Abstract
BackgroundThe effect of the onset of difficulties with activities of daily living (ADLs) on the health-related quality of life (HRQoL) of older adults is not well understood. We identified strong longitudinal associations between ADL onset and HRQoL changes for older adults in Medicare Advantage Organizations (MAOs).MethodsWe analyzed 473,282 age-eligible MAO beneficiaries in the 2008-2013 Medicare Health Outcomes Surveys (M-HOS) who reported no ADL difficulties at baseline and completed their two-year follow-ups in 2010-2015. The four HRQoL measures were the physical and mental health component scores (PCS and MCS) from the SF-12V, and the CDC’s counts of physically unhealthy and mentally unhealthy days (PUD and MUD) in the past month. Ordinary least squares (OLS) and zero-inflated negative binomial regressions were used.ResultsThe onset of difficulty/inability in bathing, dressing, eating, getting in/out of chairs, walking, and using the toilet significantly reduced PCS scores by 10.84, 11.29, 9.18, 8.98, 9.49 and 10.67 points, and MCS scores by 7.93, 8.72, 10.13, 5.34, 4.37 and 9.00 points, respectively. The onset of difficulty/inability in bathing, dressing, eating, getting in/out of chairs, walking, and using the toilet increased PUD days by 6.24, 6.83, 6.34, 4.93, 4.96 and 6.72 days, and MUD days by 3.00, 3.19, 3.54, 2.26, 2.07 and 3.27 days, respectively.ConclusionsThere is robust evidence that the onset of ADL difficulties/inabilities significantly and substantially reduced age-eligible MAO beneficiaries’ HRQoL. Prevention strategies focused on ADLs would benefit the performance of MAOs.
Highlights
The effect of the onset of difficulties with activities of daily living (ADLs) on the health-related quality of life (HRQoL) of older adults is not well understood
The Medicare Health Outcomes Surveys (M-HOS) was developed by the Centers for Medicare and Medicaid Services (CMS) to monitor and evaluate the quality of care provided to beneficiaries enrolled in Medicare Advantage Organizations (MAOs) [11]
We model the effects of the onset of difficulty with or the inability to perform Activities of Daily Living (ADL) on the Center for Disease Control and Prevention (CDC)’s physically unhealthy days (PUD) or mentally unhealthy days (MUD) HRQoL measures using the latter approach
Summary
The effect of the onset of difficulties with activities of daily living (ADLs) on the health-related quality of life (HRQoL) of older adults is not well understood. We identified strong longitudinal associations between ADL onset and HRQoL changes for older adults in Medicare Advantage Organizations (MAOs). Because older adults are more likely to have reduced functional ability and greater difficulties performing daily activities of living (ADLs), their health-related quality of life (HRQoL) has become a major public health concern. HRQoL is a multidimensional concept that measures how individuals perceive their physical and mental well-being [2]. To develop appropriate programs and interventions for reaching this Healthy People 2020 goal, a better understanding of the relationships between functional limitations and HRQoL is needed. Previous studies have shown that functional limitations are either directly or indirectly associated with poorer HRQoL.
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