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Risk factors for functional status decline in community-living elderly people: a systematic literature review


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  • Stuck, Andreas E.
  • Walthert, Jutta M.
  • Nikolaus, Thorsten
  • Büla, Christophe J.
  • Hohmann, Christoph
  • Beck, John C.
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    To lay the groundwork for devising, improving and implementing strategies to prevent or delay the onset of disability in the elderly, we conducted a systematic literature review of longitudinal studies published between 1985 and 1997 that reported statistical associations between individual base-line risk factors and subsequent functional status in community-living older persons. Functional status decline was defined as disability or physical function limitation. We used MEDLINE, PSYCINFO, SOCA, EMBASE, bibliographies and expert consultation to select the articles, 78 of which met the selection criteria. Risk factors were categorized into 14 domains and coded by two independent abstractors. Based on the methodological quality of the statistical analyses between risk factors and functional outcomes (e.g. control for base-line functional status, control for confounding, attrition rate), the strength of evidence was derived for each risk factor. The association of functional decline with medical findings was also analyzed. The highest strength of evidence for an increased risk in functional status decline was found for (alphabetical order) cognitive impairment, depression, disease burden (comorbidity), increased and decreased body mass index, lower extremity functional limitation, low frequency of social contacts, low level of physical activity, no alcohol use compared to moderate use, poor self-perceived health, smoking and vision impairment. The review revealed that some risk factors (e.g. nutrition, physical environment) have been neglected in past research. This review will help investigators set priorities for future research of the Disablement Process, plan health and social services for elderly persons and develop more cost-effective programs for preventing disability among them.

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    Bibliographic Info

    Article provided by Elsevier in its journal Social Science & Medicine.

    Volume (Year): 48 (1999)
    Issue (Month): 4 (February)
    Pages: 445-469

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    Handle: RePEc:eee:socmed:v:48:y:1999:i:4:p:445-469

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    Keywords: Disablement Disability Functional decline Elderly;


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    Cited by:
    1. Murayama, Hiroshi & Nishi, Mariko & Matsuo, Eri & Nofuji, Yu & Shimizu, Yumiko & Taniguchi, Yu & Fujiwara, Yoshinori & Shinkai, Shoji, 2013. "Do bonding and bridging social capital affect self-rated health, depressive mood and cognitive decline in older Japanese? A prospective cohort study," Social Science & Medicine, Elsevier, vol. 98(C), pages 247-252.
    2. Fogel, Robert W., 2009. "Forecasting the cost of U.S. Health Care in 2040," Journal of Policy Modeling, Elsevier, vol. 31(4), pages 482-488, July.
    3. Obrizan, Maksym, 2011. "Unobserved Factors Linking Functional Decline and Depression Among the Oldest Americans," MPRA Paper 31949, University Library of Munich, Germany.
    4. Kupper, Nicolette M. & Schreurs, Hanneke & ten Klooster, Peter M. & Bode, Christina & van Ameijden, Erik J.C., 2011. "Prevention for elderly people: Demand-oriented or problem-oriented?," Health Policy, Elsevier, vol. 102(1), pages 96-103, September.
    5. Laurie Brown & Binod Nepal & Heather Booth & Sophie Pennec & Kaarin Anstey & Ann Harding, 2011. "Dynamic Modelling of Ageing and Health: The Dynopta Microsimulation Model," NATSEM Working Paper Series 11/14, University of Canberra, National Centre for Social and Economic Modelling.
    6. David M. Cutler & Mary Beth Landrum & Kate A. Stewart, 2006. "How Do the Better Educated Do It? Socioeconomic Status and the Ability to Cope with Underlying Impairment," NBER Working Papers 12040, National Bureau of Economic Research, Inc.
    7. Oliver Schilling & Hans-Werner Wahl & Frank Oswald, 2013. "Change in Life Satisfaction Under Chronic Physical Multi-morbidity in Advanced Old Age: Potential and Limits of Adaptation," Journal of Happiness Studies, Springer, vol. 14(1), pages 19-36, March.
    8. Thomas, Patricia A., 2011. "Gender, social engagement, and limitations in late life," Social Science & Medicine, Elsevier, vol. 73(9), pages 1428-1435.
    9. Anna Matysiak & Daniele Vignoli, 2006. "Fertility and women’s employment: a meta-analysis," MPIDR Working Papers WP-2006-048, Max Planck Institute for Demographic Research, Rostock, Germany.
    10. Brenda Gannon & Kieran Walsh, 2011. "Perceived Neighbourhood Context, Disability Onset and Old Age," Working Papers 1105, Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds.
    11. Davin, Bérengère & Paraponaris, Alain & Verger, Pierre, 2009. "Socioeconomic determinants of the need for personal assistance reported by community-dwelling elderly: Empirical evidence from a French national health survey," Journal of Behavioral and Experimental Economics (formerly The Journal of Socio-Economics), Elsevier, vol. 38(1), pages 138-146, January.
    12. Clarke, Philippa & Ailshire, Jennifer A. & Lantz, Paula, 2009. "Urban built environments and trajectories of mobility disability: Findings from a national sample of community-dwelling American adults (1986-2001)," Social Science & Medicine, Elsevier, vol. 69(6), pages 964-970, September.


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