The effect of modifiable risk factors on activity limitation and limitation-free life expectancy among late midlife adults

Activity limitation significantly predicts subsequent participation restriction onset, institutionalization, and early mortality. Modifiable risk factors (MRFs) (i.e., physical activity, body mass index, and smoking status) are strong and consistent predictors of activity limitation and participation restriction. This research explores the role of MRFs on activity limitation transitions (onset and recovery) among a late midlife cohort. Additionally, this research examines the influence of MRFs on activity limitation transitions across key social statuses (i.e., gender, race/ethnicity, and educational attainment). Activity limitation is broken into two categories: act limitation and task limitation. This research examines both act limitation and task limitation as separate stages of the Participation Restriction Pathway (PRP). Act limitation is measured using mobility limitation measures such as difficulty walking and climbing stairs, while task limitation is measured using Activities of Daily Living (ADL) measures (e.g., difficulty bathing, getting in and out of bed, or dressing). Additionally, positive changes in MRFs were explored as outcome measures. Utilizing Waves 2-8 (1994-2006) of the Health and Retirement Study (HRS), discrete-time event history models with multiple competing events was estimated using multinomial logistic regression. The results demonstrate the complex relationship between activity limitation transitions and MRFs as well as complicated links between MRFs and socio-demographic characteristics. In regards to activity limitation onset, the role of MRFs was not consistent for gender, race/ethnicity, and education. Unexpectedly, MRFs had little influence on the relationship between gender, race/ethnicity, and education and activity limitation recovery, which underscores the importance of non-modifiable risk factors. The predictors of a positive change in MRFs varied by outcome and the findings support the need for a greater understanding of factors shaping health promotion. The results highlight the need for further research, and they emphasize the need for functional health promotion within a structural framework.

modifiable risk factors

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