Emergence of Disability in Late Life

TitleEmergence of Disability in Late Life
Publication TypeThesis
Year of Publication2019
AuthorsWu, C-Y
Academic DepartmentHealth and Rehabilitation Sciences
Number of Pages156
UniversityUniversity of Pittsburgh
Thesis Typephd
ISBN Number9781085724814
Keywords0212:Therapy, 0498:Occupational Therapy, Cognition, depression, Intervention, Occupational therapy, Prevention, Therapy

In 2050, the life expectancy is anticipated to be 82 years in the United States. This increased in life expectancy has raised questions as to whether a longer period of old age guarantees a longer period of good health. As of now, the potential for a healthy late life is tempered by disability – the loss of independence with activities of daily living (ADL). Disability looms as a personal, family, and public health crisis. Older adults with disability have low autonomy, require assistance from loved ones, and often require costly health care services. Effective interventions to prevent disability are critical to support wellness in late life. We identified gaps in existing non-pharmacological interventions for the prevention of disability, suggesting that 1) these interventions are associated with modest to moderate effect sizes and 2) the most robust interventions are complex and include multiple “active ingredients.” However, the best combination of “active ingredients” remains unclear, and the combinations may vary based on clinical indicators. To better understand these variations, we examined selected indicators of change in brain health (depressive symptoms, cognitive complaints) and their associations with patterns of everyday activities in at-risk older adults (i.e., with a recent diagnosis of a chronic condition). We learned that changes in these indicators of brain health accelerated disablement in older adults with a newly-diagnosed Diabetes Mellitus. We also learned that indicators of brain health influenced patterns of everyday activities in older adults at-risk for disability (i.e., self-reported changes in daily routines); depressive symptoms were associated with engagement in fewer instrumental ADL, and cognitive complaints were associated with engagement in fewer leisure activities. This information gives insight to the risk architecture contributing to the onset of disability, as well as potential clinical indicators that could be explored in future clinical trials. Age-related disability is “a situation without precedent.” The information gleaned from this dissertation may inform 1) studies to examine the health consequences of everyday activities patterns; 2) the identification of factors that may elucidate the complex disablement; and 3) the structure, timing, and dosage of future interventions that aim to prevent disability in late life.


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Citation Key10331