (4) Odds ratios and their significant
level were corrected by intra-subject
correlations due to some subjects contributing
two or threemore than one observations to the
pooled data set at a specific time (Time 1or Time
2). (5) , plt0.1 , plt0.05 , plt0.01 ,
plt0.001.
28- Among males, compared to octogenarians,
nonagenarians and centenarians have a higher risk
to develop task-specific disability in high level
of hierarchy, while they share a similar risk to
develop task disability in the low level tasks in
the hierarchy. - On the other hand, female nonagenarians and
centenarians have a significant higher risk to
develop task-specific disability in all tasks
compared to female octogenarians. The
disadvantage of older ages in effect on task
recovery is less apparent than its effect on
onset of task-specific disability (see Table 5).
Such results indicate that disability
deceleration is more obvious for males than for
females at oldest-old ages.
29- Result presented in Table 4 reveals that
urban/rural residential difference in onset of
task-specific disability is homogeneous rather
heterogeneous although urban oldest olds have a
higher chance to have onsets of task-specific
disability and lower chance to get recovery on
general. - The difference of residential effect on
task-specific disability between females was
found. Whereas urban males have same risks to
have onset of task-specific disability as rural
males, urban females experience 10-20 higher
risks to develop task-specific disability than
rural females. -
- Furthermore, Table 5 indicates that urban
oldest-olds have a lower chance to get recovery
from high level task disability for both males
and females.
30- Table 4 illustrates that Minority ethnicities
have better ADL functioning over Han, the
majority. Minorities have 20-45 lower risk to
develop task-specific disability except eating
for both males and females. - Table 5 further indicates that although
minorities have higher chances to recover once
they have onset of disability across all tasks
for both males and females, such higher chances
are not statistically significant possibly due to
highly individual variation.
31- SES has limited effect on both onset of and
recovery from task-specific disability. SES
demonstrates the similar pattern across tasks and
across genders. Living alone has significant
lower risk to develop disability across tasks for
males, but such effective is not significant
among females (Table 4). - On the other hand, the positive effects of living
alone on task-specific recovery are not all
significant across tasks despite all the odds
ratios are much higher than 1 except eating for
females (Table 5). The protective effect of
marriage on task-specific disability and recovery
was not detected.
32- Additionally, for males, chronic condition
and functional limitation will raise the risk of
developing disability across tasks. - But they dont have effect on getting recovery
from disability across tasks. - Generally speaking, persons who are in absence of
limitation in high level tasks in the hierarchy
will postpone his/her onset of disability of the
low tasks in the hierarchy. - Such pattern is similar for both males and
females (Table 4). - The results listed in Table 5 show that it will
not help male oldest-olds to get recovery from a
task disability if they have no limits in any
other task. - But for female oldest-olds, they will have a
higher chance to get recovery from a task
disability if they dont have functioning limits
in other task.
33IV. Discussion
- Slightly higher recovery from each task
disability was observed. The main possible reason
is that China has a higher mortality, which makes
the oldest-old in China more robust compared to
their counterparts in western nations. - Our results show that each sociodemographic
factor has somewhat different role in dynamics of
ADL functioning across tasks. - Consistency and inconsistency with previous
studies. - Although the results of this study are far from
conclusive and deserve further investigation,
they provide new knowledge about the general
patterns of dynamics of task-specific disability
of the oldest-old, which contributes to a better
understanding of the social and demographic
factors associated with task-specific onset of
and recovery from disability.
34- One strength point of this study lies its
systematically examination of socio-demographic
effect on dynamics of six task-specific ADL
functions at the oldest-old ages, which is rarely
touched by previous studies, but is more
informative. - One limitation of the present study is that
information on ADL status before dying for the
dead persons before the second interview is
obtained from next-to-kin, which may involve some
bias. - We only collected one episode of dynamic change
for each ADL task both among survivors and among
the deceased persons, which will not fully
capture the whole story of dynamics of each task
given.