Improvement and deterioration in physical functioning among israelis aged 60 and over
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Myers-JDC-Brookdale Institute. Center for Research on Aging. Improvement and Deterioration in Physical Functioning among Israelis Aged 60 and over. Jenny Brodsky, Tal Spalter , Yitschak Shnoor October 17, 2012. Outline. Background Study Purpose and Hypothesis Method of Analysis

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Improvement and Deterioration in Physical Functioning among Israelis Aged 60 and over

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Improvement and deterioration in physical functioning among israelis aged 60 and over

Myers-JDC-Brookdale Institute

Center for Research on Aging

Improvement and Deterioration in Physical Functioning among Israelis Aged 60 and over

Jenny Brodsky, Tal Spalter, Yitschak Shnoor

October 17, 2012


Outline

Outline

  • Background

  • Study Purpose and Hypothesis

  • Method of Analysis

  • Findings

  • Discussion


Improvement and deterioration in physical functioning among israelis aged 60 and over

Survival curves of morbidity, disability and mortality

Source: WHO 84576


The nagi disablement model

The Nagi Disablement Model


The iom disability in america

The IoM Disability in America

Disablement

Process is Dynamic-

Non-linear

IOM - Institute of Medicine report Disability in America (Pope and Tarlov 1991)


International classification of functioning disability and health

International Classification of Functioning, Disability and Health

WHO, 2001


Study objectives

Study Objectives

  • To examine the changes in physical functioning of older adults between two periods of time

  • To examine what variables predict the changes in function


Hypothesis

Hypothesis

  • Together with patterns of functional deterioration, we will also find patterns of improvement

  • Women, the old-old, minorities (Arabs), and those with low income and low education, are at higher risk of functional deterioration

  • Older adults suffering from multi-pathology, as well as individuals with cognitive and mental problems, are at higher risk of functional deterioration


Study population

Study Population

  • Individuals who were 60 and over in the first round of SHARE- Israel (2005-2006); they were 65 and over in the second round of SHARE-Israel (2009-2010)

  • N=982


Dependent variables

Dependent Variables

  • Changes in mobility(walking 100 meters, sitting for two hours, getting up from a chair, climbing several floors or one floor without resting)

  • Changes in basic functions(pulling or pushing large objects; stooping, crouching, or kneeling; reaching or extending arms above shoulder level; handling small objects; carrying 5kg)

  • Changes in ADL (washing, dressing, eating, toileting, crossing a room, getting in and out of bed)

  • Changes in IADL(preparing a hot meal, buying groceries, using the telephone, taking drugs, financial management)


Dependent variables cont

Dependent Variables cont.

  • Scales were built in the two rounds of SHARE by summing up items

  • Changes were calculated by taking round two minus round one


Independent variables

Independent Variables

  • Socio-demographic status (age, gender, living arrangements, education, income, population group)

  • Function and health (function in the first wave, No. of illnesses, change in the No. of illnesses between waves, mental health, cognitive function)

  • Social Activities(volunteering, participating in social, religious, political and educational activities)

  • Receipt of formal support (personal care and homemaking)

  • Receipt of informal support


Changes in functioning 1 n 982

Changes in Functioning1 N=982 (%)

1 The changes between rounds are significant by t-test for paired samples

**p<0.01


Linear regression to predict changes in functioning n 982

Linear Regression to Predict Changes in Functioning: N=982

*p<0.05, **p<0.01

1Standardized coefficients-b; positive=improvement & negative=deterioration


Linear regression prediction of changes in functioning

Linear regression – prediction of changes in functioning


Linear regression prediction of changes in functioning cont

Linear regression – prediction of changes in functioning (cont.)


Major findings and implications

Major Findings and Implications

  • There is no single pattern of functional deterioration over time among older adults, there is also improvement

  • Arab older adults are at higher risk of deterioration in physical functioning over time

  • Physical health indicators, mainly multi-pathology, predict deterioration in functioning (according to the Disablement Model)

  • Mental and cognitive status predict deterioration in functioning

  • Receiving informal care and formal help (in homemaking) predict deterioration


Major findings and implications cont

Major Findings and Implications (cont.)

  • These findings do not lead to the conclusion that there is no need to help the elderly.

  • However, they imply that many times, instrumental assistance to the elderly, "save the hassle" of doing things by themselves and thus, weakens a potential functional rehabilitation process.


Improvement and deterioration in physical functioning among israelis aged 60 and over

Rehabilitation

While Mr. Johns never did make it into the Olympics, he did however get full motion back in his knees


I mprovement and preservation of functional capabilities

Improvement and Preservation of Functional Capabilities

  • Professional rehabilitation

  • Training of professional and non-professional staff (i.e., nurses and homecare workers)

  • Training of family caregivers


Improvement and deterioration in physical functioning among israelis aged 60 and over

"My goal is to die before there's a technology breakthrough that forces me to live until one hundred and thirty"

Thank You


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