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Dynamics of functional impairment in late adulthood


  • Maddox, George L.
  • Clark, Daniel O.
  • Steinhauser, Karen


The inconclusive debate about Fries' theory of "natural death and the compression of morbidity" has diverted attention from two keys issues--the modifiability and related dynamics of functional impairment in late adulthood. Evidence is presented from a large (N = 11,000) panel of adults aged initially 58-63 over the period of a decade which documents substantial modification of functional status. Further, patterned changes in functional status are related to the dynamics of income, historically a major determinant of functional status, and independently to educational attainment. The dynamics of functional status, of income, and of their relationship are explored using discrete time hazard models in an event history analysis incorporating time-varying income and functional status indicators. The importance of income and of education as positive, independent predictors of functional status and patterned changes of functional status is confirmed. The implications of this finding for differentiating distal (e.g. education) and proximate (e.g. income) measures of socioeconomic status and for assessing competing theories of social causation and social selection are discussed.

Suggested Citation

  • Maddox, George L. & Clark, Daniel O. & Steinhauser, Karen, 1994. "Dynamics of functional impairment in late adulthood," Social Science & Medicine, Elsevier, vol. 38(7), pages 925-936, April.
  • Handle: RePEc:eee:socmed:v:38:y:1994:i:7:p:925-936

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    References listed on IDEAS

    1. Halkos, George, 1993. "Economic incentives for optimal sulphur abatement in Europe," MPRA Paper 33705, University Library of Munich, Germany.
    2. Ger Klaassen & David Pearce, 1995. "Introduction," Environmental & Resource Economics, Springer;European Association of Environmental and Resource Economists, vol. 5(2), pages 85-93, March.
    3. Michael Grossman, 1972. "The Demand for Health: A Theoretical and Empirical Investigation," NBER Books, National Bureau of Economic Research, Inc, number gros72-1, January.
    4. Tietenberg, T H, 1990. "Economic Instruments for Environmental Regulation," Oxford Review of Economic Policy, Oxford University Press, vol. 6(1), pages 17-33, Spring.
    5. Halkos, George E., 1993. "Sulphur abatement policy: Implications of cost differentials," Energy Policy, Elsevier, vol. 21(10), pages 1035-1043, October.
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    Cited by:

    1. Duncan Thomas & Elizabeth Frankenberg, 2001. "The Measurement and Interpretation of Health in Social Surveys," Working Papers 01-06, RAND Corporation.
    2. Newbold, K.Bruce & Simone, Dylan, 2015. "Comparing disability amongst immigrants and native-born in Canada," Social Science & Medicine, Elsevier, vol. 145(C), pages 53-62.


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