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Keywords:

  • activities of daily living;
  • staging;
  • mortality;
  • risk factors

Objectives

To examine the independent association between five stages of activities of daily living (ADLs) and mortality after accounting for known diagnostic and sociodemographic risk factors.

Design

For five stages of ADLs (0 to IV), determined according to the severity and pattern of ADL limitations, unadjusted life expectancies and adjusted associations with mortality were estimated using a Cox proportional hazards regression model.

Setting

Community.

Participants

Nine thousand four hundred forty-seven participants aged 70 and older from the second Longitudinal Study of Aging.

Measurements

One-, 5-, and 10-year survival and time to death.

Results

Median life expectancy was 10.6 years for participants with no ADL limitations and 6.5, 5.1, 3.8, and 1.6 years for those at ADL stages I, II, III, and IV, respectively. The sociodemographic- and diagnostic-adjusted hazard of death at 1 year was five times as great at stage IV as at stage 0 (hazard ratio = 5.6, 95% confidence interval = 3.8–8.3). The associations between ADL stage and mortality declined over time but remained statistically significant at 5 and 10 years.

Conclusion

ADL stage continued to explain mortality risk after adjusting for known risk factors including advanced age, stroke, and cancer. ADL stages might aid clinical care planning and policy as a powerful prognostic indicator particularly of short-term mortality, improving on current ADL measures by profiling activity limitations of relevance to determining community support needs.