title: Unmet Need for ADL Assistance Is Associated With Mortality Among Older Adults With Mild Disability.
abstract: BACKGROUND
  Unmet need for assistance with activities of daily living (ADLs) disability is associated with increased risk for future hospitalization. To further explore the association between unmet ADL need and future health outcomes, we examined the association between unmet need for ADL assistance and 1-year mortality.
  
  
  METHODS
  A prospective study of 6,730 community-living Medicare recipients was conducted among respondents to the 1994, 1999, and/or 2004 National Long Term Care Survey. Only those who reported having one or more ADL disabilities were included. Time to death within 1 year after the community survey was determined from Centers for Medicare and Medicaid Services vital statistics records. The community interviews provided demographic, health, and ADL information.
  
  
  RESULTS
  Unadjusted 1-year death rates were 8.7%, 10.6%, 11.4%, 19.2%, and 27.3%, respectively, for respondents with disabilities in 1, 2, 3, 4, and 5 ADLs. Overall, 21.3% reported unmet need for assistance for one or more ADL disabilities. After controlling for demographic and health characteristics, we found a significant interaction between unmet ADL need and level of ADL disability (p = .018). Post hoc analyses revealed that unmet ADL need was associated with increased risk for mortality only for those with one (hazard ratio = 1.96; 95% CI = 1.29-2.87) or two ADL disabilities (hazard ratio = 1.37; 95% CI = 1.07-1.75), but not for those with three or more ADL disabilities.
  
  
  CONCLUSIONS
  Future studies are needed to determine whether these findings are replicable and, if so, whether physiologic or process of care variables explain why ADL is associated with mortality only for those with mild disability.
authors.affiliation: Department of Statistics, Purdue University, West Lafayette, Indiana.
authors.forename: Shuang
authors.initials: S
authors.lastname: He
authors.affiliation: Department of Statistics, Purdue University, West Lafayette, Indiana.
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Craig
authors.affiliation: School of Medicine, Indiana University, Indianapolis.
authors.forename: Huiping
authors.initials: H
authors.lastname: Xu
authors.affiliation: Division of Geriatrics, University of California at San Francisco, San Francisco Veterans Affairs Medical Center.
authors.forename: Kenneth E
authors.initials: KE
authors.lastname: Covinsky
authors.affiliation: Center for Population Health and Aging, Duke University, Durham, North Carolina.
authors.forename: Eric
authors.initials: E
authors.lastname: Stallard
authors.affiliation: College of Pharmacy, Center on Aging and the Life Course, Regenstrief Center for Healthcare Engineering, Center for Health Outcomes Research and Policy, Purdue University, West Lafayette, Indiana.
authors.forename: Joseph
authors.initials: J
authors.lastname: Thomas
authors.affiliation: Department of Statistics, Purdue University, West Lafayette, Indiana.
authors.forename: Zach
authors.initials: Z
authors.lastname: Hass
authors.affiliation: School of Nursing and Center on Aging and the Life Course, Purdue University, West Lafayette, Indiana. lsands@vt.edu.
authors.forename: Laura P
authors.initials: LP
authors.lastname: Sands
mesh_terms: D000203:Activities of Daily Living; D000369:Aged, 80 and over; D006233:Persons with Disabilities; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D009026:Mortality; D020380:Needs Assessment; D016016:Proportional Hazards Models; D011446:Prospective Studies; D014481:United States / Q000453:epidemiology
keywords: Activities of daily living; Mortality; Unmet need.
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