1. Improvement and Deterioration in Physical Functioning among Israelis Aged 60 and over Jenny Brodsky, Tal Spalter, Yitschak Shnoor October 17, 2012 Myers-JDC-Brookdale Institute Center for Research on Aging

2. Outline  Background  Study Purpose and Hypothesis  Method of Analysis  Findings  Discussion

3. Physical and Cognitive Function of Older Adults are of Critical Importance IndividualSociety

4. Survival curves of morbidity, disability and mortality Source: WHO 84576

5. The Nagi Disablement Model PathologyImpairment Functional Limitation Disability

6. The IoM Disability in America Disablement Process is Dynamic- Non-linear IOM - Institute of Medicine report Disability in America (Pope and Tarlov 1991)

7. International Classification of Functioning, Disability and Health Health Condition (disorder or disease) Body Function and Structures Activities Environmental Factors Personal Factors Participation WHO, 2001

8. Study Objectives  To examine the changes in physical functioning of older adults between two periods of time  To examine what variables predict the changes in function

9. Hypothesis Together with patterns of functional deterioration, we will also find patterns of improvement Women, the old-old, minorities (Arabs), and those with low income and low education, are at higher risk of functional deterioration Older adults suffering from multi-pathology, as well as individuals with cognitive and mental problems, are at higher risk of functional deterioration

10. Study Population  Individuals who were 60 and over in the first round of SHARE- Israel (2005-2006); they were 65 and over in the second round of SHARE- Israel (2009-2010)  N=982

11. Dependent Variables  Changes in mobility (walking 100 meters, sitting for two hours, getting up from a chair, climbing several floors or one floor without resting)  Changes in basic functions (pulling or pushing large objects; stooping, crouching, or kneeling; reaching or extending arms above shoulder level; handling small objects; carrying 5kg)  Changes in ADL (washing, dressing, eating, toileting, crossing a room, getting in and out of bed)  Changes in IADL (preparing a hot meal, buying groceries, using the telephone, taking drugs, financial management)

12. Dependent Variables cont. Scales were built in the two rounds of SHARE by summing up items Changes were calculated by taking round two minus round one

13. Independent Variables  Socio-demographic status (age, gender, living arrangements, education, income, population group)  Function and health (function in the first wave, No. of illnesses, change in the No. of illnesses between waves, mental health, cognitive function)  Social Activities (volunteering, participating in social, religious, political and educational activities)  Receipt of formal support (personal care and homemaking)  Receipt of informal support

14. Changes in Functioning 1 N=982 (%) ImprovementNo change Deterioration Mobility**21.745.333.0 Basic** functions 21.646.132.3 ADL**6.378.715.0 IADL**7.862.829.4 **p<0.01 1 The changes between rounds are significant by t-test for paired samples

15. Linear Regression to Predict Changes in Functioning: N=982 Change in IADL 1 Change in ADL 1 Change in basic functions 1 Change in mobility 1 Variable 0.017** 0.093** 0.164** 0.184**First Step )R 2) ) 0.54** 0.56** 0.75** 0.72**Functional status wave 1 0.150** 0.091** 0.073** 0.079**Second Step (ΔR 2 ) 0.15-** 0.06-0.1-** 0.08-*Age (men compared women) 0.03 0.02- 0.00- Gender 0.07 0.00- 0.03 0.05No. of years of school 0.06 0.05 0.02 0.01Income 0.10* 0.00 0.13** 0.07* 0.11** 0.01 (compared to Arab) 0.07 0.04 Population group Veteran Jews New Immigrants FSU 0.113** 0.094** 0.105** 0.126**Third Step(ΔR 2 ( 0.21-**0.15-** 0.27-** No. of diseases 0.23-** 0.26-**0.33-**Change in No. of diseases 0.12-** 0.08-* 0.1-* 0.03-Mental Health 0.15** 0.11** 0.06 0.07Cognitive Status 0.057** 0.079** 0.049** 0.05**Fourth Step (ΔR 2 ( 0.02 0.04 Activities (compared to living alone)Living Arrangements 0.07- 0.02- 0.16-** 0.07- 0.04- 0.16-** 0.01- 0.08- 0.1-** 0.03 0.05- 0.04- Lives with spouse Lives with spouse + others Lives with others 0.17-** 0.02- 0.19-** 0.01- 0.09-* 0.01- 0.1-** 0.00 Formal -Homemaking Formal - Personal care 0.13-**0.16-** 0.18-**Informal support 0.337** 0.357** 0.391** 0.44**R2R2 *p<0.05, **p<0.01 1 Standardized coefficients-  positive=improvement & negative=deterioration

16. Linear regression – prediction of changes in functioning Socio-demographic variables Higher age predicts deterioration (except ADL) No difference by gender; education and income do not add significantly Being a veteran Jew, compared to being an Arab elder, predicts improvement (except mobility) Health variables Higher No. of diseases predicts deterioration Declined mental health status predicts deterioration (except mobility) Better cognitive status predicts improvement in ADL and IADL

17. Linear regression – prediction of changes in functioning (cont.) Social variables Recreational participation and social learning do not add significantly Living with others that are not the spouse compared to living alone, predicts deterioration Receiving help Receiving formal help with homemaking (but not with personal care) predicts deterioration Receiving informal care predicts deterioration

18. Major Findings and Implications  There is no single pattern of functional deterioration over time among older adults, there is also improvement  Arab older adults are at higher risk of deterioration in physical functioning over time  Physical health indicators, mainly multi- pathology, predict deterioration in functioning (according to the Disablement Model)  Mental and cognitive status predict deterioration in functioning  Receiving informal care and formal help (in homemaking) predict deterioration

19. These findings do not lead to the conclusion that there is no need to help the elderly. However, they imply that many times, instrumental assistance to the elderly, "save the hassle" of doing things by themselves and thus, weakens a potential functional rehabilitation process. Major Findings and Implications (cont.)

20. While Mr. Johns never did make it into the Olympics, he did however get full motion back in his knees Rehabilitation

21. I mprovement and Preservation of Functional Capabilities Professional rehabilitation Training of professional and non- professional staff (i.e., nurses and homecare workers) Training of family caregivers

22. "My goal is to die before there's a technology breakthrough that forces me to live until one hundred and thirty"