Abstract
Objectives
Focus on decline in performance of activities of daily living (ADL) has not been matched
by studies of recovery of function. Advised by a broad conceptual model of physical
resilience, we ascertain characteristics that identify (1) maintenance, (2) decline,
and (3) recovery of personal self-maintenance activities over six years in an older,
community representative, African American and white sample.
Design
Longitudinal study, analyses included descriptive statistics and repeated measures
proportional hazards.
Setting/Participants
Community-representative participants of the Duke Established Populations for Epidemiologic
Studies of the Elderly (EPESE), unimpaired at baseline (n = 3187; 46% white, 54% African
American; 64% female, 36% male), followed annually for up to 6 years.
Measures
Data included information on basic activities of daily living (BADL), demographic
characteristics, health status, social services provided and received, household size,
neighborhood safety, and survival status.
Results
Over 6 years, ∼75% remained unimpaired, of whom 30% were unimpaired when they dropped
out or died. Of ∼25% who became impaired, just under half recovered. Controlled analyses
indicated that those who became impaired were in poorer health, younger, and more
likely to be African American. Characteristics of recovery included younger age, not
hospitalized in the previous year, and larger household size.
Conclusions/Implications
Maintenance of health status facilitated continued unimpaired BADL. While decline
was associated with poorer health, younger age, and being African American, recovery
was also associated with younger age, together with larger household size, and no
further deterioration in health as measured here. Maintenance of good health is preferred,
but following decline in functioning, increased effort to improve health and avoid
further decline, which takes into account not only physical but also personal social
conditions, is needed.
Keywords
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Article info
Publication history
Published online: February 06, 2020
Footnotes
This work was supported by the National Institute on Aging at the National Institutes of Health (contract Number N01 AG12102, grant number R01 AG12765), National Institute on Aging (Duke Claude D. Pepper Older Americans Independence Center, Grant P30AG028716), the Physical Resilience Indicators and Mechanisms in the Elderly (PRIME) Collaborative (UH2AG056925), the National Center for Advancing Translational Sciences of the National Institutes of Health (UL1TR002553).
The sponsor had no role in the design, methods, participant recruitment, data collections, analysis or preparation of this article.
The authors declare no conflicts of interest.
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