Participants in the Women's Health and Aging Study (WHAS) represent the one-third most disabled older women living in the community. This chapter presents the basic demographic characteristics of this population and further characterizes their functional status and disability, including physical and cognitive functioning. The items on physical functioning were drawn from a number of sources. Questions about activities of daily living (ADLs) are based on a modified version of the Activities of Daily Living Scale (Katz et al., 1963). The questions on instrumental activities of daily living (IADLs) are adapted from the work of Lawton and Brody (1969). Questions on mobility (walking specific distances, walking up or down stairs) and ability to perform heavy housework are adapted from the Rosow and Breslau scale (1966). The question on lifting or carrying 10 pounds is from the physical function scale developed by Nagi (1976). For each of 20 tasks, the percent of the study population reporting any difficulty as well as the level of difficulty reported is presented. Even though all women in the study are disabled, there is great diversity in the type and amount of functional limitation.
Table 2.1 shows the demographic characteristics of older disabled women and the relationship of disability status and age. These weighted data indicate that 15 percent of the disabled population in the geographic target area for this study was age 85 years and older. Table 1.4, which contains unweighted data, shows that 30 percent of the actual study participants were in this age group. For other demographic data presented in Table 2.1, there are minimal differences from the unweighted data in Table 1.4. Twenty-eight percent of women were Black and 71 percent were White. Racial composition, however, varied by age group, with the proportion of African American women decreasing with increasing age. There was a wide spectrum of both educational attainment and household income levels among these disabled women. For example, at the two extremes, almost 41 percent had less than a ninth-grade education and 18 percent had more than a high school education. Thirty-four percent of the total study population reported incomes under $8,000 per year, 23 percent incomes from $8,000 to 14,999, and 30 percent incomes of $15,000 or greater; 13 percent did not know their incomes or refused to report them. The oldest women and those receiving help with ADLs were more likely than others not to provide income information. Notably, the group who received help with ADLs had the highest proportion of women with incomes below $6,000.
A high proportion of women in the study were widowed, particularly among the oldest group. At the time of the study only 25 percent were married, and this number decreased dramatically with age, from 34 percent of those age 65 to 74 years to 6 percent of those age 85 years and older (Table 2.1 ).
Severity of disability and age were strongly associated. The oldest old had the highest proportion with any ADL difficulty and the highest proportion who received help with ADLs. Seventy-five percent of the oldest women reported any ADL difficulty, and 22 percent received help, while only 25 percent of women age 85 years and older had moderate disability. In contrast, among those age 65 to 74 years, 61 percent had any ADL difficulties and 15 percent received help, while 39 percent of this age group had moderate disability (Table 2.1).
Study participants also showed diversity in terms of the combinations of disability present. For example, Figure 2.1 shows that in these disabled older women living in the community nearly 40 percent reported difficulty in two domains, 28 percent in three domains, and the remaining one-third in four domains of functioning. Figure 2.1 also shows that the distribution of severity of disability varied by age group. More than 40 percent of women age 65 to 74 years reported difficulty in only two domains, while nearly 50 percent of those age 85 years and older were disabled in four domains. Not surprisingly, high proportions of women reported difficulty with mobility and tasks demanding exercise tolerance (Table 2.2). For example, 83 percent reported difficulty stooping, crouching, or kneeling, and 74 percent reported difficulty walking for a quarter of a mile. Substantial proportions, 38 and 26 percent, respectively, were completely unable to do these activities. More than half of the women reported difficulty climbing up 10 steps without resting and one-fourth reported difficulty walking across a small room.
Across several mobility-related tasks, the prevalence of women reporting difficulty tended to increase modestly with increasing age, while inability to perform the task tended to increase more dramatically. However, there was greater variation by age on some tasks, such as walking across a small room, than on others. Overall, variation in difficulty with specific tasks appeared to be greater by disability level than by age. For example, of those who reported receiving help with ADLs, 60 percent had difficulty walking across a small room, and 27 percent were unable to do this very basic task. For those with moderate disability, 7 percent reported difficulty and 0.1 percent were unable to perform the task.
Ninety percent of the women with mobility problems had difficulty in two or more tasks in this domain (Figure 2.2). In contrast, a high proportion of those with difficulty in upper extremity tasks, IADLs, or self-care had difficulty in only one task out of the four to six assessed. Less than 15 percent of the study population had difficulty in more than two self-care tasks.
Although these women reside in the community, they had a high frequency of difficulty with many critical aspects of functioning. Table 2.3 shows upper extremity-related functioning. About 66 percent of the study population reported difficulty lifting or carrying a 10-pound bag of groceries and almost 12 percent had difficulty turning a key in a lock. There were few differences by age. Variations in reporting difficulty did occur by disability level, however. Women with ADL difficulty who received help were more likely than those less disabled to have difficulty with upper extremity tasks. Over 40 percent said they were unable to lift 10 pounds and 20 percent said they could not turn a key in a lock.
Table 2.4 shows the prevalence of difficulty in IADLs in this disabled population. These tasks are viewed as important components of routine daily life (Lawton and Brody, 1969). Age appears to be an important correlate of difficulty for many of these tasks and activities. Sixty-five percent of women age 85 years and older had difficulty shopping for personal items, and half were unable to shop for themselves. One-fourth of the oldest women had difficulty preparing their own meals, and 18 percent could not do this. Overall, of those who reported difficulty, a higher percentage were unable to perform these IADL tasks than was the case for tasks in other areas of functioning. For example, 41 percent of the total population reported difficulty shopping; two-thirds of these were unable to shop for themselves. Similarly, half of those with difficulty managing money reported being unable to do it, and over half of those with difficulty preparing meals said they could not prepare them.
Finally, Table 2.5 illustrates the severity of disability found within the subset of this disabled population with difficulty in ADLs. Inability to do ADLs was relatively rare (under 5 percent), with the exception of bathing or showering (12 percent). A slight to moderate age-gradient in prevalence of difficulty was apparent. The association with severity of disability was much more pronounced, however. For example, prevalence of difficulty with bathing or showering rose from 62 percent for those with ADL difficulty but receiving no help to 91 percent of those receiving help with ADLs. Prevalence of difficulty dressing, using the toilet, and eating was twofold higher in those receiving help with ADLs compared with those who had difficulty but received no help.
The data in Table 2.2 through 2.5 present the frequency of difficulty in specific tasks among the one-third most disabled older women living in the community. Figures 2.1 and 2.2 provide some insight into diversity of functional status among these women. This includes difficulty with functioning in multiple domains, as well as in varying numbers of tasks within a domain. As demonstrated in Chapter 1, the population of disabled women clearly reported poorer functioning than an age-comparable cross section of elderly women. Yet even among this population of moderately to severely disabled women, there is a broad spectrum of difficulty and dependency in a wide variety of tasks.
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Rosow I, Breslau N. (1966). A Guttman health scale for the aged. J Gerontol 21: 556-559.