Functional Impairment in Middle-Aged Adults

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PROJECT SUMMARY/ABSTRACT The prevalence of functional impairment – defined as having difficulty or needing help to perform one or more activities of daily living (ADLs) – is increasing among middle-aged adults in the U.S. Of the 80 million Americans ages 45-64, more than 16% report difficulty performing one or more ADLs, and this percentage has grown 3 percentage points over the past 15 years. The reasons for worsening functional status in middle age are not yet fully understood. However, it is part of a larger trend of worsening health in this age group. Since 1990, the prevalence of chronic conditions has increased in middle-aged people, including diabetes, obesity, cardiovascular disease, and depression. The risk of premature mortality has also increased, particularly among those with less than a high school education. These findings raise the concern that middle-aged Americans are experiencing accelerated aging that is causing premature functional impairment. If this is the case, middle- aged adults with functional impairment could experience persistent functional problems and associated poor health outcomes, similar to older adults. However, studies showing the growing prevalence of functional impairment in middle age have serial cross-sectional designs and do not evaluate trajectories of function or long-term effects on health outcomes. What we need to know is whether functional trajectories are worsening in middle age, what the risk factors are for adverse trajectories, and which trajectories predict poor health outcomes later in life. A longitudinal study that observes people from middle age through older age is needed to address these gaps. The aims of the proposed project are to: (1) examine the trajectories of functional impairment among middle-aged adults in the U.S.; (2) identify risk and protective factors to explain differences in functional trajectories; and (3) measure the impact of functional trajectories in middle age on later-life health and economic outcomes. We will complete these aims using longitudinal nationally representative data from the NIA-funded Health and Retirement Study linked to rich contextual measures of the physical and social environment, objective physical performance measures and lab data, and administrative data. This study will have two impacts: informing prevention of functional impairment in middle age by providing data to support next-step development and testing of interventions to improve functional outcomes; and informing policy planning to mitigate the projected burden of functional impairment and associated adverse outcomes.