Multimorbidity Patterns and the Disablement Process among Public Long-Term Care Insurance Claimants in the City of Yiwu (Zhejiang Province, China)

This study aimed to identify multimorbidity patterns and explore the disablement process by utilizing the model raised by Verbrugge and Jette as a theoretical framework. This cross-sectional study used public Long-term Care Insurance (LTCI) claimants’ assessment data of Yiwu city in Zhejiang Province, China, for 2604 individuals aged 60 years and older, from September through December 2018. Latent Class Analysis (LCA) was conducted using 10 common chronic conditions. Structural Equation Modeling was used to examine the disablement process. The latent classes of multimorbidity patterns were the “coronary atherosclerotic heart disease” class (19.0%), the “lower limb fractures” class (26.4%), and the “other diseases” class (54.6%). The structural model results show that coronary atherosclerotic heart disease had a significant influence on incontinence, but it was not statistically significant in predicting vision impairment and mobility impairment. Lower limb fractures had significant effects on vision impairment, incontinence, and mobility impairment. Vision impairment, incontinence, and mobility impairment had significant effects on physical activities of daily living (ADLs). Our findings suggest that different impairments exist from specific patterns of multimorbidity to physical ADL disability, which may provide insights for researchers and policy makers to develop tailored care and provide support for physically disabled older people.

Minority Stress in the Context of the Disablement Process Model

The changing demographics and growing diversity in the United States pose significant challenges for researchers, particularly scholarship involving sexual minority adults’ health and aging processes. Not much is known about how all minority stressors could lead to a disability. Sexual minority adults are at a greater risk of developing a disability later in life than their heterosexual counterparts (Fredriksen-Goldsen, Kim, & Barkan, 2012). Drawing from critical components of the disablement process model (Verbrugge & Jette, 1994), this dissertation sought to understand the relationship between minority stress and disability status among sexual minority adults 50 years and older. Minority stress in the context of the disablement process model is a social condition. While exploring the relationship between minority stress and disability status, intra-individual factors and extra-individual factors were assessed to see if they mediated the relationship between minority stress and disability status among sexual minorities 50 years and older. Discrimination is significantly associated with having a disability. None of the intra-individual factors and extra-individual factors mediated the relationship between minority stress and disability; however, several intra- and extra-individual were associated with greater or lesser odds of experiencing a disability. This dissertation concluded that discrimination is associated with disability status among sexual minority adults 50 years and older. On the other hand, the disablement process model does not support minority stress as a social condition leading to a disability. On the other hand, this dissertation's results support the ideology that experiencing discrimination is associated with a disability.

Fitness Staff’s Perceptions of Offering the 3-Step Workout for Life Program in Senior Living Communities

As the population of elderly adults continues to rise, a greater strain will be placed on the healthcare system. Functional exercise programs, such as the 3-Step Workout for Life, have been shown to improve activities of daily living and delay the disablement process. However, the majority of senior living communities do not utilize functional exercise in their fitness programming. This research study aimed to understand the perceptions that fitness staff working at senior living communities have towards the 3-Step Workout for Life program in order to determine the program’s acceptability, feasibility, and appeal. Individual semi-structured interviews were conducted with five fitness personnel. Participants were recruited from independent living communities. Interviews were audio-recorded and transcribed. Using NVivo 12, data was analyzed using thematic analysis techniques to identify common themes. The participants’ perceptions touch on four key themes: 1) revision of screening process; 2) group resistance band exercise would be feasible after minor adaptation; 3) individualized one-on-one ADL exercise is not currently feasible for staff or residents; 4) program addresses a gap in senior fitness. The results of this study provided insight into the feasibility of this program and helped direct modifications needed to enable successful integration.

Effects of social network diversity in the disablement process: a comparison of causal inference methods and an outcome-wide approach to the Indonesian Family Life Surveys, 2007–2015

Background Social networks (SN) have been proven to be instrumental for healthy aging and function as important safety nets, particular for older adults in low and middle-income countries (LMICs). Despite the importance of interpreting health outcomes in terms of SN, in many LMICs – including Indonesia – epidemiological studies and policy responses on the health effects of SN for aging populations are still uncommon. Using outcome-wide multi-method approaches to longitudinal panel data, this study aims to outline more clearly the role of SN diversity in the aging process in Indonesia. We explore whether and to what degree there is an association of SN diversity with adult health outcomes and investigate potential gender differences, heterogeneous treatment effects, and effect gradients along disablement processes. Methods Data came from the fourth and fifth waves of the Indonesian Family Life Survey fielded in 2007–08 and 2014–15. The analytic sample consisted of 3060 adults aged 50+ years. The primary exposure variable was the diversity of respondents’ SN at baseline. This was measured through a social network index (SNI), conjoining information about household size together with a range of social ties with whom respondents had active contact across six different types of role relationships. Guided by the disablement process model, a battery of 19 outcomes (8 pathologies, 5 impairments, 4 functional limitations, 2 disabilities) were included into analyses. Evidence for causal effects of SN diversity on health was evaluated using outcome-wide multivariable regression adjustment (RA), propensity score matching (PSM), and instrumental variable (IV) analyses. Results At baseline, 60% of respondents had a low SNI. Results from the RA and PSM models showed greatest concordance and that among women a diverse SN was positively associated with pulmonary outcomes and upper and lower body functions. Both men and women with a high SNI reported less limitations in performing activities of daily living (ADL) and instrumental ADL (IADL) tasks. A high SNI was negatively associated with C-reactive protein levels in women. The IV analyses yielded positive associations with cognitive functions for both men and women. Conclusions Diverse SN confer a wide range of strong and heterogeneous long-term health effects, particularly for older women. In settings with limited formal welfare protection, intervening in the SN of older adults and safeguarding their access to diverse networks can be an investment in population health, with manifold implications for health and public policy.

The disability process: is there a place for frailty?

Background frailty and disability are very common in older adults; they share some risk factors and pathophysiological mechanisms. Yet, they are different clinical entities. Objectives this study aimed to explore a potential hierarchical relationship between frailty and disability along the continuum of the disablement process. Design prospective cohort study. Setting the French Three-City (3C) study. Subjects the sample included 943 participants aged 75 and older. Methods the Fried frailty phenotype, Instrumental Activities of Daily Living (IADL) and basic Activities of Daily Living (ADL) were used. We distinguished between four mutually excluding groups: (i) robust (no frailty and no disability); (ii) pure frailty (no disability); (iii) frailty with IADL disability (no ADL disability) and (iv) frailty with IADL and ADL disabilities. We used Cox’s regression models to study the 4-year mortality risk associated with each status. Results Eight-two per cent of participants were classified according to the assumed hierarchy: 61.3% was robust, 5.4% frail, 10.5% frail and IADL-disabled and 4.8% frail, IADL and ADL-disabled. An extra group of 17% was identified with IADL-disabled individuals without frailty. This extra group was similar to pure frailty in terms of characteristics and risk of death, placing them along the continuum at an intermediate stage between robustness and the two most disabled sub-groups. Conclusions our findings suggest that including frailty along the continuum could be relevant to describe the whole disablement process. Frailty would occur upstream of the process and might be relevant to identify an opportune time window, where specific monitoring and clinical interventions could be implemented in order to interrupt the process at a potentially more reversible stage.

Operationalizing the Disablement Process for Research on Older Adults: A Critical Review

ABSTRACTSelf-care disability is difficulty with or dependence on others to perform activities of daily living, such as eating and dressing. Disablement is worsening self-care disability measured over time. The disablement process model (DPM) is often used to conceptualize gerontology research on self-care disability and disablement; however, no summary of variables that align with person-level DPM constructs exists. This review summarizes the results of 88 studies to identify the nature and role of variables associated with disability and disablement in older adults according to the person-level constructs (e.g., demographic characteristics, chronic pathologies) in the DPM. It also examines the evidence for cross-sectional applications of the DPM and identifies common limitations in extant literature to address in future research. Researchers can apply these results to guide theory-driven disability and disablement research using routinely collected health data from older adults.