Geriatric Conditions and Disability: The Health and Retirement Study

7 August 2007 | Volume 147 Issue 3 | Pages 156-164

Background: Geriatric conditions, such as incontinence and falling, are not part of the traditional disease model of medicine and may be overlooked in the care of older adults. The prevalence of geriatric conditions and their effect on health and disability in older adults has not been investigated in population-based samples.

Objective: To investigate the prevalence of geriatric conditions and their association with dependency in activities of daily living by using nationally representative data.

Design: Cross-sectional analysis.

Setting: Health and Retirement Study survey administered in 2000.

Participants: Adults age 65 years or older (n = 11 093, representing 34.5 million older Americans) living in the community and in nursing homes.

Measurements: Geriatric conditions (cognitive impairment, falls, incontinence, low body mass index, dizziness, vision impairment, hearing impairment) and dependency in activities of daily living (bathing, dressing, eating, transferring, toileting).

Results: Of adults age 65 years or older, 49.9% had 1 or more geriatric conditions. Some conditions were as prevalent as common chronic diseases, such as heart disease and diabetes. The association between geriatric conditions and dependency in activities of daily living was strong and significant, even after adjustment for demographic characteristics and chronic diseases (adjusted risk ratio, 2.1 [95% CI, 1.9 to 2.4] for 1 geriatric condition, 3.6 [CI, 3.1 to 4.1] for 2 conditions, and 6.6 [CI, 5.6 to 7.6] for 3 conditions).

Limitations: The study was cross-sectional and based on self-reported data. Because measures were limited by the survey questions, important conditions, such as delirium and frailty, were not assessed. Survival biases may influence the estimates.

Conclusions: Geriatric conditions are similar in prevalence to chronic diseases in older adults and in some cases are as strongly associated with disability. The findings suggest that geriatric conditions, although not a target of current models of health care, are important to the health and function of older adults and should be addressed in their care.

Editors' Notes Context Geriatric conditions, such as incontinence and falling, are prevalent and associated with disability in older adults. Contribution Using national survey data, the authors found that almost half of older U.S. adults had geriatric conditions. Some were as prevalent as common conditions, such as heart disease. The authors confirmed a strong association between having a geriatric condition and dependency in activities of daily living. Caution Conditions and dependence were identified by self-report. Implications Geriatric conditions are often overlooked in older adults, but they are as common as other chronic diseases and are as strongly associated with disability. —The Editors

 

Author and Article Information

From the University of Michigan, the Ann Arbor Veterans Affairs Healthcare System Geriatric Research, Education and Clinical Center, and the Ann Arbor Veterans Affairs Center for Practice Management and Outcomes Research, Ann Arbor, Michigan.

Note: An early version of this paper was presented at the 2004 Gerontological Society of America National Meeting in Washington, D.C.

Acknowledgments: The authors thank Tisha L. Moore for her assistance with manuscript preparation and development of the tables.

Grant Support: By a John A. Hartford Foundation pilot grant to Dr. Cigolle and a John A. Hartford Foundation grant to the Society of General Internal Medicine (2002–0013). Dr. Cigolle was supported by a National Research Service Award Institutional Training Grant (University of Michigan Institute of Gerontology) from the National Institute on Aging (5T32AG000114); by a Ruth L. Kirschstein National Research Service Award from the National Institute on Aging (1F32AG027649-01); and by the Ann Arbor Veterans Affairs Geriatric Research, Education and Clinical Center. Dr. Langa was supported by a Career Development Award from the National Institute on Aging (K08 AG19180) and a Paul Beeson Physician Faculty Scholars in Aging Research Award. Dr. Blaum was supported by the Ann Arbor Veterans Affairs Geriatric Research, Education and Clinical Center and a National Institute on Aging grant (R01:AG021493-01). The National Institute on Aging provided funding for the Health and Retirement Study (U01 AG09740), data from which were used in this study.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Christine T. Cigolle, MD, MPH, University of Michigan, 300 North Ingalls, Room 919, Ann Arbor, MI 48109.

Current Author Addresses: Dr. Cigolle and Ms. Tian: University of Michigan, 300 North Ingalls, Room 919, Ann Arbor, MI 48109.

Dr. Langa: University of Michigan, 300 North Ingalls, Room 7E01, Ann Arbor, MI 48109.

Mr. Kabeto: University of Michigan, 300 North Ingalls, Room 7B10-12, Ann Arbor, MI 48109.

Dr. Blaum: University of Michigan, 300 North Ingalls, Room 914, Ann Arbor, MI 48109.

Author Contributions: Conception and design: C.T. Cigolle, M.U. Kabeto, C.S. Blaum.

Analysis and interpretation of the data: C.T. Cigolle, K.M. Langa, M.U. Kabeto, Z. Tian, C.S. Blaum.

Drafting of the article: C.T. Cigolle, C.S. Blaum.

Critical revision of the article for important intellectual content: C.T. Cigolle, K.M. Langa, C.S. Blaum.

Final approval of the article: C.T. Cigolle, K.M. Langa, C.S. Blaum.

Statistical expertise: M.U. Kabeto, Z. Tian, C.S. Blaum.

Obtaining of funding: C.T. Cigolle, K.M. Langa, C.S. Blaum.

Administrative, technical, or logistic support: C.S. Blaum.

Collection and assembly of data: C.T. Cigolle, M.U. Kabeto, Z. Tian.