title: Effect of subclinical status in functional limitation and disability on adverse health outcomes 3 years later.
abstract: BACKGROUND
  This article examines the effect of self-reported, baseline subclinical status (i.e., independent but adaptive performance) for functional limitation and disability on adverse health outcomes.
  
  
  METHODS
  Nine hundred ninety-eight African-American men and women aged 49-65 years received in-home evaluations at baseline, and 853 were re-evaluated 3 years later. Baseline subclinical status was ascertained for five lower body tasks and seven activities of daily living (ADLs)/instrumental ADLs (IADLs). Outcomes included difficulty with lower body limitations, ADLs/IADLs, physical performance, physician visits, hospitalization, nursing home placement, and mortality.
  
  
  RESULTS
  The baseline proportion of subclinical status evidence for the five lower body items was 0.33 (standard deviation [SD] = 0.20), and for the seven ADLs/IADLs was 0.20 (SD = 0.30). Significant independent effects of subclinical status for lower body limitations were observed on physician visits and hospitalization. Significant independent effects of subclinical status for ADLs/IADLs were observed on ADLs/IADLs and physician visits.
  
  
  CONCLUSIONS
  Subclinical status for functional limitation and disability independently predicts several subsequent adverse health outcomes, although the effects of the latter (ADLs/IADLs) are stronger. Interventions to reduce frailty should focus on self-reported subclinical status as an early warning system.
authors.affiliation: Iowa City VAMC, Iowa, USA. fredric-wolinsky@uiowa.edu
authors.forename: Fredric D
authors.initials: FD
authors.lastname: Wolinsky
authors.forename: Douglas K
authors.initials: DK
authors.lastname: Miller
authors.forename: Elena M
authors.initials: EM
authors.lastname: Andresen
authors.forename: Theodore K
authors.initials: TK
authors.lastname: Malmstrom
authors.forename: J Philip
authors.initials: JP
authors.lastname: Miller
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Miller
mesh_terms: D000203:Activities of Daily Living; D000222:Adaptation, Physiological / Q000502:physiology*; D001741:Black or African American; D000368:Aged; D000375:Aging / Q000502:physiology*; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000534:rehabilitation*; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology*; D011379:Prognosis; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D015996:Survival Rate; D013997:Time Factors