Search

Background: This study aims to establish the extent of educational differences in the disability transitions of incidence, recovery and mortality in people aged 65 years and over, whether these can be explained by differentials in disease burden and their relative contribution to educational differences in prevalence and disability-free life expectancy (DFLE)., Methods: A stratified random sample of 13 004 participants in five areas in England and Wales were interviewed in 1991-94 and followed up at 2, 6 (one centre only) and 10 years. Two levels of disability were analysed: mobility difficulty and activities of daily living (ADL) disability. We fitted logistic regression models to model educational differences in disability prevalence, incidence, recovery and mortality transitions. DFLE was calculated to assess the combined effect of the dynamic transitions., Results: Those with < or =9 years education had higher ADL and mobility disability prevalence and higher incidence and lower recovery of mobility disability. Differences in disability incidence remained after adjustment for comorbidity. Women with the lowest education had shorter life expectancies (1.7 years less at the age of 65 years) than the most educated and had even shorter DFLE (1.9 years free of ADL disability and 2.8 years free of mobility difficulty at the age of 65 years)., Conclusions: Differentials in education continue to contribute to prevalence of disability at ages beyond 65 years in both men and women and independently of diseases. These appear to be driven predominantly by differentials in disability incidence that also compound to produce greater differentials in DFLE between education groups than in total years lived.

Objective: To determine how older people's economic resources affect their likelihood of care home entry in the United Kingdom., Methods: In 1988, income, home ownership, and health data were collected for 1,425 people aged 75+. Participants received up to five subsequent health assessments before the study endpoint (1999), in which care home entry was also recorded. Care home entry was identified from death certificates for those who died. Using proportional hazards regression, the effect of home ownership and income on the risk of care home entry was estimated, controlling for predisposing, enabling, and need factors, and health service utilization., Results: Age, living alone, activities of daily living restriction, cognitive impairment, poor/fair self-perceived health, and contact with services increased the risk of care home entry. Home ownership decreased it. Gender was not a significant predictor of care home entry once other factors were controlled for, and no significant effect was found for income., Discussion: UK public authorities can require older home owners to use the value of their homes to pay for institutional but not community-based care, thus producing a financial incentive to place home owners in institutional settings. However, we find that home ownership reduces the likelihood of care home entry, suggesting that other factors dominate the decision process.

Background. The consequences of diseases in later life have been judged predominantly through mortality, resulting in an emphasis on the fatal rather than the nonfatal disabling conditions. We use a longitudinal study with follow-up at 2, 6, and 10 years to assess the impact of different diseases on both total life expectancy (TLE) and disability-free life expectancy (DFLE). Methods. The Medical Research Council Cognitive Function and Ageing Study investigators interviewed 13,004 people aged 65 years and older from five U.K. centers starting in 1991. Persons aged 75 years and older were oversampled. Disability (mild, moderate, and severe) was assessed through basic Activities of Daily Living (ADL) and Instrumental ADL (IADL) scales at baseline and at follow-ups at 2, 6, and 10 years. TLE and DFLE were compared for persons with and without each of nine conditions. Results. At age 65, men had a TLE of 15.3 years of which 12.1 (79%) were free of any disability, whereas women of the same age had an average TLE of 19.4 years, 11.0 years (57%) disability-free. Men (women) aged 65 years without stroke had 4.8 (4.6) more years of TLE and 6.5 (5.8) more years DFLE. Without diabetes, men (women) lived 4.4 (5.6) years longer and had 4.1 (5.1) years disability-free. Conclusions. More disability-free years were gained than total life years in persons free of stroke, cognitive impairment, arthritis, and/or visual impairment at baseline. This finding suggests that elimination of these conditions would result in a compression of disability. [ABSTRACT FROM AUTHOR]