Article Text

OP04 Does the hierarchy of loss in functional ability start in midlife? Findings from a British Birth Cohort
  1. E Wloch,
  2. D Kuh,
  3. R Cooper
  1. MRC Unit for Lifelong Health and Ageing, University College London, London, UK


Background As physical capability declines in later life difficulties performing a range of common tasks of daily living develop in a commonly observed sequence. Difficulty is initially reported in tasks considered hardest to perform (e.g. climbing stairs) before being reported in less complex tasks (e.g. feeding oneself). Most previous work has demonstrated this hierarchy of loss cross-sectionally and in older populations (>70 years). The aim of this study was to use longitudinal data to examine the hierarchy of loss in midlife, at an age when there may be greater opportunity for intervention to prevent disability.

Methods In the Medical Research Council (MRC) National Survey of Health and Development self-reported measures of functional ability have been collected at ages 43, 53 and 60–64. Using these data we calculated the prevalence of difficulties in three of the most complex tasks (i.e. gripping, walking and stair-climbing) at all three ages. We then calculated the prevalence of reported difficulty in all 17 tasks at 60–64, using Mokken Scaling to establish the hierarchical order of these. Finally, we examined progression across the hierarchy over time. Using logistic regression we calculated the odds ratio of reporting difficulty performing tasks at the bottom of the hierarchy (i.e. feeding, washing and/or toileting) at age 60–64 by reported difficulty performing tasks at the top of the hierarchy (i.e. gripping, walking and/or stair-climbing) at age 43. Adjustments were made for sex, age, body mass index, health status and socio-economic position and, those with severe disability at 43 were excluded.

Results At age 43, the prevalence of reported difficulties gripping, walking and stepping ranged between 1.3–3.0% but by age 60–64 had increased to 11.0–19.3%. At age 60–64 a strong hierarchical order to the loss of function was observed (Loevinger Scalability Coefficient H=0.56); gripping was the first task participants reported difficulty with and feeding oneself the last. Participants who reported difficulty gripping, walking and/or stair-climbing at 43 were 3.34 (95% CI: 1.71–6.50) times more likely to report difficulty feeding, washing and/or toileting at 60–64 than people who reported no difficulty at 43.

Conclusion These findings demonstrate that the hierarchy of loss in functional ability is observed in younger populations. This suggests that targeted interventions to prevent mobility disability should not be delayed until old age as high risk individuals can be identified in midlife, with substantial declines in functional ability already occurring in some people by this age.

  • healthy ageing
  • physical capability
  • Birth cohort

Statistics from

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.