Unmet Need for ADL Assistance Is Associated With Mortality Among Older Adults With Mild Disability.
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BACKGROUND: Unmet need for assistance with activities of daily living (ADLs) disability is associated with increased risk for future hospitalization. To further explore the association between unmet ADL need and future health outcomes, we examined the association between unmet need for ADL assistance and 1-year mortality. METHODS: A prospective study of 6,730 community-living Medicare recipients was conducted among respondents to the 1994, 1999, and/or 2004 National Long Term Care Survey. Only those who reported having one or more ADL disabilities were included. Time to death within 1 year after the community survey was determined from Centers for Medicare and Medicaid Services vital statistics records. The community interviews provided demographic, health, and ADL information. RESULTS: Unadjusted 1-year death rates were 8.7%, 10.6%, 11.4%, 19.2%, and 27.3%, respectively, for respondents with disabilities in 1, 2, 3, 4, and 5 ADLs. Overall, 21.3% reported unmet need for assistance for one or more ADL disabilities. After controlling for demographic and health characteristics, we found a significant interaction between unmet ADL need and level of ADL disability (p = .018). Post hoc analyses revealed that unmet ADL need was associated with increased risk for mortality only for those with one (hazard ratio = 1.96; 95% CI = 1.29-2.87) or two ADL disabilities (hazard ratio = 1.37; 95% CI = 1.07-1.75), but not for those with three or more ADL disabilities. CONCLUSION: Future studies are needed to determine whether these findings are replicable and, if so, whether physiologic or process of care variables explain why ADL is associated with mortality only for those with mild disability.
SubjectActivities of daily living
Activities of Daily Living
Aged, 80 and over
Proportional Hazards Models
Published Version (Please cite this version)10.1093/gerona/glv028
Publication InfoHe, S; Craig, BA; Xu, H; Covinsky, KE; Stallard, Eric; Thomas, J; ... Sands, LP (2015). Unmet Need for ADL Assistance Is Associated With Mortality Among Older Adults With Mild Disability. J Gerontol A Biol Sci Med Sci, 70(9). pp. 1128-1132. 10.1093/gerona/glv028. Retrieved from https://hdl.handle.net/10161/14897.
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Research Professor in the SocialScience Research Institute
I am a Research Professor in the Social Science Research Institute and Co-Director of the Biodemography of Aging Research Unit at Duke University. I am a Member of the American Academy of Actuaries, a Fellow of the Conference of Consulting Actuaries, and an Associate of the Society of Actuaries. My research expertise includes modeling and forecasting for biomedical demography and health/LTC actuarial practice. My expertise in these areas is evidenced by my five books, five monographs, 151 sci