Effect of Arthritis in Middle Age on Older-Age Functioning

Authors

  • Kenneth E. Covinsky MD, MPH,

    1. From the *Department of Medicine, Division of Geriatrics, #Division of Rheumatology, School of Medicine and **Institute for Health Policy Studies, University of California, San Francisco, CaliforniaSan Francisco Veterans Affairs Medical Center, San Francisco, California§Institute for Healthcare Studies, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IllinoisDepartment of Medicine, School of Medicine, Yale University, New Haven, Connecticut.
    Search for more papers by this author
  • Karla Lindquist MS,

    1. From the *Department of Medicine, Division of Geriatrics, #Division of Rheumatology, School of Medicine and **Institute for Health Policy Studies, University of California, San Francisco, CaliforniaSan Francisco Veterans Affairs Medical Center, San Francisco, California§Institute for Healthcare Studies, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IllinoisDepartment of Medicine, School of Medicine, Yale University, New Haven, Connecticut.
    Search for more papers by this author
  • Dorothy D. Dunlop PhD,

    1. From the *Department of Medicine, Division of Geriatrics, #Division of Rheumatology, School of Medicine and **Institute for Health Policy Studies, University of California, San Francisco, CaliforniaSan Francisco Veterans Affairs Medical Center, San Francisco, California§Institute for Healthcare Studies, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IllinoisDepartment of Medicine, School of Medicine, Yale University, New Haven, Connecticut.
    Search for more papers by this author
  • Thomas M. Gill MD,

    1. From the *Department of Medicine, Division of Geriatrics, #Division of Rheumatology, School of Medicine and **Institute for Health Policy Studies, University of California, San Francisco, CaliforniaSan Francisco Veterans Affairs Medical Center, San Francisco, California§Institute for Healthcare Studies, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IllinoisDepartment of Medicine, School of Medicine, Yale University, New Haven, Connecticut.
    Search for more papers by this author
  • Edward Yelin PhD

    1. From the *Department of Medicine, Division of Geriatrics, #Division of Rheumatology, School of Medicine and **Institute for Health Policy Studies, University of California, San Francisco, CaliforniaSan Francisco Veterans Affairs Medical Center, San Francisco, California§Institute for Healthcare Studies, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IllinoisDepartment of Medicine, School of Medicine, Yale University, New Haven, Connecticut.
    Search for more papers by this author

Address correspondence to Kenneth Covinsky, MD, MPH, University of California, San Francisco, San Francisco VA Medical Center (181G), 4150 Clement, San Francisco, CA 94121. E-mail: ken.covinsky@ucsf.edu

Abstract

OBJECTIVES: To examine whether symptomatic arthritis in middle age predicts the earlier onset of functional difficulties (difficulty with activities of daily living (ADLs) and walking) that are associated with loss of independence in older persons.

DESIGN: Prospective longitudinal study.

SETTING: The Health and Retirement Study, a nationally representative sample of persons aged 50 to 62 at baseline who were followed for 10 years.

PARTICIPANTS: Seven thousand five hundred forty-three subjects with no difficulty in mobility or ADL function at baseline.

MEASUREMENTS: Arthritis was measured at baseline according to self-report. The primary outcome was time to persistent difficulty in one of five ADLs or mobility (walking several blocks or up a flight of stairs). Difficulty with ADLs or mobility was assessed according to subject interview every 2 years. Analyses were adjusted for other comorbid conditions, body mass index, exercise, and demographic characteristics.

RESULTS: Twenty-nine percent of subjects reported arthritis at baseline. Subjects with arthritis were more likely to develop persistent difficulty in mobility or ADL function over 10 years of follow-up (34% vs 18%, adjusted hazard ratio (HR)=1.63, 95% confidence interval (CI)=1.43–1.86). When each component of the primary outcome was assessed separately, arthritis was also associated with persistent difficulty in mobility (30% vs 16%, adjusted HR=1.55, 95% CI=1.41–1.71) and persistent difficulty in ADL function (13% vs 5%, adjusted HR=1.85, 95% CI=1.58–2.16).

CONCLUSION: Middle-aged persons who report a history of arthritis are more likely to develop mobility and ADL difficulties as they enter old age. This finding highlights the need to develop interventions and treatments that take a life-course approach to preventing the disabling effect of arthritis.

Ancillary