title: Decline in health for older adults: five-year change in 13 key measures of standardized health.
abstract: BACKGROUND
  The health of older adults declines over time, but there are many ways of measuring health. It is unclear whether all health measures decline at the same rate or whether some aspects of health are less sensitive to aging than others.
  
  
  METHODS
  We compared the decline in 13 measures of physical, mental, and functional health from the Cardiovascular Health Study: hospitalization, bed days, cognition, extremity strength, feelings about life as a whole, satisfaction with the purpose of life, self-rated health, depression, digit symbol substitution test, grip strength, activities of daily living, instrumental activities of daily living, and gait speed. Each measure was standardized against self-rated health. We compared the 5-year change to see which of the 13 measures declined the fastest and the slowest.
  
  
  RESULTS
  The 5-year change in standardized health varied from a decline of 12 points (out of 100) for hospitalization to a decline of 17 points for gait speed. In most comparisons, standardized health from hospitalization and bed days declined the least, whereas health measured by activities of daily living, instrumental activities of daily living, and gait speed declined the most. These rankings were independent of age, sex, mortality patterns, and the method of standardization.
  
  
  CONCLUSIONS
  All of the health variables declined, on average, with advancing age, but at significantly different rates. Standardized measures of mental health, cognition, quality of life, and hospital utilization did not decline as fast as gait speed, activities of daily living, and instrumental activities of daily living. Public health interventions to address problems with gait speed, activities of daily living, and instrumental activities of daily living may help older adults to remain healthier in all dimensions.
authors.affiliation: Department of Biostatistics, University of Washington, 1959 NE Pacific Ave, Seattle, WA 98195, USA. pdiehr@uw.edu
authors.forename: Paula H
authors.initials: PH
authors.lastname: Diehr
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Thielke
authors.forename: Anne B
authors.initials: AB
authors.lastname: Newman
authors.forename: Calvin
authors.initials: C
authors.lastname: Hirsch
authors.forename: Russell
authors.initials: R
authors.lastname: Tracy
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000375:Aging / Q000502:physiology* / Q000523:psychology*; D015331:Cohort Studies; D005260:Female; D005684:Gait / Q000502:physiology; D006304:Health Status; D006305:Health Status Indicators; D006760:Hospitalization / Q000639:trends; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008603:Mental Health / Q000639:trends; D011788:Quality of Life; D057566:Self Report; D014481:United States
keywords: ADL; Aging; Cognition; Gait.; IADL