title: Disability Stage is an Independent Risk Factor for Mortality in Medicare Beneficiaries Aged 65 Years and Older.
abstract: BACKGROUND
  Stages of activity limitation based on activities of daily living (ADLs) and instrumental activities of daily living (IADLs) have been found to predict mortality in persons aged 70 years and older but have not been examined in Medicare beneficiaries aged 65 years and older using data that are routinely collected.
  
  
  OBJECTIVE
  To examine the association between functional stages based on items of ADLs and IADLs with 3-year mortality in Medicare beneficiaries aged 65 years and older, accounting for baseline sociodemographics, health status, smoking, subjective health, and psychological well-being.
  
  
  METHODS
  A cohort study using the Medicare Current Beneficiary Survey (MCBS) and associated health care utilization data.
  
  
  METHODS
  Community administered survey.
  
  
  METHODS
  The study included 9698 Medicare beneficiaries aged 65 years and older who participated in the MCBS in 2005-2007.
  
  
  METHODS
  Death within 3 years of cohort entry.
  
  
  RESULTS
  The overall mortality rate was 3.6 per 100 person years, and 3-year cumulative mortality was 10.3%. Unadjusted 3-year mortality was monotonically associated with both ADL stage and IADL stage. Adjusted 3-year mortality was associated with ADL and IADL stages, except that in some models the hazard ratio for stage III (which includes persons with atypical activity limitation patterns) was numerically lower than that for stage II.
  
  
  CONCLUSIONS
  We found nearly monotonic relationships between ADL and IADL stage and adjusted 3-year mortality. These findings could aid in the development of population health approaches and metrics for evaluating the success of alternative economic, social, or health policies on the longevity of older adults with activity limitations.
authors.affiliation: Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, 803 Blockley Hall, 423 Guardian Dr, Philadelphia, PA 19104-6021.|Center for Pharmacoepidemiology Research and Training, University of Pennsylvania, Philadelphia, PA.
authors.forename: Sean
authors.initials: S
authors.lastname: Hennessy
authors.affiliation: Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Jibby E
authors.initials: JE
authors.lastname: Kurichi
authors.affiliation: Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Pan
authors.affiliation: Geriatric Psychiatry Section of the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.|VISN 4 Mental Illness Research Education and Clinical Center, Philadelphia VA Medical Center, Philadelphia, PA.
authors.forename: Joel E
authors.initials: JE
authors.lastname: Streim
authors.affiliation: Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA.
authors.forename: Hillary R
authors.initials: HR
authors.lastname: Bogner
authors.affiliation: Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Dawei
authors.initials: D
authors.lastname: Xie
authors.affiliation: Department of Physical Medicine and Rehabilitation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Margaret G
authors.initials: MG
authors.lastname: Stineman
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D006233:Persons with Disabilities / Q000534:rehabilitation* / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D051346:Mobility Limitation; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014481:United States / Q000453:epidemiology