title: Longitudinal Predictors of Functional Impairment in Older Adults in Europe--Evidence from the Survey of Health, Ageing and Retirement in Europe.
abstract: OBJECTIVE
  To examine time-dependent predictors of functional impairment in older adults in Europe longitudinally.
  
  
  METHODS
  Data were derived from the Survey of Health Ageing, and Retirement in Europe (2004-2013). Functional impairment was assessed by using activities of daily living (ADL) and instrumental activities of daily living (IADL) indices. Fixed effects regressions were used to estimate the effects of sociodemographic factors (age, marital status, living situation, and income deciles (median split)), lifestyle factors (smoking status and alcohol consumption per week), depression, cognitive function and chronic diseases on the outcome variables.
  
  
  RESULTS
  Longitudinal regressions revealed that functional impairment increased significantly with age, the occurrence of depression, cognitive impairment, the number of chronic conditions, and less than daily alcohol consumption in the total sample and in both sexes. Moreover, the onset of smoking and living without a spouse/partner in household increased functional impairment in the total sample. The effect of depression on functional impairment was significantly more pronounced in men.
  
  
  CONCLUSIONS
  Our findings highlight the relevance of changes in age, depression, cognitive function, smoking and chronic diseases for functional impairment. Since particularly depression and smoking may be avoidable, developing strategies to prevent depression or stop smoking might be useful approaches to postpone functional impairment in older adults.
authors.affiliation: Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: André
authors.initials: A
authors.lastname: Hajek
authors.affiliation: Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Hans-Helmut
authors.initials: HH
authors.lastname: König
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D002908:Chronic Disease / Q000453:epidemiology; D003072:Cognition Disorders / Q000453:epidemiology*; D003866:Depressive Disorder / Q000453:epidemiology*; D005060:Europe / Q000453:epidemiology; D015577:Geriatric Assessment / Q000379:methods*; D006306:Health Surveys / Q000379:methods*; D006801:Humans; D017567:Karnofsky Performance Status; D008019:Life Style; D008137:Longitudinal Studies; D008875:Middle Aged; D012179:Retirement / Q000706:statistics & numerical data; D018570:Risk Assessment / Q000379:methods