Lower Body Functional Limitations Research Articles

Associations between spousal caregiving and health among older adults in Mexico: A targeted estimation approach.

To evaluate associations between spousal caregiving and mental and physical health among older adults in Mexico. Data come from the Mexican Health & Aging Study, a national population-based study of adults ≥50 years and their spouses (2001-2015). We compared outcomes for spousal caregivers to outcomes for those whose spouses had difficulty with at least one basic or instrumental activity of daily living (I/ADL) but were not providing care; the control group conventionally includes all married respondents regardless of spouse's need for care. We used targeted maximum likelihood estimation to evaluate the associations with past-week depressive symptoms, lower-body functional limitations, and chronic health conditions. At baseline, 846 women and 629 men had a spouse with ≥1 I/ADL. Of these, 60.9% of women and 52.6% of men were spousal caregivers. Spousal caregiving was associated with more past-week depressive symptoms for men (Marginal Risk Difference (RD): 0.27, 95% confidence internal [CI]: 0.03, 0.51) and women (RD: 0.15, 95% CI: 0.07, 0.23). We could not draw conclusions about associations with lower-body functional limitations and chronic health conditions. On average, all respondents whose spouses had caregiving needs had poorer health than the overall sample. We found evidence of an association between spousal caregiving and mental health among older Mexican adults with spouses who had need for care. However, our findings suggest that older adults who are both currently providing or at risk of providing spousal care may need targeted programs and policies to support health and long-term care needs.

NATIVITY AND DISABILITY TRAJECTORIES AMONG TWO COHORTS

Nativity is an important characteristic in the context of disability in older adults, as it may influence attitudes and behaviors that can delay or accelerate the disability process. This study aims to assess trajectories of disability (defined as lower-body functional limitations, limitations in daily and instrumental activities of daily living, and gross mobility) in foreign-born and US-born Mexican Americans between 1993 and 2013. We used eight waves (1993 -2013) from the Hispanic Established Populations for the Epidemiologic Study of the Elderly (HEPESE; N=3050, mean age at baseline=73.6 (±6.8). Disability was assessed using self-reported limitations in activities of daily living (ADL /IADL). Nativity and age-at-migration were collected by self-report. We used linear and quadratic growth curve models to evaluate the trajectory of ADL/IADL disability over a period of 20 years and assessed variations by nativity status while adjusting for potential confounders. Approximately 19% of foreign-born and 17% of US-born reported having at least one ADL, while 51.5% natives and 58.7% of foreign-born had at least one IADL. Our results showed that after controlling for age at baseline, sex, marital status, self-reported health, chronic conditions, and education, foreign-born older adults were less likely to have ADL/IADL disability at baseline, but exhibited a faster rate of increase in disability over time (β =0.31 for ADL, β=0.07 for IADL). Our findings show that foreign-born older adults are accumulating disability at faster compared with their native peers, highlighting the importance of evaluating nativity differences in the health outcomes of Hispanic population at old age.

Having an Adult Child in the United States, Physical Functioning, and Unmet Needs for Care Among Older Mexican Adults.

Migration of adult children may impact the health of aging parents who remain in low- and middle-income countries. Prior studies have uncovered mixed associations between adult child migration status and physical functioning of older parents; none to our knowledge has examined the impact on unmet caregiving needs. Data come from a population-based study of Mexican adults ≥50 years. We used longitudinal targeted maximum likelihood estimation to estimate associations between having an adult child US migrant and lower-body functional limitations, and both needs and unmet needs for assistance with basic or instrumental activities of daily living (ADLs/IADLs) for 11,806 respondents surveyed over an 11-year period. For women, having an adult child US migrant at baseline and 2-year follow-up was associated with fewer lower-body functional limitations [marginal risk difference (RD) = -0.14, 95% confidence interval (CI) = -0.26, -0.01] and ADLs/IADLs (RD = -0.08, 95% CI = -0.16, -0.001) at 2-year follow-up. Having an adult child US migrant at all waves was associated with a higher prevalence of functional limitations at 11-year follow-up (RD = 0.04, 95% CI = 0.01, 0.06). Having an adult child US migrant was associated with a higher prevalence of unmet needs for assistance at 2 (RD = 0.13, 95% CI = 0.04, 0.21) and 11-year follow-up for women (RD = 0.07, 95% CI = -0.02, 0.15) and 11-year follow-up for men (RD = 0.08, 95% CI = 0.00, 0.16). Having an adult child US migrant had mixed associations with physical functioning, but substantial adverse associations with unmet caregiving needs for a cohort of older adults in Mexico.

Childhood Conditions Predict Chronic Diseases and Functional Limitations Among Older Adults: The Case of Indonesia.

Objective: Limited knowledge exists about whether childhood health and socioeconomic status (SES) conditions influence health among older adults in Indonesia. Method: Data from Wave 5 (2014/2015) of the Indonesian Family Life Survey (N = 6,530) was used to examine associations between childhood health and SES and hypertension, lung conditions, diabetes, lower body functional limitations (LBFL), and instrumental activities of daily living limitations (IADL). Results: Poor childhood health was associated with 34% higher odds of hypertension (odds ratio [OR] = 1.34, p < .05), 37% higher odds of diabetes (OR = 1.37, p < .05), and 32% higher odds of lung conditions (OR = 1.32, p < .05). Household overcrowding was associated with 22% higher odds of a LBFL (OR = 1.22, p < .05) and 24% higher odds of an IADL (OR = 1.24, p < .01). Lacking a household toilet was associated with 18% higher odds of a LBFL (OR = 1.18, p < .05). Adjusting for adult SES and current health did not account for these relationships. Discussion: Childhood conditions appear to shape older adult health in Indonesia.

Fruit and Vegetable Intake and Physical Activity as Predictors of Disability Risk Factors in African-American Middle-Aged Individuals.

To investigate fruit and vegetable intake (FVI) and different dimensions of physical activity (PA) as predictors of change in disabilities and other known precursors of progressive disability in a population-based sample of African Americans. Longitudinal investigation of the independent associations of reported FVI and PA with six-year changes in disabilities and other known precursors of progressive disability. Longitudinal study of a population-representative cohort of late middle-aged African Americans. 432 cohort participants with complete information on all measures. Measurements and Analytic Approach: During wave 8 (2008), FVI was measured using 2005 Behavioral Risk Factor Surveillance System questions and PA dimensions using the Yale Physical Activity Survey (YPAS). Disability measures included basic activities of daily living (ADLs) and instrumental ADLs (IADLs); other precursors included measured gait speed, grip strength, and short physical performance battery (SPPB) and reported lower body functional limitations (LBFLs) and FRAIL scale; these were measured at wave 4 (2004) and wave 10 (2010). Residual-change score linear regression was used to identify FVI and PA factors that were independently associated with six-year changes in disability and other precursors. The study cohort was less active than the YPAS-development group. Longitudinally, leisurely walking was independently associated with better ADL, IADL, grip strength, SPPB, LBFL, and frailty outcomes; standing with better IADL and SPPB; intake of vegetables other than carrots, salads, or potatoes with better grip strength and frailty; and fruit juice intake with worse grip strength and frailty. In this relatively inactive cohort, leisurely walking was associated with multiple beneficial outcomes. Benefits were also seen with vegetables other than potato intake, and fruit juice intake was associated with detrimental effects. This study highlights the importance of finding strategies to help this population increase PA (especially leisurely walking) and intake of whole fruits and vegetables.

Effect of street connectivity on incidence of lower-body functional limitations among middle-aged African Americans

PurposeWe hypothesize that lower street connectivity increases the risk of incident lower-body functional limitations (LBFLs) among urban African Americans aged 49–65 years. MethodsThis population-based cohort was interviewed in home visits. Five items measuring LBFL were obtained at baseline and after 3 years. Participants were considered to have LBFL if they reported difficulty on at least two of the five tasks. Census-tract street connectivity was measured as the ratio of the number of street intersections to the maximum possible number of intersections. ResultsOf 563 subjects with zero or one LBFL at baseline, 109 (19.4%) experienced two or more LBFLs at the 3-year follow-up. Adjusted logistic regression showed that persons who lived in census tracts with the lowest quartile of street connectivity were 3.45 times (95% confidence interval, 1.21–9.78) more likely to develop two or more LBFLs than those who lived in census tracts with the highest quartile of street connectivity independent of other important environmental factors. ConclusionsAreas with low street connectivity appear to be an independent contributor to the risk of incident LBFL in middle-aged African Americans.

Uninsured persons with disability confront substantial barriers to health care services

Background Despite social “safety net” programs, many U.S. residents with disabilities lack insurance coverage and thus risk financial barriers to accessing care. The study objectives were to characterize working-age adults with disabilities who lack health insurance and to examine their self-reported barriers to care. Methods The authors conducted analyses of nationally representative Medical Expenditure Panel Survey data from 2000 through 2006. Results During this time period, 14.8% of working-age U.S. residents lacked health insurance, including 11.6% of persons with disabilities. Focusing only on uninsured individuals, persons with disabilities were significantly ( p = .001) more likely than those without disabilities to have a usual source of care. However, on 6 other access measures (those that comprised our composite indicator of access barriers), uninsured persons with disabilities reported barriers significantly ( p = .001) more often than did individuals without disabilities: 36.0% of uninsured persons with disabilities reported being unable to get necessary medical care, compared with 9.5% of uninsured, nondisabled persons; and 26.9% of uninsured persons with disabilities reported being unable to get necessary medications, compared with 5.3% of uninsured individuals without disabilities. Having a cognitive impairment produced the largest adjusted odds ratio (AOR) of reporting any access barrier (1.64, 95% CI 144-1.87), while having lower body functional limitations or hearing deficits also produced relatively high AORs (1.47, 1.32-1.65 and 1.48, 1.11-1.98, respectively). Conclusions Uninsured individuals with disabilities confront significantly more barriers to accessing care than do nondisabled persons without health insurance. Certain types of disabilities appear especially associated with experiencing access barriers, suggesting areas requiring particular attention.

Do early-life conditions predict functional health status in adulthood? The case of Mexico.

Relatively few researchers have investigated early antecedents of adult functional limitations in developing countries. In this study, we assessed associations between childhood conditions and adult lower-body functional limitations (LBFL) as well as the potential mediating role of adult socioeconomic status, smoking, body mass index, and chronic diseases or symptoms. Based on data from the Mexican Health and Aging Study (MHAS) of individuals born prior to 1951 and contacted in 2001 and 2003, we found that childhood nutritional deprivation, serious health problems, and family background predict adult LBFL in Mexico. Adjustment for the potential mediators in adulthood attenuates these associations only to a modest degree.

Testosterone is not associated with mortality in older African-American males

Introduction. Although testosterone and its association with disease progression and mortality is a widely studied topic, no studies have evaluated mortality risks related to testosterone levels in an older African-American population. The mechanisms for known racial differences in mortality risk for certain cancers and cardiovascular risk factors are largely unknown. Elucidating a mortality risk associated with testosterone levels may give insight into the elevated risk for certain diseases in African-Americans.Methods and results. Study data were derived from a cohort 622 African-Americans (age 80.05 ± 6.4, range 68–102) from Saint Louis, Missouri that includes 190 males (age 79.38 ± 6.2, range 70–102). The eligible sample for this report includes 56 of the 190 males (age 78.89 ± 6.9, range 70–102) who donated blood at baseline in 1992–1994 and subsequently tested for total testosterone and bioavailable testosterone. Covariates for adjusted analyses were lower body functional limitations, physician visits and comorbidities, also collected at baseline. Males' mean bioavailable testosterone levels (ng/dl) were 33.33 ± 24.4 (n above 70 ng/dl = 5) and mean total testosterone levels (ng/dl) were 246.63 ± 118.7 (n above 300 ng/dl = 20). Vital status was determined through 2002; 41 males (73%) were deceased and 15 were alive. Mortality did not differ among males with testosterone levels <300 versus 300+ (p = 0.42) or with bioavailable testosterone levels <70 versus > 70 (p = 0.34). Total testosterone levels did not predict mortality when adjusted for age (Adjusted Hazard Ratio [AHR] = 0.998; 95% confidence interval [CI] 0.995–1.001; p = 0.28) or adjusted for age and other covariates (AHR = 0.099; 95% CI 0.996, 1.002; p = 0.35). Bioavailable testosterone levels did not predict mortality when adjusted for age (AHR = 0.992; 95% CI .977–1.007; p = 0.30) or when adjusted for age and other covariates (AHR 0.991; 95% CI .976–1.006; p = 0.261).Conclusion. In older African-American males, total and bioavailable testosterone levels, with and without adjustment for covariates, are not independently associated with mortality risk.

Neighborhood conditions, diabetes, and risk of lower-body functional limitations among middle-aged African Americans: A cohort study

BackgroundThe relationship between presence of diabetes and adverse neighborhood and housing conditions and their effect on functional decline is unclear. We examined the association of adverse neighborhood (block face) and housing conditions with incidence of lower-body functional limitations among persons with and those without diabetes using a prospective population-based cohort study of 563 African Americans 49-65 years of age at their 2000-2001 baseline interviews.MethodsParticipants were randomly sampled African Americans living in the St. Louis area (response rate: 76%). Physician-diagnosed diabetes was self reported at baseline interview. Lower-body functional limitations were self reported based on the Nagi physical performance scale at baseline and the three-year follow-up interviews. The external appearance of the block the respondent lived on and five housing conditions were rated by study interviewers. All analyses were done using propensity score methods to control for confounders.Results109 (19.4%) of subjects experienced incident lower-body functional limitations at three-year follow-up. In adjusted analysis, persons with diabetes who lived on block faces rated as fair-poor on each of the five conditions had higher odds (7.79 [95% confidence interval: 1.36-37.55] to 144.6 [95% confidence interval: 4.45-775.53]) of developing lower-body functional limitations than the referent group of persons without diabetes who lived on block faces rated as good-excellent. At least 80 percent of incident lower-body functional limitations was attributable to the interaction between block face conditions and diabetes status.ConclusionsAdverse neighborhood conditions appear to exacerbate the detrimental effects on lower-body functioning associated with diabetes.

National estimates of racial disparities in health status and behavioral risk factors among long-term cancer survivors and non-cancer controls

We examined racial disparities (White, African American, and other race) in health status (self-rated health, lower-body functional limitations, psychological distress, and body mass index [BMI]) and behaviors (smoking, alcohol use, and physical activity) of long-term cancer survivors (>or=5 years) when compared to non-cancer controls. Using 2005-2007 National Health Interview Survey data, we computed adjusted prevalence estimates of health status and behaviors for all six groups, controlling for sociodemographic factors, medical-care access, or presence of other chronic conditions. The sample included 2,762 (3.6%) survivors and 73,059 controls. Adjusted prevalence estimates for each race were higher for long-term survivors than controls in terms of having fair-poor self-rated health, >or=1 limitation, psychological distress, and higher BMI but were similar between survivors and controls in terms of physical activity, smoking, and alcohol use. Adjusted prevalence estimates for having fair-poor self-rated health were higher for African American survivors than white survivors, lower for psychological distress, physical activity and alcohol use, and similar for smoking and BMI. With the exception of smoking and limitations, racial differences existed among survivors for all health-status and behavioral measures. Clinicians may play a key role in helping to reduce disparities.

Predictors of Change in Grip Strength Over 3 Years in the African American Health Project

To examine factors associated with change in grip strength. Grip strength was measured at baseline and 3 years later. Change was divided into "decreased >/=5 kg," "increased >/=5 kg," and "no change" and analyzed using multinomial multivariable logistic regression. Decline in grip strength was more likely for men, those reporting having cardiovascular disease, and those with instrumental activities of daily living, lower body functional limitations, high diastolic blood pressure, higher physical activity, and greater body mass. Decline was less likely among those ever having Medicaid, those with basic activities of daily living disabilities, and those unable to see a doctor in past year due to cost. Gain in grip strength was more likely for men and those with instrumental activities of daily living disabilities, lower body functional limitations, high diastolic blood pressure, and higher physical activity; it was less likely for older participants. Results can be used to design interventions to improve strength outcomes.

An evaluation of lower‐body functional limitations among long‐term survivors of 11 different types of cancers

The authors examined potential reasons (sociodemographics, psychologic distress, health behavior, chronic health conditions, access to medical care) for increased prevalence of lower-body functional limitations among long-term (> or =5 years) cancer survivors. The authors used National Health Interview Survey data from 2005 through 2007, and defined lower-body functional limitation as reporting difficulty/inability to perform at least 1 of 5 activities (walking approximately one-quarter of a mile; walking up and down 10 steps without rest; standing for 2 hours; stooping, crouching, or kneeling; and lifting 10 lbs). Increased prevalence of lower-body functional limitations was compared between long-term survivors of each of 11 cancer types reported by > or =50 respondents (n = 2143) and persons without cancer history (controls; n = 72,618). Among cancer survivors, 57.0% had a lower-body functional limitation versus 26.6% of controls. The unadjusted prevalence of lower-body functional limitations varied by cancer type, ranging from 44.9% (lymphoma survivors) to 88.8% (lung cancer survivors). Long-term lung (odds ratio [OR], 7.91), uterine (OR, 2.41), thyroid (OR, 2.27), cervical (OR, 1.76), ovarian (OR, 1.75), and breast (OR, 1.35) cancer survivors had increased odds of reporting a lower-body functional limitation than controls after adjusting for sociodemographic factors (all P < .05). Differences in the prevalence of arthritis and lower-back pain and in access to medical care explained differences in lower-body functional limitation prevalence between controls and long-term breast, cervical, ovarian, and uterine cancer survivors. Long-term bladder, colorectal, lymphoma, melanoma, and prostate cancer survivors were equally likely to report a lower-body functional limitation as controls. Treatment of arthritis and lower-back pain and increasing access to medical care might help reduce the risk of lower-body functional limitations and improve quality of life among specific long-term cancer survivors.

Higher C-Reactive Protein and Soluble Tumor Necrosis Factor Receptor Levels Are Associated With Poor Physical Function and Disability: A Cross-Sectional Analysis of a Cohort of Late Middle-Aged African Americans

This cohort of "late middle-aged" African Americans has an excess of disability. We aimed to determine associations of circulating cytokine receptors (sTNFR1, sTNFR2, and sIL-6R) and C-reactive protein (CRP) with disability, physical function, and body composition. Stratified sampling of two socioeconomically diverse strata of St Louis, Missouri, occurred in 2000-2001. Inclusion criteria were self-reported black or African American race, born 1936-1950 inclusive, and Mini-Mental State Examination score of 16 or greater. In-home evaluations of handgrip strength, lean body mass percentage (LBM%), physical performance, upper and lower body functional limitations (UBFLs and LBFLs), and basic and instrumental activities of daily living (BADLs and IADLs) were collected. Of the 998 participants, 368 had blood sampled at baseline. Serum was stored and assayed in 2006. Absolute risks were LBFLs of 2 or more, 46%; UBFLs of 1 or more, 23.5%; BADLs of 2 or more, 20.6%; and IADLs of 2 or more, 22.5%. Independent of age, sex, and underlying comorbid conditions, higher CRP and sTNFR were associated with poorer physical performance (beta = -1.462, p < .001 and beta = -0.618, p = .003), UBFLs (odds ratio [OR] 2.26, 95% confidence interval [CI] 1.1-4.64 and OR 1.39, 95% CI 0.96-2.02), LBFLs (OR 2.30, 95% CI 1.19-4.45 and OR 1.91, 95% CI 1.26-2.91), BADLs (OR 2.79, 95% CI 1.03-5.96 and OR 1.66, 95% CI 1.11-2.46), and IADLs (OR 2.13, 95% CI 1.03-4.41 and OR 1.43, 95% CI 0.99-2.08). Higher CRP (beta = -3.251, p <.001), sIL-6R (beta = -6.152, p = .013), and lower adiponectin (beta = 2.947, p = .052) were associated with lower LBM%. Higher CRP and sTNFR are independently associated with disability and physical dysfunction. Higher sIL-6R, CRP, and lower adiponectin associate with lower LBM%.

Use of the Short Physical Performance Battery Score to Predict Loss of Ability to Walk 400 Meters: Analysis From the InCHIANTI Study

Early detection of mobility limitations remains an important goal for preventing mobility disability. The purpose of this study was to examine the association between the Short Physical Performance Battery (SPPB) and the loss of ability to walk 400 m, an objectively assessed mobility outcome increasingly used in clinical trials. The study sample consisted of 542 adults from the InCHIANTI study aged 65 and older, who completed the 400 m walk at baseline and had evaluations on the SPPB and 400 m walk at baseline and 3-year follow-up. Multiple logistic regression models were used to determine whether SPPB scores predict the loss of ability to walk 400 m at follow-up among persons able to walk 400 m at baseline. The 3-year incidence of failing the 400 m walk was 15.5%. After adjusting for age, sex, education, body mass index, Mini-Mental State Examination, number of medical conditions, and 400 m walk gait speed at baseline, SPPB score was significantly associated with loss of ability to walk 400 m after 3 years. Participants with SPPB scores of 10 or lower at baseline had significantly higher odds of mobility disability at follow-up (odds ratio [OR] = 3.38, 95% confidence interval [CI]: 1.32-8.65) compared with those who scored 12, with a graded response across the range of SPPB scores (OR = 26.93, 95% CI: 7.51-96.50; OR = 7.67, 95% CI: 2.26-26.04; OR = 8.28, 95% CI: 3.32-20.67 for SPPB < or = 7, SPPB 8, and SPPB 9, respectively). The SPPB strongly predicts loss of ability to walk 400 m. Thus, using the SPPB to identify older persons at high risk of lower body functional limitations seems a valid means of recognizing individuals who would benefit most from preventive interventions.

Hospital Episodes and Physician Visits

Health services use typically is examined using either self-reports or administrative data, but the concordance between the 2 is not well established. We evaluated the concordance of hospital and physician utilization data from self-reports and claims data, and identified factors associated with disagreement. We performed a secondary analysis on linked observational and administrative data. A national sample of 4310 respondents who were 70 years old or older at their baseline interviews was used. Self-reported and Medicare claims-based hospital episodes and physician visits for 12 months before baseline were examined. Kappa statistics were used to evaluate concordance, and multivariable multinomial logistic regression was used to identify factors associated with overreporting (self-reports > claims), underreporting (self-reports < claims), and concordant-reporting (self-reports approximately claims). The concordance of hospital episodes was high (kappa = 0.767 for the 2 x 2 comparison of none vs. some and kappa = 0.671 for the 6 x 6 comparison of none, 1, ..., 4, or 5 or more), but concordance for physician visits was low (kappa = 0.255 for the 2 x 2 comparison of none versus some and kappa = 0.351 for the 14 x 14 comparison of none, 1, ..., 12, and 13 or more). Multivariable multinomial logistic regression indicated that over-, under-, and concordant-reporting of hospital episodes was significantly associated with gender, alcohol consumption, arthritis, cancer, heart disease, psychologic problems, lower body functional limitations, self-rated health, and depressive symptoms. Over-, under-, and concordant-reporting of physician visits were significantly associated with age, gender, race, living alone, veteran status, private health insurance, arthritis, cancer, diabetes, hypertension, heart disease, lower body functional limitations, and poor memory. Concordance between self-reported and claims-based hospital episodes was high, but concordance for physician visits was low. Factors significantly associated with bidirectional (over- and underreporting) and unidirectional (over- or underreporting) error patterns were detected. Therefore, caution is advised when drawing conclusions based on just one physician visit data source.

Cross-Sectional and Longitudinal Risk Factors for Falls, Fear of Falling, and Falls Efficacy in a Cohort of Middle-Aged African Americans

The purpose of this study is to cross-sectionally and longitudinally identify risk factors for falls, fear of falling, and falls efficacy in late-middle-aged African Americans. We performed in-home assessments on a probability sample of 998 African Americans and conducted two annual follow-up interviews. Multiple logistic regression modeled the associations with falls (any fall or injurious fall) during 2 years prior to the baseline interview, and baseline fear of falling and falls efficacy with 2-year prospective risks for falling and fear of falling. The most consistent association for all outcomes was depressive symptoms. Age was associated with increased risk of prior and prospective falls. Lower-body functional limitations were associated with prior falls, baseline fear of falling, and low falls efficacy, whereas low ability with one-leg stands prospectively predicted fear of falling. The greatest prospective risk for incident falls was having had a prior fall (odds ratio = 2.51), and the greatest prospective risk for fear of falling was having been afraid of falling at baseline (odds ratio = 8.14). Falls, fear of falling, and low falls efficacy are important issues for late-middle-aged as well as older persons. Interventions should focus on younger adults and attend especially to lower-body function and depressive symptoms as well as building self-efficacy for safe exercise, dealing with falls risks, and managing falls themselves.

Neighborhood Conditions and Risk of Incident Lower-Body Functional Limitations among Middle-aged African Americans

The authors investigated the association between observed neighborhood conditions and lower-body functional limitations (LBFLs) using data from 563 subjects of the African-American Health Study. This population-based cohort received in-home evaluations. Five items involving LBFL were obtained at baseline (2000-2001) and 3 years later. Subjects were considered to have LBFL if they reported difficulty on at least two of the five tasks. The external appearance of the block the respondent lived on was rated during sample enumeration by use of five items (rated excellent, good, fair, or poor). Of 563 subjects with 0-1 LBFL at baseline, 15% and 14% lived in neighborhoods with 4-5 and 2-3 fair/poor conditions, respectively. Logistic regression adjusting for propensity scores showed that persons who lived in neighborhoods with 4-5 versus 0-1 fair/poor condition were 3.07 times (95% confidence interval: 1.58, 5.94) more likely to develop two or more LBFLs. The odds ratio was 2.24 (95% confidence interval: 1.07, 4.70) when living in neighborhoods with 2-3 conditions versus 0-1 fair/poor condition. Odds ratios for individual neighborhood characteristics varied from 3.45 (fair/poor street conditions) to 2.01 (fair/poor noise level). Sensitivity analyses showed the robustness of the findings. Poor neighborhood conditions appear to be an independent contributor to the risk of incident LBFLs in middle-aged African Americans.

114: Neighborhood Conditions and Risk of Incident Lower Body Functional Limitations Among Middle-Aged African Americans

114: Neighborhood Conditions and Risk of Incident Lower Body Functional Limitations Among Middle-Aged African Americans

Functional limitations and religious service attendance in later life: barrier and/or benefit mechanism?

Why do some studies report a negative relationship between religious service attendance and functional limitations? Two possible mechanisms, the health benefit mechanism and the functional barrier mechanism, were systematically examined. With 2 waves of a national probability sample of adults aged 60 years and older, this research used structural equation models to estimate the influence of these 2 mechanisms. Results indicated that functional limitations were associated with less frequent religious service attendance at the same wave, largely because of the barrier mechanism; no support was found for the benefit mechanism. Neither mechanism was significant over time. Findings suggest that there is a temporal and salient decline in social activities such as religious service attendance when lower body functional limitations are highest. However, long-term engagement in religious service attendance is not predicted by baseline functional limitations, indicating that there are not long-term declines in attendance because of higher levels of functional limitations.