Functional Impairment in Middle-Aged Adults

PROJECT SUMMARY/ABSTRACT
The prevalence of functional impairment – defined as having difficulty or needing help to perform one or more
activities of daily living (ADLs) – is increasing among middle-aged adults in the U.S. Of the 80 million
Americans ages 45-64, more than 16% report difficulty performing one or more ADLs, and this percentage has
grown 3 percentage points over the past 15 years. The reasons for worsening functional status in middle age
are not yet fully understood. However, it is part of a larger trend of worsening health in this age group. Since
1990, the prevalence of chronic conditions has increased in middle-aged people, including diabetes, obesity,
cardiovascular disease, and depression. The risk of premature mortality has also increased, particularly among
those with less than a high school education. These findings raise the concern that middle-aged Americans are
experiencing accelerated aging that is causing premature functional impairment. If this is the case, middle-
aged adults with functional impairment could experience persistent functional problems and associated poor
health outcomes, similar to older adults. However, studies showing the growing prevalence of functional
impairment in middle age have serial cross-sectional designs and do not evaluate trajectories of function or
long-term effects on health outcomes. What we need to know is whether functional trajectories are worsening
in middle age, what the risk factors are for adverse trajectories, and which trajectories predict poor health
outcomes later in life. A longitudinal study that observes people from middle age through older age is needed
to address these gaps. The aims of the proposed project are to: (1) examine the trajectories of functional
impairment among middle-aged adults in the U.S.; (2) identify risk and protective factors to explain differences
in functional trajectories; and (3) measure the impact of functional trajectories in middle age on later-life health
and economic outcomes. We will complete these aims using longitudinal nationally representative data from
the NIA-funded Health and Retirement Study linked to rich contextual measures of the physical and social
environment, objective physical performance measures and lab data, and administrative data. This study will
have two impacts: informing prevention of functional impairment in middle age by providing data to support
next-step development and testing of interventions to improve functional outcomes; and informing policy
planning to mitigate the projected burden of functional impairment and associated adverse outcomes.

Grant Number: 5R01AG071730-04
NIH Institute/Center: NIH
Principal Investigator: Rebecca Brown