Abstract
Functional limitation is increasingly common as people age and is often associated with negative consequences. Evidence of the dynamics of functional limitation within couples in China is still inadequate. To examine whether functional limitation was associated within middle-aged and older couples and to explore sex differences in spousal associations. In this nationwide, population-based cohort study performed from January 1, 2011, to December 31, 2018, participants were selected using multistage probability sampling, and 5207 community-dwelling couples (10 414 individuals) 45 years or older were included in the nationally representative China Health and Retirement Longitudinal Study. Data analysis was performed from January 1 to February 28, 2021. The exposure variable was the presence of functional limitation in spouses. Functional limitation was measured by the activities of daily living (ADLs) and instrumental activities of daily living (IADLs) scales and was defined as having difficulty in independently performing at least 1 ADL or IADL item. The main outcome was functional limitation in index participants. Multivariable logistic regression with generalized estimating equations was used to estimate the reciprocal association of functional limitation within couples over time. A total of 5207 married, different-sex couples (mean [SD] age, 59.1 [8.8] years for husbands and 57.0 [8.2] years for wives) were included in the study. For husbands, the number (percentage) of participants classified with baseline functional limitation was 1140 (21.9%), the number (percentage) with ADL limitation was 684 (13.1%), and the number (percentage) with IADL limitation was 834 (16.0%). For wives, the number (percentage) of participants classified with baseline functional limitation was 1502 (28.8%), the number (percentage) with ADL limitation was 887 (17.0%), and the number (percentage) with IADL limitation was 1183 (22.7%). Longitudinal results demonstrated an association in spouses developing functional limitation (adjusted odds ratio [OR], 2.55; 95% CI, 2.41-2.69; P < .001), ADL limitation (adjusted OR, 2.26; 95% CI, 2.11-2.41; P < .001), and IADL limitation (adjusted OR, 2.58; 95% CI, 2.43-2.73; P < .001). Subgroup analyses by sex revealed similar patterns of spousal health concordance in terms of all studied outcomes, indicating no sex specificity. This population-based cohort study suggests that among Chinese middle-aged and older couples there is significant concordance in the development of functional limitation. This study of spousal functional ability from a dyadic perspective may help in the understanding of health risks within a wider familial context and offers novel insights for prioritizing policy focus from individual centered to couple based.
Highlights
The World Health Organization reports that developing and maintaining functional ability that enables an individual’s dignity and well-being in older age represents a top priority for healthy aging.[1]
The number of participants classified with baseline functional limitation was 1140 (21.9%), the number with activities of daily living (ADLs) limitation was 684 (13.1%), and the number with instrumental activities of daily living (IADLs) limitation was 834 (16.0%)
The number of participants classified with baseline functional limitation was 1502 (28.8%), the number with ADL limitation was 887 (17.0%), and the number with IADL limitation was 1183 (22.7%)
Summary
The World Health Organization reports that developing and maintaining functional ability that enables an individual’s dignity and well-being in older age represents a top priority for healthy aging.[1] functional limitation, a substantial impairment in a person’s ability to effectively perform main daily tasks (such as mobility and personal hygiene),[2,3,4] is still an increasingly common experience in later life and becomes a significant public health concern worldwide. The origin of functional limitation remains unclear, empirical studies[14,15,16,17] have identified numerous influencing factors, including sociodemographic characteristics, physical and biological status, and lifestyle. They live in a shared environment, gain almost equal access to resources, have similar health behaviors, demonstrate convergent mood, and are exposed to common stressors.[19,21,22,23] spousal health is not supposed to develop in isolation: characteristics of one are likely to influence the other, and spouses form a reasonable and important dyad for evaluating interdependency
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