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PubMed2004

[Relationship between rate of unemployment and incidence of disability pension in Iceland 1992-2003.].

OBJECTIVE: To evaluate the effect of unemployment and the introduction of a new method of disability assessment on the number of recipients of disability pension in Iceland by examining changes in the incidence of disability pension and unemployment year by year from 1992 to 2003. MATERIAL AND METHODS: Information on gender, age and disability grade of new recipients of disability pension in Iceland and corresponding information on the Icelandic population for each year in the period 1992 to 2003 was used to calculate the incidence of disability pension. The results were compared with data on the rate of unemployment in Iceland. RESULTS: The incidence of disability pension was relatively high from 1992 to 1995, was lower from 1996 to 2002 and then increased markedly in 2003. There is a strong correlation between the incidence of disability pension and the rate of unemployment among both genders in Iceland during the period covered by the study. An increase from 1999 to 2000 in the incidence of disability pension among females coincided in time with the introduction of a new method of disability assessment in September 1999, but also with an increase in the rate of unemployment among females. CONCLUSION: It is not warranted to claim that the introduction of a new method of disability evaluation in September 1999 has resulted in a decisive increase in the incidence of disability pension in Iceland. The increase in the number of recipients of disability pension in Iceland recently has a strong statistical correlation with changes in the labour marked, especially with rising unemployment and increased pressure at work.

English Abstract↗

PubMed2006

Assessing mental disability in minors.

Forensic psychiatry devotes a great deal of attention to the "imprecise" and "insufficiently scientific" nature of psychiatric disability assessment, and, for this reason, it is vitally important to establish a reliable method of assessing different levels of disability. The assessment of mental disability in minors is unique in that it involves developmental aspects, which affect the formation and outcome of the disability. The relationship between disability and development is reciprocal: disability can affect development, thereby intensifying the degree of disability, while development affects integration of the disability into the personality and self-image, thereby preventing or reducing the transformation of disability into handicap. Only an understanding of both the psychopathological structure and its interaction with developmental elements can lead to an accurate assessment of the degree of disability. Such an understanding is vital to the proper practice of forensic psychiatry. We hereby propose a new formula for disability quantification which provides an arithmetical means for the calculation of disability percentages in minors, and we recommend its use in the assessment of demands for National Insurance benefits and compensation claims. The relationship between this new formula and the existing Children's Global Assessment Scale (CGAS) functional scale, when tested retrospectively on 50 clinical reports composed by the writers of this article, showed a good correlation in the results obtained independently by each writer. Two case studies are presented here. A further evaluation by objective evaluators is necessary in order to construct a model for a final objective evaluation of disability in children and adolescents.

Adolescent↗

PubMed2005

Compensatory strategy use identifies risk of incident disability for the visually impaired.

BACKGROUND: Use of compensatory strategies may be a marker for preclinical disability. OBJECTIVE: To determine, among persons who did not report mobility disability, if the reported use of compensatory strategies was a predictor of subsequent disability at 2 years in those who did and did not have visual impairment at baseline. METHODS: Within a population-based sample of 2520 persons aged 65 to 84 years, those who reported no difficulty walking or stair-climbing at baseline (not disabled) were studied. Visual impairment was defined as a visual acuity worse than 20/40, log contrast sensitivity less than 1.5, or more than 30 points missing in the visual field. Use of compensatory strategies at baseline was reported as changing the frequency or method used to walk or climb stairs. Incident disability was defined as report of new difficulty in mobility at 2 years. RESULTS: Those using compensatory strategies at baseline were 3 times more likely to report incident disability in walking and stair-climbing, compared with persons who did not use compensatory strategies. Visual field impairment was the most significant predictor of incident mobility disability of all the vision measures studied. Among those with visual field impairment, users of compensatory strategies were 3 times more likely to report incident walking disability (95% confidence interval, 1.87-5.58) and incident stair-climbing disability (95% confidence interval, 1.86-4.83) compared with those who did not use compensatory strategies. CONCLUSION: Preclinical disability, characterized by use of compensatory strategies in those with no disability, is a predictor for subsequent disability and may help identify patients with visual impairment for whom mobility interventions are warranted.

Activities of Daily Living↗

PubMed2004

Severity, timing, and structure of disability.

OBJECTIVES: Severity and timing are key aspects of disability experience for individuals. They also generate a population's disability structure (prevalence, counts, patterns). We study links among severity, duration, and structure for community-dwelling adults in the US. METHODS: The data source is the National Health Interview Survey Disability Supplement. Disabilities in personal care (ADL), household management (IADL), and physical functions (PLIM) are analyzed. RESULTS: Many combinations of disabilities are possible, but just a few are frequent; the top-10 patterns cover 70% of ADL, 89% of IADL, and 47% of PLIM disabled adults. Hierarchical patterns are common for ADLs and IADLs. People with many disabilities also have more-severe ones, and their disabilities often started at the same time. CONCLUSIONS: Disability structure reflects severity and timing of specific disabilities, sometimes strongly, and other times weakly due to exit processes from the community. Assumptions that disability occurs in "hard" tasks first and "easy" ones last, and that hard-and-early connotes mild disability whereas easy-and-late connotes severe, need direct empirical testing.

Activities of Daily Living↗

PubMed2005

Educational inequalities in the prevalence and incidence of disability in Italy and the Netherlands were observed.

BACKGROUND AND OBJECTIVES: Information on socioeconomic inequalities in incidence of and recovery from disability is still scarce, as is information on socioeconomic inequalities in performance-based disability as compared to self-reported disability. This study aimed to estimate educational inequalities in the prevalence, incidence, and recovery of self-reported and performance-based disability in two European populations. STUDY DESIGN AND SETTING: We analyzed data from two longitudinal studies on aging. At each wave, participants were asked to what degree they experienced difficulty with several functional tasks, and interviewers rated their performance on several tasks. Educational inequalities in both outcomes were expressed in terms of prevalence, incidence, and recovery ratios. RESULTS: Educational inequalities in both prevalence and incidence of disability were observed. No large educational inequalities in recovery from disability could be demonstrated. Compared to inequalities in self-reports of disability, inequalities in performance-based disability were equally large in the Dutch study, but smaller in the Italian study. CONCLUSIONS: Inequalities in performance-based measures of disability stress the importance of the association of socioeconomic position with disability among older populations. Our results suggest that higher education serves to postpone or avoid disability, but provides less benefit when disability is already present.

Aged↗

PubMed2002

Disabling symptoms: what do older women report?.

OBJECTIVE: To answer the question, "What do older disabled women report as the main symptoms causing their disability?" DESIGN: Cross-sectional study of 876 women aged 65 and older who participated in the second interview of the Women's Health and Aging Study, a longitudinal study of community-living women, representing the one third of older women with at least mild to moderate disability. MEASUREMENTS AND MAIN RESULTS: Women were asked to identify the symptom and the condition that was the main cause of disability in basic and instrumental activities of daily living, and lower extremity mobility. Musculoskeletal pain symptoms were reported as the main cause of disability by at least one third of women with each type of disability. Other symptoms that were less frequently reported as main causes of disability were weakness, fatigue, and unsteadiness. Fear of falls was reported by 14% (95% confidence interval, 11.2% to 17.6%) of 472 women with disability in bathing. When asked to report on the main condition causing their disability, many women responded, "old age" or "no specific disease," but were able to identify symptoms causing their disabilities. CONCLUSIONS: Musculoskeletal pain was the most common cause of disability reported by older women, followed by weakness and balance difficulties. Greater attention to symptoms that interfere with daily activities of older persons may reduce the burden of disability.

Activities of Daily Living↗

PubMed2002

Common chronic diseases and general impairments as determinants of walking disability in the oldest-old population.

OBJECTIVES: Walking disability affects older people's autonomy and well-being. We investigated the relative effect of common chronic diseases and general impairments on walking disability in the general oldest-old population. DESIGN: Population-based cohort study. SETTING: Leiden 85-plus Study, the Netherlands. PARTICIPANTS: Five hundred ninety-nine persons aged 85, response rate 87%. MEASUREMENTS: Walking disability was assessed using a 6-meter walking test. Persons with a walking time below the 25th percentile and those who were physically unable to perform the walking test were categorized as having a walking disability. Information on common chronic diseases was obtained from records of subjects' general practitioners and pharmacies. General impairments were assessed with functional tests and standardized questions during face-to-face interviews. We expressed the effect of common chronic diseases and general impairments as the population attributable risk (PAR), indicating how much disability can be prevented when the identified risk factor is eliminated from the population. RESULTS: One hundred ninety-two persons (33%) had a walking disability. This disability was highly associated with poor mobility in daily life, recurrent falls, and poor well-being (all P <.001). Of the common chronic diseases, stroke, angina pectoris, diabetes mellitus, and hip fracture but not arthritis contributed most (PARs from 6% to 15%) to walking disability in the population at large. General impairments had higher prevalence rates and higher PARs than common chronic diseases. Cognitive impairment, depressive symptoms, and dizziness upon rising contributed most (PARs between 22 to 27%) to walking disability. In multivariate regression analyses of all common chronic diseases and general impairments, associations remained significant. CONCLUSION: Within the general oldest-old population, general impairments contribute more substantially to walking disability than do common chronic diseases. The diagnosed diseases did not explain the impairments that led to walking disability. Especially in the oldest old, clinicians should focus not merely on common chronic diseases but particularly on general impairments as targets for diagnostic analysis and treatment to decrease walking disability.

Aged↗

PubMed2003

The burden and patterns of disability in activities of daily living among community-living older persons.

BACKGROUND: The onset of disability in activities of daily living (ADLs) is considered a sentinel event in the life of an older person, but recent evidence suggests that newly disabled elders have high rates of recovery. We performed a longitudinal study to determine the burden and patterns of ADL disability among previously nondisabled, community-living older persons. METHODS: We studied 754 community-living persons, aged 70 years or older, who were categorized into three groups according to their risk for disability (low, intermediate, high). Participants were interviewed each month for 2 years to determine the presence and severity of disability in four key ADLs: bathing, dressing, walking, or transferring. RESULTS: Among the 690 nondecedents, the rates of any disability were 17.7%, 48.7%, and 65.2%, respectively, for the low-, intermediate-, and high-risk groups. Whereas only 6.9% of nondecedents in the low-risk group had more than 1 month of disability, 38.2% and 50.6% of nondecedents in the intermediate- and high-risk groups (i.e., physically frail), respectively, had multiple months and/or episodes of disability. The patterns of disability were quite diverse, with no single pattern representing the disability experience of more than half the decedents or nondecedents in any of the risk groups. CONCLUSIONS: Disability among community-living older persons, particularly those who are physically frail, is a highly dynamic process with considerable diversity. Our results provide strong evidence to support an emerging paradigm of disability as a reversible, and often recurrent, event.

Activities of Daily Living↗

PubMed2002

Prevalence and severity of mental health-related disability and relationship to diagnosis.

OBJECTIVE: Psychiatric disability has been defined largely from measures that focus on serious mental illness. This practice may have led to substantial underestimation of the total impact of mental disorders on community health. In this study a generic measure of mental health-related disability was used to examine disabilities attributable to various common mental disorders. METHODS: Data were drawn from the Australian National Survey of Mental Health and Wellbeing, a household survey of 10,641 adults that assessed participants for 14 DSM-IV disorders with use of the Composite International Diagnostic Interview. Screening instruments were used to identify likely cases of ICD-10 personality disorder, neurasthenia (an undifferentiated somatoform disorder), and psychosis. Mental health disability was assessed with the Medical Outcomes Study 12-item Short Form (SF-12) mental health summary scale, which was administered to all participants. RESULTS: Disability was significantly greater among participants with a current psychiatric diagnosis, and disability varied by type of disorder. Diagnosis remained a strong predictor of disability after sociodemographic factors and physical illness were controlled for. Disorders found to be independently associated with disability were depression, panic disorder, agoraphobia, social phobia, generalized anxiety disorder, alcohol dependence, and drug dependence. CONCLUSIONS: Substantial proportions of persons with mental disorders that are not usually classified as major mental disorders reported moderate and severe disability. A generic measure of mental health-related disability was able to detect variations in disability among persons with different diagnoses. Although such a measure is not as sensitive as a disorder-specific measure developed for use in psychiatric populations, it can facilitate comparison of disability across common mental disorders.

Adult↗

PubMedDate not supplied

The impact of chronic obstructive pulmonary disease on long-term disability costs.

OBJECTIVES: Chronic obstructive pulmonary disease (COPD) as a cause of disability with subsequent costs remains poorly recognized. The small, growing body of literature on COPD shows that it is one of the leading causes of missed work.greater than asthma or diabetes. However, much less is known about the impact of COPD on long-term disability (LTD). Because the health care burden for disabled, working-age patients will fall heavily on managed care organizations, better estimates of the economic and pharmacoeconomic costs of COPD are required. We seek to improve understanding of the burden of COPD on several national LTD programs. METHODS: We reviewed occupational health and disability literature and government statistics to determine how long-term, respiratory-related disability is addressed by disability pension programs in 8 developed countries (Canada, France, Germany, Italy, Japan, Spain, the United Kingdom, and the United States). We then applied respiratory-specific disability definitions to country-specific population and pension information to estimate the potential burden of COPD on LTD insurance programs in each country. RESULTS: Comprehensive, relevant data to evaluate respiratory-related disability are lacking. Of the study countries, only the United States has explicit respiratory specific criteria for disability eligibility, which are based solely on spirometry. We estimate that the total burden of COPD in the study countries may range from 5 billion dollars to as high as 25 billion dollars per year if all persons who met U.S. eligibility criteria for respiratory-related disability were granted compensation. CONCLUSION: The potential burden of COPD on LTD programs may be large. The lack of standard criteria for respiratory-related disability may lead to underrecognition of COPD's true potential impact. Further work is needed to develop consistent and cost-effective ways to measure the impact of COPD and to assist in disability determination for COPD patients.

Cost of Illness↗

PubMed2001

Physical exercise and the prevention of disability in activities of daily living in older persons with osteoarthritis.

BACKGROUND: The prevention of disability in activities of daily living (ADL) may prolong older persons' autonomy (older persons are defined in this study as those aged > or =60 years). However, proved preventive strategies for ADL disability are lacking. A sedentary lifestyle is an important cause of disability. This study examines whether an exercise program can prevent ADL disability. METHODS: A 2-center, randomized, single-blind, controlled trial was conducted in which participants were assigned to an aerobic exercise program, a resistance exercise program, or an attention control group. Of the 439 community-dwelling persons aged 60 years or older with knee osteoarthritis originally recruited, the 250 participants initially free of ADL disability were used for this study. Incident ADL disability, defined as developing difficulty in transferring from a bed to a chair, eating, dressing, using the toilet, or bathing, was assessed quarterly during 18 months of follow-up. RESULTS: The cumulative incidence of ADL disability was lower in the exercise groups (37.1%) than in the attention control group (52.5%) (P =.02). After adjustment for demographics and baseline physical function, the relative risk of incident ADL disability for assignment to exercise was 0.57 (95% confidence interval, 0.38-0.85; P =.006). Both exercise programs prevented ADL disability; the relative risks were 0.60 (95% confidence interval, 0.38-0.97; P =.04) for resistance exercise and 0.53 (95% confidence interval, 0.33-0.85; P =.009) for aerobic exercise. The lowest ADL disability risks were found for participants with the highest compliance to exercise. CONCLUSIONS: Aerobic and resistance exercise may reduce the incidence of ADL disability in older persons with knee osteoarthritis. Exercise may be an effective strategy for preventing ADL disability and, consequently, may prolong older persons' autonomy.

Activities of Daily Living↗

PubMed1988

Predictors of disability among midlife men and women: differences by severity of impairment.

This study examines the influences on disability among men and women controlling for the degree of functional incapacity imposed by chronic illness or impairment. The associations between demographic, attitude, social role characteristics and disability are separately examined for persons with mild and severe levels of limitation in order to determine whether different factors are associated with disability when impairment is mild as opposed to severe. Separate logit regressions are estimated for four sex/severity groups using data from the 1978 Survey of Disability and Work. It is hypothesized that among persons with severe impairments, only demographic variables will be significantly associated with disability because the severity of limitations would make other factors unimportant, while among persons who are mildly impaired attitudes and social roles will be important influences. Contrary to these expectations, the factors associated with disability are similar among the four sex/severity groups. In all four groups the presence of pain and fatigue strongly influence disability while gender roles are generally not associated with disability. Attitudes regarding the importance of work for self-esteem are also found to be associated with reports of disability. An unexpected outcome of this analysis is an indication of what predicts the absence of disability among severely impaired persons. In particular, persons who report that their sense of self-esteem is tied to work are least likely to report disability. These findings suggest which non-medical factors may contribute to the maintenance of usual work roles and life activities among persons with severe levels of impairment. They also identify variables which may link impairment and disability across all levels of severity.

Activities of Daily Living↗

PubMed2006

Disability determination: validity with occupational low back pain.

UNLABELLED: Disability determination for occupational low back pain challenges indemnification systems because spinal pathoanatomy is weakly related to pain intensity and functional capacity, making judgments of disability vulnerable to such confounding factors as sociodemographic variables (eg, race, socioeconomic status). To assess the contribution of impairment, race, and socioeconomic status to disability ratings and post settlement functional status, the current study investigated 580 African American and 892 white workers' compensation claimants with occupational low back pain who were surveyed an average of 21 months after claim settlement. Results indicated that diagnosis, surgery, and medical costs (indicators of impairment) were associated with disability ratings at the time of case settlement. African American race was negatively associated with disability ratings and also with diagnosis/surgery and medical costs. Disability ratings, however, correlated only weakly with post settlement status at 21-month follow-up. The association between race and disability ratings suggests that inequities operate in disability determination. Furthermore, the relative lack of association between disability ratings and postsettlement status raises questions about the validity of disability determination for workers' compensation claimants with low back pain. PERSPECTIVE: Results demonstrated apparent racial/ethnic disparities in treatment and little association between disability ratings and post settlement status. Together, these results raise questions about social justice in the management of occupational back pain, as well as the validity of associated disability determination processes.

Adolescent↗

PubMed1996

Sexual functioning among women with physical disabilities.

OBJECTIVE: Three a priori hypotheses were tested: (1) There are significant differences in sociosexual behaviors of women with physical disabilities compared with women without disabilities; (2) the sexual functioning of women with disabilities is significantly related to age at onset of disability; (3) psychological factors explain more of the variance in the sexual functioning of women with physical disabilities than do disability, social and environmental factors. DESIGN: Case-comparison study using written survey. SETTING: General community. PARTICIPANTS: The questionnaire was mailed to 1,150 women with physical disabilities who were recruited as volunteers or through independent living centers. Each woman gave a second copy of the questionnaire to an able-bodied female friend, which comprised the comparison group. The response rate was 45%, with 475 cases and 425 comparisons eligible to participate. The most common disability type was spinal cord injury (24%), followed by polio (18%), muscular dystrophy (11%), cerebral palsy (11%), multiple sclerosis (10%), joint disorders (7%), and skeletal abnormalities (5%). INTERVENTIONS: None. MAIN OUTCOME MEASURES: Sexual-functioning, consisting of four factors: (1) sexual desire, (2) sexual activity, (3) sexual response, (4) sexual satisfaction. RESULTS: Highly significant differences were found in level of sexual activity (p = .000001), response (p = .000009), and satisfaction (p=.000001) between women with and without disabilities. No significant differences were found between groups on sexual desire. Severity of disability was not significantly related to level of sexual activity. CONCLUSIONS: Psychological and social factors exert a strong impact on the sexual functioning of women with physical disabilities. Further investigations is needed of the effect of social environment on development of self-esteem and sexual self-image, and how these influences affect levels of sexual functioning in women with physical disabilities.

Adolescent↗

PubMed2000

The prevalence of disabilities and maltreatment among runaway children.

OBJECTIVE: This research was conducted to determine the prevalence of disabilities among abused and nonabused runaways within a hospital population (Study 1) and community school population (Study 2) and to identify any associations between disability, maltreatment, family stress factors, academic achievement, school attendance, domestic violence and runaway status. METHOD: Descriptive information was collected for maltreated and nonmaltreated runaways from hospital (N = 39,352; 255 runaways) and school (N = 40,211; 562 runaways) populations including: disability status, type of maltreatment, family stress factors, record of domestic violence in the family, academic achievement and attendance. RESULTS: The prevalence rate of disabilities among the maltreated runaways was 83.1% and 47% among the nonmaltreated runaways in the hospital sample and 34% and 17%, respectively, in the school sample. Children and youth with disabilities were at increased risk to become runaways in both populations. The presence of maltreatment significantly increased the association between running away and disability status. Children with behavior disorders, mental retardation, and some type of communication disorder were significantly more likely to run away than children with other disabilities. Among the maltreated runaways with and without disabilities, physical abuse and sexual abuse were significantly associated with running away. Records of domestic violence were more prevalent in the families of runaways with behavior disorders and no diagnosed disability. Lower academic achievement, poor school attendance, and more family stress factors were associated with maltreatment, disability and runaway status. CONCLUSIONS: Children and youth with disabilities are unidentified and unrecognized among runaways. Professionals working with runaways and their families need to be cognizant of the special needs of the population, particularly with respect to behavior disorders, communication disabilities, and mental retardation and reconsider current policy to routinely reunite runaways with their families when running away was precipitated by traumatagenic factors within the family.

Achievement↗

PubMed1999

Self efficacy as a mediator of the relationship between pain intensity, disability and depression in chronic pain patients.

To clarify the relationships between physical, and psychosocial components of chronic pain, a path analytic model was tested conceptualizing self efficacy as a mediator of disability. In turn, disability was hypothesized to mediate depression. This model could help explain the circumstances under which disability develops and why so many chronic pain patients become depressed. Questionnaires from 126 chronic pain patients (without prior depression) were reviewed from three pain clinics. Hypothesized and alternate models were tested using separate regression equations to identified models which best fit these data. Regression analysis supported that self efficacy partially mediates the relationship between pain intensity and disability. This model accounted for 47% of the explained variance in disability (P < 0.001). Six additional variables that were significantly related to disability in preliminary analysis, added to the explained variance in disability (R2 = 0.56), with gender and pain location paths remaining significant. In separate regression analyses, disability was found to partially mediate the relationship between pain intensity and depression (b = 0.47-0.33). This model accounted for 26% of the explained variance in depression. The addition of self efficacy to this model supported it as a stronger mediator (R2 = 0.32), and suggested that support for disability as a mediator of depression was a spurious finding. Both pain intensity and self efficacy contribute to the development of disability and depression in patients with chronic pain. Therefore, the lack of belief in ones own ability to manage pain, cope and function despite persistent pain, is a significant predictor of the extent to which individuals with chronic pain become disabled and/or depressed. Nevertheless, these mediators did not eliminate the strong impact that high pain intensity has on disability and depression. Therefore, therapy should target multiple goals, including: pain reduction, functional improvement and the enhancement of self efficacy beliefs.

Adult↗

PubMed2000

Disabilities due to injury in the military.

INTRODUCTION: Disability is a major health and economic issue in the Armed Forces associated with increased use of medical care, the loss of active duty time, and substantial compensation costs. METHODS: The role of injuries in physical disability from the early 1980s to 1994 was assessed by reviewing administrative data from the U.S. Army Physical Disability Agency, the Naval Disability Evaluation Board, and the Air Force Physical Disability Division. Information on the number of disability cases reviewed in 1994, the leading causes of disability, and the disposition of each case were examined most closely. Also, information from the Department of Defense on the cost of compensating disability cases was reviewed. RESULTS: Disability generally appears to be significant across the services, ranging from 10 to 30 events per 1000 personnel per year depending on the service. Evidence from the data reviewed indicates that 30% to 50% of disability cases may be due to injury. The leading conditions that bring about board reviews and lifetime compensation appear to be lower back and knee conditions, both commonly thought to be due to injuries. Total direct costs of compensation reached $1. 5 billion for fiscal year 1990. CONCLUSIONS: While current disability data systems are maintained for administrative and not research purposes, the information available may be valuable for injury surveillance and research and suggests that injury-related disability is a major health and economic burden for the Armed Forces.

Adult↗

PubMed2001

Self-reported preclinical disability identifies older women with early declines in performance and early disease.

There appears to be a preclinical stage of physical disability which precedes onset of task difficulty (disability) in those who develop disability progressively as a result of chronic disease. Such a stage provides a basis for identifying older adults at risk of becoming disabled. This cross-sectional study evaluated whether a preclinical stage of physical function identified by self-report is associated with decrements in objective physical performance measures or increases in disease; that is, whether these measures, in those with preclinical disability, are intermediate between individuals who report no difficulty and no preclinical changes and those who report difficulty. The Women's Health and Aging Study II, an observational study of 436 women 70-80 years of age who were among the two-thirds least disabled living in the community. Participants were sampled from the HCFA Medicare eligibility lists and were determined eligible if they reported no difficulty, or difficulty in only one of four domains of physical function: mobility, upper extremity, IADL and ADL tasks. At the first follow-up (18 months after baseline), participants completed questionnaires on physical functioning for tasks in each of these domains, with possible answer options for each task: they had (1) difficulty (disabled); (2) no difficulty and no modification of task performance (High Function); or (3) no difficulty but reported modification and/or change in frequency of task performance (a self-report measure of preclinical disability predictive of incident difficulty). At the same visit, standardized, objective measures of function and disease were obtained, including measured walk; chair stands; strength: hip flexion, knee extension, ankle dorsiflexion, and grip; balance: function reach, single leg stand, tandem stand; joint exam: hip pain on passive motion and knee pain or tenderness; spirometry; ankle:arm blood pressure ratio; visual function: acuity, contrast sensitivity, stereopsis; and graded treadmill exercise test. Data were analyzed from the first follow-up examination. Physical performance decreased, and disease frequency increased, in association with decreasing self-reported mobility function (in walking one-half mile and climbing 10 steps), across three self-report categories: High Function, Preclinical Disability (Task Modification but No Difficulty) and Disability (Difficulty). These findings pertained for measures of walking speed, balance, strength, and knee and hip osteoarthritis. Self-reported level of function predicted differences in ranges as well as means for walking speed, balance and strength. These findings indicate a physiologic basis for self-reported function, including preclinical disability, specifically that different levels of disease severity, impairments and physical performance are concurrently associated with different categories of self-reported function. They also suggest new avenues for screening and intervention to prevent disability.

Aged↗