title: Behavioral adaptation and late-life disability: a new spectrum for assessing public health impacts.
abstract: OBJECTIVE
  To inform public health efforts to promote independent functioning among older adults, we have provided new national estimates of late-life disability that explicitly recognize behavioral adaptations.
  
  
  METHODS
  We analyzed the 2011 National Health and Aging Trends Study, a study of Medicare enrollees aged 65 years and older (n = 8077). For 7 mobility and self-care activities we identified 5 hierarchical stages--fully able, successful accommodation with devices, activity reduction, difficulty despite accommodations, and receipt of help--and explored disparities and associations with quality of life measures.
  
  
  RESULTS
  Among older adults, 31% were fully able to complete self-care and mobility activities. The remaining groups successfully accommodated with devices (25%), reduced their activities (6%), reported difficulty despite accommodations (18%), or received help (21%). With successive stages, physical and cognitive capacity decreased and symptoms and multimorbidity increased. Successful accommodation was associated with maintaining participation in valued activities and high well-being, but substantial disparities by race, ethnicity, and income existed.
  
  
  CONCLUSIONS
  Increased public health attention to behavioral adaptations to functional change can promote independence for older adults and may enhance quality of life.
authors: Vicki A. Freedman is with the Institute for Social Research, University of Michigan, Ann Arbor. Judith D. Kasper is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Brenda C. Spillman is with the Health Policy Center, the Urban Institute, Washington, DC. Emily M. Agree is with the Department of Sociology, Johns Hopkins University. Vincent Mor is with the Department of Health Services, Policy and Practice, Brown University, Providence, RI. Robert B. Wallace is with the Department of Epidemiology, University of Iowa, Iowa City. Douglas A. Wolf is with the Department of Public Administration and International Affairs, Syracuse University, Syracuse, NY.
authors: Vicki A
authors: VA
authors: Freedman
authors: Judith D
authors: JD
authors: Kasper
authors: Brenda C
authors: BC
authors: Spillman
authors: Emily M
authors: EM
authors: Agree
authors: Vincent
authors: V
authors: Mor
authors: Robert B
authors: RB
authors: Wallace
authors: Douglas A
authors: DA
authors: Wolf
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000223:Adaptation, Psychological; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000523:psychology*; D003072:Cognition Disorders / Q000453:epidemiology / Q000523:psychology; D006233:Persons with Disabilities / Q000523:psychology* / Q000706:statistics & numerical data*; D004777:Environment; D005260:Female; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D051346:Mobility Limitation; D011634:Public Health; D012648:Self Care / Q000523:psychology / Q000706:statistics & numerical data; D012656:Self-Help Devices / Q000706:statistics & numerical data; D012737:Sex Factors; D012959:Socioeconomic Factors; D014481:United States