Improvement and Deterioration in Physical

Functioning among Israelis Aged 60 and over

Jenny Brodsky, Tal Spalter, Yitschak Shnoor

October 17, 2012

Myers-JDC-Brookdale InstituteCenter for Research on Aging

Outline Background Study Purpose and Hypothesis Method of Analysis Findings Discussion

Physical and Cognitive Function of Older Adults are of Critical Importance

Individual Society

Survival curves of morbidity, disability and

mortality

Source: WHO 84576

The Nagi Disablement Model

Pathology

ImpairmentFunctional Limitation Disability

The IoM Disability in America

Disablement Process is Dynamic-

Non-linear

IOM - Institute of Medicine report Disability in America (Pope and Tarlov 1991)

International Classification of Functioning, Disability and Health

Health Condition (disorder or

disease)

Body Function and Structures Activities

Environmental Factors

Personal Factors

Participation

WHO, 2001

Study Objectives To examine the changes in physical

functioning of older adults between two periods of time

To examine what variables predict the changes in function

Hypothesis• Together with patterns of functional deterioration, we

will also find patterns of improvement

• Women, the old-old, minorities (Arabs), and those with low income and low education, are at higher risk of functional deterioration

• Older adults suffering from multi-pathology, as well as individuals with cognitive and mental problems, are at higher risk of functional deterioration

Study Population Individuals who were 60 and over in

the first round of SHARE- Israel (2005-2006); they were 65 and over in the second round of SHARE-Israel (2009-2010)

N=982

Dependent Variables Changes in mobility (walking 100 meters, sitting for two

hours, getting up from a chair, climbing several floors or one floor without resting)

Changes in basic functions (pulling or pushing large objects; stooping, crouching, or kneeling; reaching or extending arms above shoulder level; handling small objects; carrying 5kg)

Changes in ADL (washing, dressing, eating, toileting, crossing a room, getting in and out of bed)

Changes in IADL (preparing a hot meal, buying groceries, using the telephone, taking drugs, financial management)

Dependent Variables cont.

• Scales were built in the two rounds of SHARE by summing up items

• Changes were calculated by taking round two minus round one

Independent Variables Socio-demographic status (age, gender, living

arrangements, education, income, population group)

Function and health (function in the first wave, No. of illnesses, change in the No. of illnesses between waves, mental health, cognitive function)

Social Activities (volunteering, participating in social, religious, political and educational activities)

Receipt of formal support (personal care and homemaking)

Receipt of informal support

Changes in Functioning1 N=982 (%)

Improvement No change

Deterioration

Mobility** 21.7 45.3 33.0Basic** functions

21.6 46.1 32.3

ADL** 6.3 78.7 15.0IADL** 7.8 62.8 29.4

**p<0.011 The changes between rounds are significant by t-test for paired samples

Linear Regression to Predict Changes in Functioning: N=982Change in IADL1 Change in ADL1 Change in basic

functions1Change in mobility1 Variable

0.017** 0.093** 0.164** 0.184** First Step )R2)) 0.54** 0.56** 0.75** 0.72** Functional status wave 1

0.150** 0.091** 0.073** 0.079** Second Step (ΔR2)0.15-** 0.06- 0.1-** 0.08-* Age (men compared women) 0.03 0.02- 0.00- 0.00- Gender 0.07 0.00- 0.03 0.05 No. of years of school 0.06 0.05 0.02 0.01 Income

  0.10* 0.00

0.13** 0.07*

  0.11** 0.01

 (compared to Arab) 0.07 0.04

Population group Veteran JewsNew Immigrants FSU

0.113** 0.094** 0.105** 0.126** Third Step(ΔR2(0.21-** 0.15-** 0.27-** 0.27-** No. of diseases0.23-** 0.23-** 0.26-** 0.33-** Change in No. of diseases

0.12-** 0.08-* 0.1-* 0.03- Mental Health 0.15** 0.11** 0.06 0.07 Cognitive Status

0.057** 0.079** 0.049** 0.05** Fourth Step (ΔR2( 0.02 0.02 0.04 0.04 Activities

(compared to living alone) Living Arrangements  0.07- 0.02- 0.16-**

 0.07- 0.04-0.16-**

 0.01- 0.08-

0.1-**

 0.03 0.05- 0.04-

Lives with spouseLives with spouse + othersLives with others

 0.17-** 0.02-

 0.19-** 0.01-

 0.09-* 0.01-

 0.1-** 0.00

Formal -HomemakingFormal - Personal care

0.13-** 0.16-** 0.16-** 0.18-** Informal support0.337** 0.357** 0.391** 0.44** R2

*p<0.05, **p<0.011Standardized coefficients-b; positive=improvement & negative=deterioration

Linear regression – prediction of changes in functioning

Socio-demographic variables• Higher age predicts deterioration (except ADL) • No difference by gender; education and income do

not add significantly• Being a veteran Jew, compared to being an Arab

elder, predicts improvement (except mobility)Health variables• Higher No. of diseases predicts deterioration• Declined mental health status predicts

deterioration (except mobility)• Better cognitive status predicts improvement in ADL

and IADL

Linear regression – prediction of changes in functioning (cont.)Social variables

• Recreational participation and social learning do not add significantly

• Living with others that are not the spouse compared to living alone, predicts deterioration

Receiving help

• Receiving formal help with homemaking (but not with personal care) predicts deterioration

• Receiving informal care predicts deterioration

Major Findings and Implications There is no single pattern of functional deterioration over

time among older adults, there is also improvement Arab older adults are at higher risk of deterioration in

physical functioning over time Physical health indicators, mainly multi-pathology, predict

deterioration in functioning (according to the Disablement Model)

Mental and cognitive status predict deterioration in functioning

Receiving informal care and formal help (in homemaking) predict deterioration

These findings do not lead to the conclusion that there is no need to help the elderly.

However, they imply that many times, instrumental assistance to the elderly, "save the hassle" of doing things by themselves and thus, weakens a potential functional rehabilitation process.

Major Findings and Implications (cont.)

While Mr. Johns never did make it into the Olympics, he did however get full motion back in his knees

Rehabilitation

Improvement and Preservation of Functional Capabilities

Professional rehabilitationTraining of professional and non-

professional staff (i.e., nurses and homecare workers)

Training of family caregivers

Thank You

"My goal is to die before there's a technology breakthrough that

forces me to live until one hundred and thirty"