Hierarchy of higher-level physical functions: a longitudinal investigation on a nationally representative population of community-dwelling middle-aged and elderly persons

Abstract

Purpose: Understanding the hierarchy of higher-level physical functions to infer disability level (mild, moderate or severe) is essential for the precise targeting of preventive interventions and has been examined previously in a cross-sectional study. Based on longitudinal data, this study evaluated the hierarchy of higher-level physical functions. Methods: Data from a cohort of 2729 community-dwelling persons aged over 50 with no initial disability were drawn from the “Survey of Health and Living Status of the Elderly in Taiwan” from 1996 through 2007. The three-level hierarchy of eight chosen activities was examined by the median ages to disability onset with survival analyses and by Cox regressions, which examined the effects of sex and age on the development of this hierarchy. Results: The progression of incident disability was as follows: mild level-running, carrying weight, and squatting; moderate level-climbing stairs, walking, and standing; and severe level-grasping and raising arms up. Women and older persons were at greater risk of developing more severe levels of disability. Another Cox regression with one index activity from each hierarchical level revealed similar results. Conclusions: The three-level hierarchy of higher-level physical functions has been validated longitudinally, suggesting rich research and clinical implications.Implications for RehabilitationHigher-level physical functions demand greater challenges than the activities of daily living.This longitudinal study, based on nationally representative data, has validated a three-level hierarchy of higher-level physical functions.This three-level hierarchy forms a basis of rapidscreening of high-risk people eligible for preventive interventions, which may help to reverse disability status or to prevent progression of disability.Future work could investigate the effects of focused targeting of people with different levels of disability to administer preventive interventions.