Late Life Disability Research Articles

Meal-based enhancement of protein quality and quantity during weight loss in obese older adults with mobility limitations: Rationale and design for the MEASUR-UP trial

Obese older adults with even modest functional limitations are at a disadvantage for maintaining their independence into late life. However, there is no established intervention for obesity in older individuals. The Measuring Eating, Activity, and Strength: Understanding the Response — Using Protein (MEASUR-UP) trial is a randomized controlled pilot study of obese women and men aged ≥60years with mild to moderate functional impairments. Changes in body composition (lean and fat mass) and function (Short Physical Performance Battery) in an enhanced protein weight reduction (Protein) arm will be compared to those in a traditional weight loss (Control) arm. The Protein intervention is based on evidence that older adults achieve optimal rates of muscle protein synthesis when consuming about 25–30g of high quality protein per meal; these participants will consume ~30g of animal protein at each meal via a combination of provided protein (beef) servings and diet counseling. This trial will provide information on the feasibility and efficacy of enhancing protein quantity and quality in the context of a weight reduction regimen and determine the impact of this intervention on body weight, functional status, and lean muscle mass. We hypothesize that the enhancement of protein quantity and quality in the Protein arm will result in better outcomes for function and/or lean muscle mass than in the Control arm. Ultimately, we hope our findings will help identify a safe weight loss approach that can delay or prevent late life disability by changing the trajectory of age-associated functional impairment associated with obesity.

Trends in disability in activities of daily living among Chinese older adults, 1997-2006: the China Health and Nutrition Survey.

A decline in prevalence of late-life disability in activities of daily living (ADLs) has been reported in Western countries. We investigate the time trend of disability in basic ADLs among Chinese older people in 1997-2006, and explore the potential contribution of cardiometabolic diseases to the trend. The study included 7,845 participants (age ≥ 60 years) in the China Health and Nutrition Survey who were examined in 1997, 2000, 2004, and 2006. Data on ADLs were collected through interviews. Disability in basic ADLs was defined as need of assistance or inability to perform at least one of the five self-care activities of bathing, dressing, toileting, feeding, and transferring. Generalized estimating equation models were used to test the time trend in ADL disability and its association with cardiometabolic diseases. Prevalence of ADL disability decreased from 13.2% in 1997 to 9.9% in 2006; the trend was statistically evident among people aged 60-69 years, women, and rural residents (p trend < .05). From 1997 to 2006, the prevalence of ADL disability decreased at a relative annual rate of 3.1% in total sample; the decline was statistically more evident in young-olds than older-olds, in men than women, and in rural than urban residents. The disabling effect decreased over time for stroke (p trend = .032) and multiple cardiometabolic diseases (p trend = .014). The prevalence of disability in basic ADLs among Chinese older adults decreased from 1997 to 2006. Stroke and multiple cardiometabolic diseases appear to become less disabling over time, which may partly contribute to the favorable trend in ADL disability.

Adiposity, physical activity, and muscle quality are independently related to physical function performance in middle-aged postmenopausal women

Poor physical function performance is associated with risks for disability in late life; however, determinants of physical function are not well characterized in middle-aged women. The aim of this cross-sectional study was to examine the contributions of body composition, physical activity, muscle capacity, and muscle quality to physical function performance. Postmenopausal women (N = 64; mean [SD] age, 58.6 [3.6] y) were assessed for body composition via dual-energy x-ray absorptiometry, for physical activity via accelerometer (steps per day), and for physical function via Timed Up and Go, 30-second chair stand, and 6-minute walk. Leg strength was assessed using isokinetic dynamometry at 60° second. Leg power was assessed with the Nottingham Leg Extensor Power Rig. Muscle quality was calculated as (1) the ratio of leg strength at 60° second to upper leg lean mass and (2) the ratio of leg power to total lower body lean mass. Regression analyses revealed the following: (1) age and muscle quality calculated with leg power are independently related to Timed Up and Go, explaining 12% and 11% of the variance, respectively (P < 0.05); (2) age and muscle quality calculated with leg strength are independently related to 30-second chair stand, explaining 12% and 10% of the variance, respectively (P < 0.05); and (3) number of medical conditions, muscle quality calculated with leg strength, steps per day, and adiposity are independent predictors of 6-minute walk, collectively explaining 51% of the variance. In postmenopausal women, a more optimal body composition (including lower adiposity and higher lean mass) and higher levels of physical activity are associated with better physical function performance at midlife.

PO-0929 “low Dose” Postnatal Corticosteroids For Preterm Infants At Risk Of Severe Bpd – A Myth?

<h3>Background</h3> Prescribing postnatal corticosteroids (PCS) for ventilator dependent preterm infant remains controversial. PCS improve short term lung function but may increase the risk of disability in later life. The DART study¹was designed to address this risk using a 10-day tapering protocol with a total dose of dexamethasone of 0.89 mg/kg. We aimed to audit practice and calculate the total dose of PCS at a single centre using the DART protocol. <h3>Method</h3> Over a four year period patients were identified from an electronic database and hospital charts reviewed. Infants receiving peri-extubation steroids were excluded. <h3>Results</h3> Forty six infants with mean (SD) gestational age 25.0 (1.3) weeks, birth weight 685 (192) g received PCS as per DART protocol at a median (range) age of 25(6–197) days. Ventilatory support at the start of treatment: 6 infants on CPAP, 24 conventional and 16 high frequency ventilation. Mean FiO₂ prior to PCS was 0.55 (0.22) with mean airway pressure of 10.9 (2.7) falling to 9.1 (2.3) cm H₂O after three days. Median duration of therapy was 20 (3–86)days, with a total dexamethasone dose of 1.44 (0.375–9.1) mg/kg. Glycosuria was common (67%), one infant developed NEC and there were seven deaths with a 93% rate of either death or BPD (oxygen dependency at 36 weeks). <h3>Conclusions</h3> PCS prescribed beyond three weeks has minimal impact on reducing BPD despite the total dose of PCS often exceeding those used in published studies. Long term follow up of these patients is recommended. <h3>Reference</h3> 1 Doyle <i>et al</i>.<i> Pediatrics</i> 2006;117:75–83

Systematic review of functional training on muscle strength, physical functioning, and activities of daily living in older adults

Exercise programs are often recommended for preventing or delaying late-life disability. Programs that incorporate functional training, which uses movements similar to performing activities of daily living, may be suitable for such recommendation. The purpose of this systematic review was to examine the effects of functional training on muscle strength, physical functioning, and activities of daily living in older adults. Studies in three electronic databases (MEDLINE, CINAHL, and SPORTDiscus) were searched, screened, and appraised. Thirteen studies were included in the review. These studies vary greatly in participant recruitment criteria, functional training content, and selection of comparison groups. Mobility exercises were the most common element in functional training across studies. Results show beneficial effects on muscle strength, balance, mobility, and activities of daily living, particularly when the training content was specific to that outcome. Functional training may be used to improve functional performance in older adults.

Nutrition and Ageing.

The world elderly population is rapidly increasing. This demographic change represents a new challenge for the society and demands for a multisectorial intervention to promote a long, healthy, and active life span. Between the factors that contribute in fostering a long healthy life, the nutritional regime plays a central role and is recognized as a major factor in the onset of chronic diseases. A better understanding of the interaction between nutrition and ageing is essential to unravel the mechanisms responsible for these positive/negative effects and to identify diet components promoting the quality of life in the old age and to contribute to the prevention of late-life disabilities. At Università Cattolica del Sacro Cuore, the research activity in food science is focusing on four main objectives: food quality, food safety, functional foods and diet balancing. These objectives are the target of multidisciplinary ongoing and future research activities for a better understanding of the link between diet and ageing. Briefly, the different activities are addressed to the study of the following subjects: the most relevant factors affecting food choices and habits of old aged persons; the effects of long term low dose supplementation of conjugated linoleic acid in mouse; the use of low glycemic index and high resistant starch foods to prevent diabetes and obesity; the adjuvant effect of food bacteria for vaccination; the role of food ingredients in disease; the immunosuppression effect of mycotoxins, and its relevance in ageing people; the production of sustainable and natural antioxidant ingredients to encourage a healthy diet. Our research projects emphasize an holistic and integrated approach that, by bringing together complementary research groups, can combine the collective expertise and thus provide a comprehensive assessment of the role of nutrition in healthy ageing people.

The impact of waist circumference on function and physical activity in older adults: longitudinal observational data from the osteoarthritis initiative.

BackgroundWe previously demonstrated that BMI is associated with functional decline and reduced quality of life. While BMI in older adults is fraught with challenges, waist circumference (WC) is a marker of visceral adiposity that can also predict mortality. However, its association with function and quality of life in older adults is not well understood and hence we sought to examine the impact of WC on six-year outcomes.MethodsWe identified adults aged ≥60 years from the longitudinal Osteoarthritis Initiative and stratified the cohort into quartiles based on WC. Our primary outcome measures of function at six year follow-up included: self-reported quality of life [Short Form-12 (SF-12)], physical function [Physical Activity Scale for the Elderly (PASE)] and disability [Late-life Disability Index (LLDI)]. Linear regression analyses predicted 6-year outcomes based on WC quartile category (lowest = referent), adjusted for age, sex, race, education, knee pain, smoking status, a modified Charlson co-morbidity index and baseline scores, where available.ResultsWe identified 2,182 subjects meeting our inclusion criteria and stratified the study cohort by quartiles of WC. Mean age ranged from 67.5-68.7 years, 60-71% were female and 80-86% were white. The highest WC quartile compared to 50-75th, 25-50th or lowest quartile, was associated with a greater number of medications (4.3, 4.0, 3.6 and 3.4 [p < 0.001]), lower gait speeds (1.23, 1.27, 1.32, and 1.34 m/s[p < 0.001]), higher rates of knee osteoarthritis (70.2, 62.2, 60.2, 48.6;p < 0.001), higher Charlson co-morbidity scores and greater knee pain (WOMAC scores) (all p < 0.001). At follow-up, adjusted SF-12 physical function subscale and PASE scores, were lowest in the highest WC quartile as compared to the 50-75%, 25-50%, and lowest quartiles [(SF-12 scores: 45.5, 46.7, 47.6, and 47.9), and (PASE scores: 109.6, 128.7, 126.6, and 131.0). The LLDI limitation subscale for disability demonstrated lower scores in the high WC quartile as opposed to the referent group.ConclusionsElevated WC is associated with lower quality of life, a decline in physical function, and a slightly higher risk of disability over time. Intervention studies are needed to prevent functional decline in this high-risk population.

Do Higher Levels of Resilience Buffer the Deleterious Impact of Chronic Illness on Disability in Later Life?

In examining the ability of resilience, or the ability to navigate adversity in a manner that protects well-being, to buffer the impact of chronic disease onset on disability in later life, the authors tested 2 hypotheses: (a) People with greater levels of resilience will have lower levels of disability and (b) resilience will moderate the association between the onset of a new chronic condition and subsequent disability. This study used a sample of 10,753 Americans between the ages of 51 and 98, derived from 3 waves of the Health and Retirement Study (2006-2010). Ordinary least squares regression was used to estimate the impact of resilience on changes in disability (measured as difficulty with activities of daily living [ADLs] and instrumental activities of daily living [IADLs]) over a 2-year period using a simplified resilience score. Resilience protects against increases in ADL and IADL limitations that are often associated with aging. Resilience mitigates a considerable amount of the deleterious consequences related to the onset of chronic illness and subsequent disability. Our results support our hypotheses and are consistent with claims that high levels of resilience can protect against the negative impact of disability in later life.

Measurement Properties of the Late Life Disability Index Among Individuals Who Use Power Wheelchairs as Their Primary Means of Mobility

ObjectiveTo examine the reliability, validity, and factor structure of the Late Life Disability Instrument (LLDI) in individuals who use power wheelchairs as their primary means of mobility. DesignA 4-week, test-retest study design. SettingFive Canadian cities. ParticipantsThe validity sample included 115 new and experienced power mobility users, and the reliability sample included 85 experienced users (N=115). These volunteer samples included individuals who were aged ≥50 years and independently used power mobility as their primary means of mobility. InterventionsNot applicable. Main Outcome MeasureThe LLDI measures participation in 2 dimensions of 16 life activities: frequency and perceived limitations. Validity measures included the Wheelchair Skills Test–power version, the Assistive Technology Outcomes Profile for Mobility, the Hospital Anxiety and Depression Scale, the Power Mobility Wheelchair Confidence Measure, and the Life Space Assessment. ResultsFor the reliability sample, raw intraclass correlational coefficients for limitation and frequency dimension scores ranged from .855 (95% confidence interval .781–.905) to .883 (95% confidence interval, .822–.924), respectively. For the validity sample, scores on the LLDI were correlated as hypothesized with scores on validity measures. The factor structure that was identified with the original sample was not replicated among power wheelchair users. For LLDI frequency, exploratory factor analysis indicated that 5 of the original 16 items did not perform similarly among power wheelchair users. For LLDI limitations, a 1-factor, rather than a 2-factor, solution was identified. ConclusionsThe study provides evidence in support of the reliability and validity of the measure but suggests that the original subscale scores may not be applicable to power wheelchair users.

Task-specific balance training improves self-assessed function in community-dwelling older adults with balance deficits and fear of falling: a randomized controlled trial

Objective: To evaluate the effects of a 12-week balance training programme on self-assessed function and disability in healthy community-dwelling older adults with self-perceived balance deficits and fear of falling. Design: A prospective, randomized controlled trial. Setting: Stockholm County, Sweden. Participants: A total of 59 community-dwelling older adults (42 women and 17 men) aged 67–93 were randomized to either an intervention group (n = 38) or to serve as controls (n = 21) after baseline testing. Intervention: The intervention was a 12-week, three times per week, progressive, specific and individually adjusted group balance-training programme. Main measures: Self-perceived function and disability measured with Late Life Function and Disability Instrument. Results: The intervention group reported improvement in overall function (p = 0.016), as well as in basic (p = 0.044) and advanced lower extremity function (p = 0.025) compared with the control group. The study showed no improvement in overall disability or upper extremity function. Conclusion: This group balance training programme improves self-assessed function in community-dwelling older adults with balance deficits and fear of falling.

The Study on the Disability in Later Life and the Characteristics of Community Environments

The Study on the Disability in Later Life and the Characteristics of Community Environments

Mild cognitive impairment status and mobility performance: an analysis from the Boston RISE study.

The prevalence of mild cognitive impairment (MCI) and mobility limitations is high among older adults. The aim of this study was to investigate the association between MCI status and both performance-based and self-report measures of mobility in community-dwelling older adults. An analysis was conducted on baseline data from the Boston Rehabilitative Impairment Study in the Elderly study, a cohort study of 430 primary care patients aged 65 or older. Neuropsychological tests identified participants with MCI and further subclassified those with impairment in memory domains (aMCI), nonmemory domains (naMCI), and multiple domains (mdMCI). Linear regression models were used to assess the association between MCI status and mobility performance in the Habitual Gait Speed, Figure of 8 Walk, Short Physical Performance Battery, and self-reported Late Life Function and Disability Instrument's Basic Lower Extremity and Advanced Lower Extremity function scales. Participants had a mean age of 76.6 years, and 42% were characterized with MCI. Participants with MCI performed significantly worse than participants without MCI (No-MCI) on all performance and self-report measures (p < .01). All MCI subtypes performed significantly worse than No-MCI on all mobility measures (p < .05) except for aMCI versus No-MCI on the Figure of 8 Walk (p = .054) and Basic Lower Extremity (p = .11). Moreover, compared with aMCI, mdMCI manifested worse performance on the Figure of 8 Walk and Short Physical Performance Battery, and naMCI manifested worse performance on Short Physical Performance Battery and Basic Lower Extremity. Among older community-dwelling primary care patients, performance on a broad range of mobility measures was worse among those with MCI, appearing poorest among those with nonmemory MCI.

Evaluation of the Late-Life Disability Instrument (LLDI) in Low-Income Older Populations

To assess the construct and convergent validity of the 16 items of the Late-Life Disability Instrument (LLDI) in Latin American seniors. Exploratory and confirmatory factor analyses were performed to assess the factor structure of frequency and limitation sub-scales of the LLDI. ANOVA and t test were used to determine the convergent and construct validity of the LLDI by exploring associations with physical performance tests, mobility limitations, depression, cognition, self-reported health, as well as with sex, education, and income. Factor analysis resulted in one-factor solution and acceptable model fit. Participants with better physical function, less mobility limitations, better self-reported health, and intact cognition reported more frequent activities and fewer limitations, indicating good convergent and construct validity of our measure. LLDI is a good instrument to assess disability in low-income populations. Further research is needed to include culturally acceptable activities for the frequency sub-scale.

Better immunity in later life: a position paper

Ageing is the greatest challenge that health-care systems will have to deal with this century. This is because a wide spectrum of pathological impairments emerge in the later part of the human life course which sharply increase mortality and reduce quality of life. Dysfunction of the immune system with advancing age is of crucial importance to the development of disability in later life and finally death. Understanding immune ageing, immunosenescence, has long been recognised as an essential prerequisite for the delivery of effective interventions which will improve late life health. Ten years ago, the ImAginE consortium undertook a broad ranging series of projects which added significantly to our understanding of how fundamental ageing mechanisms drove immune decline. In the decade which followed, abundant evidence has accumulated from nonhuman model systems that ageing results from the progressive operation of a relatively few common processes which act across the major organ systems. These advances in fundamental understanding both allow better clarification of the potential cross-system dysregulation that occurs in ageing and open new avenues for intervention. Over the course of a 2-day workshop, the original ImAginE participants have considered these issues and present some suggestions for current priority areas in immunosenescence.

Essential timing of orthopaedic treatment in children with Ehlers-Danlos syndrome arthrochalasia type: a case report

Objective: This case report presents the orthopaedic impact of arthrochalasia-type Ehlers-Danlos syndrome (EDS) (former type VIIA and B) in a young girl.Methods: The characteristics of EDSs are skin abnormalities and tissue fragility with orthopaedic consequences including joint hypermobility and dislocations. In EDS arthrochalasia type (former type VIIA and B) severe general hypotonia and congenital bilateral hip dislocation are distinctive symptoms. This type of EDS is less common than other types and just a few cases have been reported.Results: This report describes a case of a 3-year old girl with EDS arthrochalasia type and bilateral high hip dislocation, spontaneous shoulder dislocation and scoliosis as orthopaedic consequences.Conclusions: Orthopaedic consequences in these cases can be severe so conservative or surgical treatment will be necessary to reduce disability in later life. Timing of either conservative or surgical intervention is essential. According to the literature, most conservative treatments fail. Also, surgical treatment is rarely effective in most of the cases. Both conservative and surgical treatment should be considered carefully in the treatment of EDS arthrochalasia type, each of which has pros and cons. The best treatment depends on the prognosis and current situation of the child.

Men benefit more from midlife leisure-time physical activity than women regarding the development of late-life disability — Results of the KORA-Age study

ObjectiveEncouraging physical activity is an important public health measure to reduce disability prevalence in the aged. The aims of this study were to determine the association between midlife physical activity and late-life disability and to investigate gender-specific differences. MethodThis data originates from the KORA-Age cohort, a follow-up in 2008 of the MONICA (Multinational Monitoring of Trends and Determinants in Cardiovascular Diseases)/KORA (Cooperative Health Research in the Region of Augsburg) S1–S4 surveys (1984–2001) situated in Augsburg, a city in Southern Germany. We applied a multivariable hurdle model to investigate the association of physical activity and disability. ResultsWe analysed 3333 persons with a mean follow-up of 18±5.5years. Using hurdle models, moderate activity and high activity had a protective effect on the occurrence of disability (OR (odds ratio)=0.80 and 0.73), but not on severity (i.e. number of limitations). We observed a strong gender-specific difference in this association, with men benefitting more from exercise. ConclusionElevated physical activity reduces the risk of becoming disabled and postpones the onset of disability by several years, but we could not show an effect on the severity of disability. In addition, men seem to benefit more from leisure-time physical activity than women.

Association between self-efficacy and participation in community-dwelling manual wheelchair users aged 50 years or older.

Self-efficacy with using a wheelchair is an emerging construct in the wheelchair-use literature that may have implications for the participation frequency in social and personal roles of wheelchair users. The aim of this study was to investigate the direct and mediated effects of self-efficacy on participation frequency in community-dwelling manual wheelchair users aged 50 years or older. A cross-sectional study was conducted. Participants were community-dwelling wheelchair users (N=124), 50 years of age or older (mean=59.7 years), with at least 6 months of experience with wheelchair use. The Late-Life Disability Instrument, the Wheelchair Use Confidence Scale, the Life-Space Assessment, and the Wheelchair Skills Test-Questionnaire Version measured participation frequency, self-efficacy, life-space mobility, and wheelchair skills, respectively. Multiple regression analyses with bootstrapping were used to investigate the direct and mediated effects. The International Classification of Functioning, Disability and Health was used to guide the analyses. Self-efficacy was a statistically significant determinant of participation frequency and accounted for 17.2% of the participation variance after controlling for age, number of comorbidities, and social support. The total mediating effect by life-space mobility, wheelchair skills, and perceived participation limitations was statistically significant (point estimate=0.14; bootstrapped 95% confidence interval=0.04, 0.24); however, the specific indirect effect by the wheelchair skills variable did not contribute to the total effect above and beyond the other 2 mediators. The mediated model accounted for 55.0% of the participation variance. Causality cannot be established due to the cross-sectional nature of the data, and the self-report nature of our data from a volunteer sample may be influenced by measurement bias or social desirability, or both. Self-efficacy directly and indirectly influences the participation frequency in community-dwelling manual wheelchair users aged 50 years or older. Development of interventions to address low self-efficacy is warranted.

Psychosocial Influences in Onset and Progression of Late Life Disability

Disability in older age has been related to several psychosocial characteristics, including social networks, social engagement, and depression. However, the exact role of these characteristics in the disablement process remains uncertain. Data come from a population-based study of black and white adults aged ≥65 years (N = 5,306), with up to 9 yearly data on the primary outcome measure, activities of daily living (ADL) disability. We use a two-part regression model to simultaneously test the association between each psychosocial characteristic and both onset and progression of ADL disability, while controlling for demographic variables, education, and mode of interview in the first model and health status variables in the second model. Social networks were negatively associated with onset of ADL disability but not associated with progression. The association became non-significant after adjustment for health status. Social engagement was negatively associated with both onset and progression of disability, even after adjustment for health status. Depression was significantly associated with onset of disability after adjustment for health status but not with progression of disability. The results suggest a differential role for psychosocial characteristics in the disablement process, with generally stronger associations for transitions to onset of ADL disability than progression of ADL disability.

Tele-rehabilitation to Promote Exercise in Veterans Post-Stroke: An Observational Pilot Study

Objectives: The objectives of this study were to: 1) explore the feasibility of implementing in-home exercises via a tele-rehabilitation program for Veterans with stroke in Home-Based Primary Care (HBPC) in a single US Department of Veteran’s Affairs Medical Center (VAMC); and 2) assess exercise adherence and progression in Veterans with stroke during the program. Materials and Methods: Study participants completed 3 televideo visits and 5 telephone visits with a physical therapist (PT) over a 3 month period. Participants were instructed in an exercise program and were asked to report adherence with the exercise program and reasons for non-adherence per a standardized questionnaire throughout the program. Televideo visits were conducted using a video link installed on a lap top computer taken to the participant’s home and a desk-top computer at the PT work station. The Late Life Function and Disability Instrument (LLFDI) were used to assess self-report of disability and function at baseline and 3 months. Results: Six male Veterans with a mean age of 61 years enrolled in the study. Four study participants completed the intervention with an average exercise adherence rate of 90%. Self-reported reasons for non-adherence were lack of strength, lack of understanding and lack of needed assistance for the exercises. Increased exercise intensity was demonstrated by all 4 participants. Modest improvements in disability (7%) and function (6%) were reported on the LLFDI. Conclusions: Veterans with stroke were able to actively participate in a tele-rehabilitation program. Study participants reported good exercise adherence and improved disability/function thatwas not statistically significant as well as increased exercise intensity throughout the intervention. Based on these preliminary findings with a small sample, a tele-rehabilitation program aimed at p

Behavioral Adaptation and Late-Life Disability: A New Spectrum for Assessing Public Health Impacts

To inform public health efforts to promote independent functioning among older adults, we have provided new national estimates of late-life disability that explicitly recognize behavioral adaptations. We analyzed the 2011 National Health and Aging Trends Study, a study of Medicare enrollees aged 65 years and older (n = 8077). For 7 mobility and self-care activities we identified 5 hierarchical stages--fully able, successful accommodation with devices, activity reduction, difficulty despite accommodations, and receipt of help--and explored disparities and associations with quality of life measures. Among older adults, 31% were fully able to complete self-care and mobility activities. The remaining groups successfully accommodated with devices (25%), reduced their activities (6%), reported difficulty despite accommodations (18%), or received help (21%). With successive stages, physical and cognitive capacity decreased and symptoms and multimorbidity increased. Successful accommodation was associated with maintaining participation in valued activities and high well-being, but substantial disparities by race, ethnicity, and income existed. Increased public health attention to behavioral adaptations to functional change can promote independence for older adults and may enhance quality of life.