Predictors of disability in elderly finnish men—A longitudinal study

doi:10.1016/0895-4356(89)90120-0

Journal of Clinical Epidemiology

Volume 42, Issue 12, 1989, Pages 1215-1225

https://doi.org/10.1016/0895-4356(89)90120-0 Get rights and content

Abstract

Factors predicting disability in late life were studied in 716 men from eastern or southwestern Finland in connection with the 25-year follow-up. of the East-West Study, which is part of the Seven Countries Study, in 1984. In middle-aged men, low forced vital capacity, occurrence of diabetes, presence of intermittent claudication, high diastolic blood pressure, higher age and lower educational level showed the greatest predicting power for future disability 15–25 years later. In later middle age, low forced vital capacity, presence of intermittent claudication, cerebrovascular disease or coronary heart disease and higher age were the most powerful predictors for disability 10 years later. In order to lower disability in old age, it is important to prevent deterioration of ventilatory function and cardiovascular diseases in middle-aged populations and to treat chronic diseases adequately.

References (46)

I. Ruikka et al.
The health of the aged in Turku
Ann Acad Sci Fenn A
(1966)
E. Shanas et al.
Old People in Three Industrial Societies
(1968)
A.E. Bennett et al.
Chronic disease and disability in the community: a prevalence study
Br Med J
(1970)
A.I. Harris
Handicapped and Impaired in Great Britain, Part 1. Office of Population Census and Surveys, Social Survey Division
(1971)
A.J. Akhtar et al.
Disability and dependence in the elderly at home
Age Ageing
(1973)
S.Z. Nagi
An epidemiology of disability among adults in the United States
Milbank Mem Fund Q
(1976)
P. Karjalainen
Vanhusten kontaktit, avuntarve ja palvelujen saatavuus
E. Heikkinen et al.
The Elderly in Eleven Countries. A Sociomedical Survey
I. Ruikka et al.
Turun vanhusten terveydeutila vuonna 1983
A.M. Jette et al.
Impairment and disability in the aged
J Chrou Dis
(1985)

S.-L. Kivela

Disability among home-nursed patients and homehelp clients

Scand J Soc Med

(1985)

A. Nissinen et al.

65–74 -vuotiaiden itäsuomalaisten terveys ja toimintakyky

Suom Lääkäril

(1985)

S.-L. Kivelä et al.

Iäkkäiden terveys ja elinolot

Ähtärin kaupungin julkaisusarja N:o I

(1986)

U.-K. Lammi et al.

Functional capacity and associated factors in elderly Finnish men

Scand J Soc Med

(1989)

H. Simonen

Toiminnanvajavuus ja ikääntyneet pitkäaikaissa raat

Kansanterveystieteen julkaisuja M53

(1980)

L.G. Branch et al.

A prospective study of functional status among community elders

Am J Public Health

(1984)

E.B. Palmore et al.

Predictors of function among the old-old: a 10 year follow-up

J Geroutol

(1985)

J.L. Pinsky et al.

Framingham disability study: relationship of disability to cardiovascular risk factors among persons free of diagnosed cardiovascular disease

Am J Epidemiol

(1985)

WHO

Protecting the Health of the Elderly

J. Cornoni-Huntley et al.

Epidemiology of disability in the oldest old: methodologic issues and preliminary findings

Milbank Mem Fund Q

(1985)

M.J. Karvonen et al.

Men in rural east and west Finland

M.J. Karvonen et al.

Cigarette smoking, serum cholesterol, blood pressure and body fatness. Observations in Finland

Lancet

(1959)

M.J. Karvonen

Epidemiology of ischaemic heart disease in Finland

Cited by (42)

Coffee and the Risk of Dementia and Cognitive Impairment
2015, Diet and Nutrition in Dementia and Cognitive Decline
As current treatments for dementia provide limited clinical benefit (Raina et al., 2008 [1]), preventive strategies are needed to stem the epidemic of dementia that is estimated to affect more than 115 million people worldwide by 2050 (World Health Organization, 2012 [2]). Early in the search for modifiable risk factors in the study of dementia, coffee consumption was identified as a potential target for prevention. Since then, however, prospective studies have provided variable answers regarding whether coffee plays a protective role in the development of dementia. While research thus far, taken together, appears to show a possible neuroprotective effect of coffee, inter-study heterogeneity prevents definitive conclusions, and further work is needed. In this chapter, we will summarize the knowledge to date regarding the role of coffee intake in the development of dementia. We will then address some of the limitations inherent to these studies, which must be considered in their interpretation.
Disability and its correlates with chronic morbidities among U.S. adults aged 50-< 65 years
2009, Preventive Medicine
Citation Excerpt :
Of the three pathways to disability, the most common is associated with chronic conditions that become so severe that they limit function. Studies have reported that chronic morbidities are predictors of disability in people aged ≥ 65 years (Cho et al., 1998; Harris et al., 1989; Lammi et al., 1989; Wang et al., 2002), and arthritis and other musculoskeletal diseases were the primary causes of disability in older people (Ettinger et al., 1994a, 1994b; Guralnik et al., 1995). In addition, coronary heart disease, injury, lung disease, and stroke were also causes of disability in these groups (Ettinger et al., 1994a, 1994b).
To examine the prevalence of disability and its associations with multiple chronic morbidities in U.S. adults aged 50−< 65 years.
Self-reported data on disability and chronic morbidities were collected from 95,103 participants (aged 50−< 65 years) of the 2005 Behavioral Risk Factor Surveillance System. Prevalence estimates for disability and chronic morbidities were age-standardized to the 2000 U.S. population. Adjusted odds ratios for disability among people with chronic morbidities (versus those without) were estimated using logistic regression analyses.
The age-adjusted prevalence of the six chronic morbidities ranged from 3.1% (for stroke) to 40.3% (for arthritis). Overall, the prevalence of disability was 26.3%; it was significantly higher in adults with chronic morbidities than in those without and increased linearly with the number of the chronic morbidities. Adults with any of the chronic morbidities were 1.9 to 4.5 times as likely, and adults with 1 to 5−6 of the chronic morbidities were 2.7 to 42.9 times as likely, to have disability as those without after adjustment for demographics, smoking and leisure-time exercise.
Chronic morbidities remain major factors associated with disability in adults aged 50−< 65 years. Effective interventions to prevent and manage chronic diseases from an earlier age may help reduce the risk of disability.
The development of a comorbidity index with physical function as the outcome
2005, Journal of Clinical Epidemiology
Citation Excerpt :
However, in many types of research it is essential to adjust for other diseases, called comorbid diseases, in addition to the disease of concern, which may be related to the outcome(s) of interest. This is of particular importance in research conducted in older populations where many chronic illnesses may be present in the same patient [2–14]. Without this adjustment outcomes cannot be attributed to investigative interventions as the patients themselves may differ substantially in prognostic expectations due to their initial comorbid illnesses [2].
Physical function is an important measure of success of many medical and surgical interventions. Ability to adjust for comorbid disease is essential in health services research and epidemiologic studies. Current indices have primarily been developed with mortality as the outcome, and are not sensitive enough when the outcome is physical function. The objective of this study was to develop a self-administered Functional Comorbidity Index with physical function as the outcome.
The index was developed using two databases: a cross-sectional, simple random sample of 9,423 Canadian adults and a sample of 28,349 US adults seeking treatment for spine ailments. The primary outcome measure was the SF-36 physical function (PF) subscale.
The Functional Comorbidity Index, an 18-item list of diagnoses, showed stronger association with physical function (model R² = 0.29) compared with the Charlson (model R² = 0.18), and Kaplan-Feinstein (model R² = 0.07) indices. The Functional Comorbidity Index correctly classified patients into high and low function, in 77% of cases.
This new index contains diagnoses such as arthritis not found on indices used to predict mortality, and the FCI explained more variance in PF scores compared to indices designed to predict mortality.
Nondisease factors affected trajectories of disability in a prospective study
2005, Journal of Clinical Epidemiology
Citation Excerpt :
Long-term disability was measured using the Organization for Economic Cooperation and Development questionnaire [23], as well as a questionnaire with additional items referring to activity restrictions in activities of daily living (ADL) and mobility [24]. Similar to disability scales used in prior research on determinants of disability (e.g., [13,14], our disability scale includes physical performance (walking a quarter of a mile (400 m), carrying an object of 10 pounds (5 kg), bending and picking up a shoe), gross mobility capacity (walking up and down the stairs, walking outside [no distance], getting outside), and basic activities of daily living (getting in and out of bed, getting in and out of a chair, dressing; washing hands and face, walking across a room, bathing or showering). Each disability item was scored on a four-point scale ranging from 1 (without any difficulty) to 4 (unable to do or only with help).
To examine nondisease factors, including sociodemographic variables, health behaviors and psychosocial factors as determinants of trajectories of disability.
We used a classification of 10 trajectories of disability based on a multiround prospective study design; nine trajectories grouped survivors with a similar level and time course of disability, one included all deaths. Multinomial logistic regression was used to assess associations between these trajectories and a wide range of nondisease factors.
Correcting for age, sex, and four chronic diseases, we found that sociodemographic factors (education and income), health behaviors (leisure-time physical activity and BMI), and psychosocial factors (locus of control, neuroticism, and active problem focusing) were significantly associated with the trajectories of disability. Moreover, our results pointed to factors associated with disability trajectories that were characterized by sudden increase (external locus of control and, to a lesser extent, BMI), strong fluctuations (neuroticism, BMI, external locus of control), or high severity (leisure-time physical inactivity) of disability.
A wide range of nondisease factors is associated with the trajectories of disability. Preventing obesity, developing a more internal locus of control, and increasing physical activity could contribute to preventing trajectories characterized by rapid decline, large fluctuations or severe disability. Understanding the role of these factors should receive high priority.
The relationship of self-rated vision and hearing to functional status and well-being among seniors 70 years and older
1999, American Journal of Ophthalmology
Purpose: To describe the relationship between self-reported visual and hearing impairment and an index of global functional status among seniors age 70 years or older.
Methods: A total of 7,320 United States community-dwelling persons aged 70 years or older participating in the 1993 Assets and Health Dynamics of the Oldest Old Survey (AHEAD) completed detailed questionnaires about their demographic, socioeconomic, and health status. Multivariate analyses of functional status (using a global index of functional status based on self-reported limitations in 11 activities) were conducted, controlling for demographic and socioeconomic status and common medical conditions, as well as independently for hearing and vision.
Results: Of the respondents, 27% rated their vision as fair or poor, whereas 25% rated their hearing as fair or poor. Controlling for demographic factors, socioeconomic status, medical conditions, and general health status, limitations in both vision and hearing correlated independently with worsened functional status. Controlling for income, wealth, and education did not greatly reduce the strength of the association between visual and hearing impairment and function.
Conclusions: Visual and hearing impairment appear to have a significant relationship to overall functioning in the oldest old, regardless of income or wealth. By confirming these findings across income and household wealth groups, adjusted for medical conditions and general health status, in a nationally representative population of Americans age 70 years or older, this study provides a powerful added impetus to efforts for improving vision and hearing for all other Americans, including the oldest old.
The associations between self-rated vision and hearing and functional status in middle age
1999, Ophthalmology
To describe the associations between self-reported visual and hearing impairment and an index of global functional status among community-dwelling, middle-aged Americans.
Cross-sectional.
A total of 9744 U.S. community-dwelling persons 51 to 61 years of age participated.
Multivariate analyses of functional status based on cross-sectional data from Wave I (1992) of the Health and Retirement Study (HRS), controlling for demographic and socioeconomic status, common chronic medical conditions, and general health status, were performed.
A global index of functional status based on self-reported limitations in 17 activities was measured.
Approximately 3% of respondents in the HRS rated their vision or hearing as poor. Even after controlling for demographic factors, socioeconomic status, medical conditions, and general health status, limitations in both vision and hearing were independently correlated with worse functional status. In addition, controlling for income, wealth, and education reduced the strength of the associations between vision and hearing impairment and function, but did not eliminate them. The magnitude of effect of poor vision exceeded all medical conditions except stroke.
Visual and hearing impairment appear to have a significant relationship with overall functional status, among even community-dwelling, middle-aged Americans and even after controlling for general health status, medical comorbidities, and socioeconomic status.

View all citing articles on Scopus

View full text

Original articlePredictors of disability in elderly finnish men—A longitudinal study

Abstract

The health of the aged in Turku

Ann Acad Sci Fenn A

Old People in Three Industrial Societies

Chronic disease and disability in the community: a prevalence study

Br Med J

Handicapped and Impaired in Great Britain, Part 1. Office of Population Census and Surveys, Social Survey Division

Disability and dependence in the elderly at home

Age Ageing

An epidemiology of disability among adults in the United States

Milbank Mem Fund Q

Vanhusten kontaktit, avuntarve ja palvelujen saatavuus

The Elderly in Eleven Countries. A Sociomedical Survey

Turun vanhusten terveydeutila vuonna 1983

Impairment and disability in the aged

J Chrou Dis

Disability among home-nursed patients and homehelp clients

Scand J Soc Med

65–74 -vuotiaiden itäsuomalaisten terveys ja toimintakyky

Suom Lääkäril

Iäkkäiden terveys ja elinolot

Ähtärin kaupungin julkaisusarja N:o I

Functional capacity and associated factors in elderly Finnish men

Scand J Soc Med

Toiminnanvajavuus ja ikääntyneet pitkäaikaissa raat

Kansanterveystieteen julkaisuja M53

A prospective study of functional status among community elders

Am J Public Health

Predictors of function among the old-old: a 10 year follow-up

J Geroutol

Framingham disability study: relationship of disability to cardiovascular risk factors among persons free of diagnosed cardiovascular disease

Am J Epidemiol

Protecting the Health of the Elderly

Epidemiology of disability in the oldest old: methodologic issues and preliminary findings

Milbank Mem Fund Q

Men in rural east and west Finland

Cigarette smoking, serum cholesterol, blood pressure and body fatness. Observations in Finland

Lancet

Epidemiology of ischaemic heart disease in Finland

Original article
Predictors of disability in elderly finnish men—A longitudinal study