Population Council Research that makes a difference

Abstract

Recent trends in disability and functioning among older adults in the United States: A systematic review 
Freedman,Vicki A.; Martin,Linda G.; Schoeni,Robert F.
Journal of the American Medical Association 288(24): 3137-3146
Publication date: 2002


Context
Several well-publicized recent studies have suggestedthat disability among older Americans has declined in the lastdecade.

Objectives
To assess the quality, quantity, and consistencyof recent evidence on US trends in the prevalence of self-ratedold age disability and physical, cognitive, and sensory limitationsduring the late 1980s and 1990s and to evaluate the evidenceon trends in disparities by major demographic groups.

Data Sources
We searched MEDLINE and AGELINE for relevantarticles published from January 1990 through May 2002 and reviewedreference lists in published articles.

Study Selection
From more than 800 titles reviewed, weselected 16 articles based on 8 unique repeat cross-sectionaland cohort surveys of US prevalence trends in disability orfunctioning among persons generally aged 65 or 70 years or older.

Data Extraction
We evaluated survey quality accordingto 10 criteria, ranked the surveys as good, fair, or poor, andcalculated for each outcome the average annual percent change.

Data Synthesis
Among the 8 surveys, 2 were rated as good,4 as fair, 1 as poor, and 1 as mixed (fair or poor, dependingon the outcome) for assessing trends. Analyses of surveys ratedfair or good showed consistency of declines in any disability(-1.55% to -0.92% per year), instrumental activities of dailyliving disability (-2.74% to -0.40% per year), and functionallimitations. Surveys provided limited evidence on cognitionand conflicting evidence on self-reported ADL (changes rangedfrom -1.38% to 1.53% per year) and vision trends. Evidence ontrends in disparities by age, sex, race, and education was limitedand mixed, with no consensus yet emerging.

Conclusions
Several measures of old age disability andlimitations have shown improvements in the last decade. Researchinto the causes of these improvements is needed to understandthe implications for the future demand for medical care.