Original Study
Comparisons Between Older Men and Women in the Trajectory and Burden of Disability Over the Course of Nearly 14 Years

https://doi.org/10.1016/j.jamda.2012.11.011Get rights and content

Abstract

Objectives

Across the life span, women live longer than men but experience higher rates of disability. To more completely evaluate these gender differences, the current study set out to compare the trajectories and burden of disability over an extended period between older men and women.

Design

Prospective, longitudinal study with 13.5 years of follow-up.

Setting

Greater New Haven, Connecticut.

Participants

Participants were 754 persons, aged 70 years or older, who were initially community-living and nondisabled in their basic activities of daily living.

Measurements

Disability in 13 basic, instrumental, and mobility activities was assessed during monthly interviews, whereas demographic and clinical covariates were measured during comprehensive assessments every 18 months.

Results

Five distinct trajectories were identified over successive 18-month intervals: independent, mild disability, mild to moderate disability, moderate disability, and severe disability. Women were more likely than men to experience the moderate and severe disability trajectories, but were less likely to transition from the independent trajectory to a worse disability trajectory during the subsequent 18-month interval. Women were also less likely to die after each of the five trajectories, and these differences were at least marginally significant for all but the independent trajectory. Over the entire duration of follow-up, women suffered from a greater burden of disability than men, but these differences were greatly attenuated after adjustment for the baseline levels of disability.

Conclusions

Gender differences in disability over an extended period can be explained, at least in part, by the higher mortality experienced by older men and the higher initial levels of disability among older women. These results suggest the need to take a life-course approach to better understand gender differences in disability.

Section snippets

Study Population

Participants were members of the Precipitating Events Project, a longitudinal study of community-living persons, aged 70 years or older, who were nondisabled (ie, required no personal assistance) at baseline in four basic activities of daily living: bathing, dressing, walking inside the house, and transferring from a chair.5 Exclusion criteria included significant cognitive impairment with no available proxy,6 inability to speak English, diagnosis of a terminal illness with a life expectancy

Results

Table 1 provides the baseline characteristics of the 265 men and 487 women in our analytic sample. The men were more highly educated, whereas the women had higher levels of disability in instrumental and mobility activities and were more likely to live alone, be physically frail, have depressive symptoms, and be obese. There were no gender differences according to age, race/ethnicity, number of chronic conditions, cognitive impairment, or low physical activity.

Based on a total disability score

Discussion

In this prospective longitudinal study, which included monthly assessments of 13 basic, instrumental, and mobility activities, we identified five distinct trajectories of disability over intervals of 18 months, and we compared these trajectories and the overall burden of disability over the course of 13.5 years between older men and women. Four major findings warrant comment. First, women were more likely than men to experience trajectories that were characterized by moderate and severe levels

Acknowledgments

We thank Denise Shepard, BSN, MBA, Andrea Benjamin, BSN, Paula Clark, RN, Martha Oravetz, RN, Shirley Hannan, RN, Barbara Foster, the late Alice Van Wie, BSW, Patricia Fugal, BS, and Amy Shelton, MPH, for assistance with data collection; Wanda Carr and Geraldine Hawthorne, BS, for assistance with data entry and management; Peter Charpentier, MPH, for design and development of the study database and participant tracking system; Linda Leo-Summers, MPH, for assistance with Fig. 1, Fig. 2; and

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    This study was funded by grants from the National Institute on Aging (R37AG17560, R01AG031850, K24AG021507). The study was conducted at the Yale Claude D. Pepper Older Americans Independence Center (P30AG21342).

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