The devil's in the details: Variation in estimates of late-life activity limitations across national cohort studies.

TitleThe devil's in the details: Variation in estimates of late-life activity limitations across national cohort studies.
Publication TypeJournal Article
Year of Publication2023
AuthorsAnkuda, CK, Covinsky, K, Freedman, VA, Langa, KM, Aldridge, MD, Yee, C, Kelley, AS
JournalJ of the American Geriatric Society
Volume71
Issue3
Pagination858-868
ISSN Number1532-5415
KeywordsActivities of Daily Living, Cohort Studies, Disabled Persons, Medicare, Self Care
Abstract

BACKGROUND: Assessing activity limitations is central to aging research. However, assessments of activity limitations vary, and this may have implications for the populations identified. We aim to compare measures of activities of daily living (ADLs) and their resulting prevalence and mortality across three nationally-representative cohort studies: the National Health and Aging Trends Study (NHATS), the Health and Retirement Survey (HRS), and the Medicare Current Beneficiary Survey (MCBS).

METHODS: We compared the phrasing and context of questions around help and difficulty with six self-care activities: eating, bathing, toileting, dressing, walking inside, and transferring. We then compared the prevalence and 1-year mortality for difficulty and help with eating and dressing.

RESULTS: NHATS, HRS, and MCBS varied widely in phrasing and framing of questions around activity limitations, impacting the proportion of the population found to experience difficulty or receive help. For example, in NHATS 12.4% [95% confidence interval (CI) 11.5%-13.4%] of the cohort received help with dressing, while in HRS this figure was 6.4% [95% CI 5.7%-7.2%] and MCBS 5.3% [95% CI 4.7%-5.8%]. When combined with variation in sampling frame and survey approach of each survey, such differences resulted in large variation in estimates of the older population of older adults with ADL disability.

CONCLUSIONS: In order to take late-life activity limitations seriously, we must clearly define the measures we use. Further, researchers and clinicians seeking to understand the experience of older adults with activity limitations should be careful to interpret findings in light of the framing of the question asked.

DOI10.1111/jgs.18158
Citation Key13506
PubMed ID36511646
PubMed Central IDPMC10023348
Grant ListP30 AG028741 / AG / NIA NIH HHS / United States
K23 AG040774 / AG / NIA NIH HHS / United States
U01 AG032947 / AG / NIA NIH HHS / United States
P01 AG066605 / AG / NIA NIH HHS / United States
K24 AG062785 / AG / NIA NIH HHS / United States
K76 AG064427 / AG / NIA NIH HHS / United States
L30 AG064691 / AG / NIA NIH HHS / United States