Declines in late-life disability: The role of early- and mid-life factors
Declines in late-life disability: The role of early- and mid-life factors
复制标题
DOI：
10.1016/j.socscimed.2007.11.037
复制
发表时间：
2008-04-01
影响因子：
5.4
通讯作者：
Cornman, Jennifer C.
中科院分区：
文献类型：
--
作者：
Freedman, Vicki A.;Martin, Linda G.;Cornman, Jennifer C.
对晚年残疾下降原因的调查主要集中在同期因素的作用上。以生命历程的视角为背景，在本文中，我们询问某些早年和中年因素是否也在衰退中发挥了作用，如果是的话，这些因素是否通过残疾发生或康复风险的变化而发挥作用。根据1995年至2004年的五波美国健康与退休研究，我们发现美国75岁及以上人群的日常生活活动困难（ADL）患病率从1995年的30.2%下降到2004年的26.0%，而工具性日常生活活动（IADL）困难的趋势则持平。在此期间，日常生活活动受限的发生也有所减少，而恢复则有所增加。老年人口教育构成的变化与ADL限制发生率的下降有关，但母亲的教育程度、儿童自评健康状况和终生职业的变化也有一定的贡献。晚年视力障碍的减少和财富的增加也对下降趋势做出了重大贡献，如果慢性病没有增加，下降幅度还会更大。日常生活能力限制发生率的降低部分归因于受访者及其母亲受教育程度的变化，以及晚年视力和财富的改善。相比之下，复苏趋势并未受到早年或中年因素变化的影响。我们的结论是，早年和中年因素与晚年因素一起对美国晚年残疾趋势产生了影响，主要是通过它们对限制的发生而不是恢复的影响。 (c) 2007 Elsevier Ltd. 保留所有权利。
Investigations into the reasons for declines in late-life disability have largely focused on the role of contemporaneous factors. Adopting a life-course perspective as a backdrop, in this paper we ask whether there also has been a role for selected early- and mid-life factors in the decline, and if so whether these factors have been operating through changes in the risks of disability onset or recovery. Drawing on five waves from 1995 to 2004 of the U.S. Health and Retirement Study, we found for the 75 years and older population in the United States that the prevalence of difficulty with activities of daily living (ADL) declined from 30.2% in 1995 to 26.0% in 2004, whereas the trend in difficulty with instrumental activities of daily living (IADL) was flat. Onset of ADL limitations also was reduced during this period while recovery increased. Changes in the educational composition of the older population were linked to declines in the prevalence of ADL limitations, but there were also modest contributions of changes in mother's education, self-rated childhood health, and lifetime occupation. Declines in late-life vision impairments and increases in wealth also contributed substantially to the downward trend, and had chronic conditions not increased, it would have been even larger. Reductions in the onset of ADL limitations were partly driven by changes in educational attainment of respondents and their mothers and, in late-life, better vision and wealth. In contrast, the recovery trend was not accounted for by changes in early- or mid-life factors. We conclude that early- and mid-life factors have contributed along with late-life factors to U.S. late-life disability trends mainly through their influence on the onset of, rather than recovery from, limitations. (c) 2007 Elsevier Ltd. All rights reserved.