Background Understanding the hierarchy of functional impairment in older adults has helped illuminate mechanisms of impairment and inform interventions, but little is known about whether hierarchies vary by age. We compared the pattern of new-onset impairments in activities of daily living (ADLs) and instrumental ADLs (IADLs) from middle age through older age. Methods We conducted a cohort study using nationally representative data from 32 486 individuals enrolled in the Health and Retirement Study. The outcomes were new-onset impairment in each ADL and IADL, defined as self-reported difficulty performing each task, assessed yearly for 9 years. We used multistate models and competing risks survival analysis to estimate the cumulative incidence of impairment in each task by age group (ages 50–64, 65–74, 75–84, and 85 or older). Results The pattern of incident ADL impairments differed by age group. Among individuals ages 50–64 and 65–74 who were independent at baseline, over 9 years’ follow-up, difficulties dressing and transferring were the most common impairments to develop. In individuals ages 75–84 and 85 or older who were independent at baseline, difficulties bathing, dressing, and walking were most common. For IADLs, the pattern of impairments was similar across age groups; difficulty shopping was most common followed by difficulty managing money and preparing meals. Complementary analyses demonstrated a similar pattern. Conclusions These findings suggest that the hierarchy of ADL impairment differs by age. These findings have implications for the development of age-specific interventions to prevent or delay functional impairment.

中文翻译：

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从中年到老年的功能障碍等级变化

背景 了解老年人功能障碍的等级有助于阐明障碍机制并为干预措施提供信息，但对于等级是否因年龄而异，我们知之甚少。我们比较了从中年到老年的日常生活活动 (ADLs) 和工具性 ADLs (IADLs) 新发障碍的模式。方法 我们使用来自参加健康和退休研究的 32 486 名个人的具有全国代表性的数据进行了一项队列研究。结果是每个 ADL 和 IADL 的新发损伤，定义为自我报告的执行每项任务的困难，每年评估一次，为期 9 年。我们使用多状态模型和竞争风险生存分析来按年龄组（50-64 岁、65-74 岁、75-84 岁和 85 岁或以上）估计每项任务中损伤的累积发生率。结果 事件 ADL 损伤的模式因年龄组而异。在基线时独立的 50-64 岁和 65-74 岁的个体中，超过 9 年的随访，穿衣和转移困难是最常见的障碍。在基线时独立的 75-84 岁和 85 岁或以上的个体中，洗澡、穿衣和行走困难最为常见。对于 IADL，不同年龄组的损伤模式相似；购物困难最常见，其次是理财和做饭困难。补充分析显示了类似的模式。结论 这些发现表明，ADL 损伤的等级因年龄而异。这些发现对开发针对特定年龄的干预措施以预防或延缓功能障碍具有重要意义。