Abstract
To live independently, individuals must be able to perform basic activities of daily living (ADLs), including bathing, dressing, and transferring out of a bed or chair. When older adults develop difficulty or the need for help performing ADLs, they experience decreased quality of life and an increased risk of acute care utilization, nursing home admission, and death. For these reasons, slowing or preventing the progression to functional problems is a key focus of the care of older adults. While preventive efforts currently focus mainly on older people, difficulty performing basic ADLs (“functional impairment”) affects nearly 15% of middle-aged adults, and this prevalence is increasing. People who develop functional impairment in middle age are at increased risk for adverse outcomes similar to those experienced by older adults. Developing ADL impairment in middle age also impacts work force participation and health expenditures, not just in middle age but also older age. Middle-aged adults have a high capacity for recovery from functional impairment, and many risk factors for developing functional impairment in middle and older age have their roots in mid-life. Taken together, these findings suggest that middle age may be an ideal period to intervene to prevent or delay functional impairment. To address the rising prevalence of functional impairment in middle age, we will need to work on several fronts. These include developing improved prognostic tools to identify middle-aged people at highest risk for functional impairment and developing interventions to prevent or delay impairment among middle-aged people. More broadly, we need to recognize functional impairment in middle age as a problem that is as prevalent and central to health outcomes as many chronic medical conditions.
Highlights
Epidemiology and outcomes of functional impairment in middle age Functional impairment is becoming more common in middle age A growing body of research shows that over the past two decades, health has worsened among middle-aged people in the United States
Recent research shows that developing Activities of daily living (ADL) difficulty in middle age is associated with outcomes similar to those seen in late life, including hospitalization, nursing home admission, and death [13]
The prevalence of functional impairment among middleaged Americans is increasing. Functional impairment in this age group is associated with adverse outcomes similar to those experienced by older adults, including hospitalization, nursing home admission, and death
Summary
Individuals must be able to perform basic activities of daily living (ADLs), including bathing, dressing, toileting, transferring out of a bed or chair, and feeding oneself As people age, they may develop difficulty performing these activities, or “functional impairment.”. While research among older adults has advanced from identifying those at risk to implementing interventions to prevent functional impairment, we lack similar progress to address functional impairment among middle-aged people. In this commentary, we will discuss why middle age may be an ideal time to intervene to prevent or delay the development of functional impairment in both middle age and older age. We will consider what types of interventions may be most effective in this age group
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