Third, our findings indicate that older women incur disability at earlier ages and
experience higher incidence rates of impairment with longer retention rates of impairment, but
have lower mortality rates than older men. Women aged 70 through 84 years without baseline
impairments averaged 1.2 years of impaired living (with disabilities in one or more activities of
daily living) over the 6 years after baseline, compared with 1.0 years for older men. Women
aged 85 years or older without baseline impair ments averaged 1.7 years of impaired living
over the follow-up period, compared with 1.5 years for the oldest old men. Although these
differential rates are partly due to the longer lifespan of women, this finding has
important impli cations for risk of needing/using long term care services.
Our study of disability is limited by
the use of self-reported vs observed disability. These self-reports may reflect morbidity and
cognition as they relate to disability. Also, disability for a specific activity in this study
is defined as difficulty performing that function. It is possible that more restrictive
definitions of disability could yield other incidence orders.
To summarize, these findings support a hierarchical pattern of disability in activities of daily
living based on incidence of disabilities over time, and they suggest possible gender differences
in incidence of disability. The longitudinal pattern of disability provides insight into the
natural history of the progression of disability and has important public health implications.
Knowledge of a pattern of progression aids in the identification of older people at high risk of
disability, which is important for targeting interventions aimed at maintaining independence
among older American men and women. In addition, the prediction of disability progression is
important for forecasting public and private lifetime costs required
to support disabled elderly persons. D