Methods and Prevalence of ADL Limitations in Hispanic and Non-Hispanic White Subjects in Rural Colorado

Abstract

PURPOSE: The Hispanic population in the United States is the fastest growing minority group, yet there is little understanding of the disability patterns that occur as this population ages. We conducted a cross-sectional study to define the prevalence of limitations of activities of daily living (ADL) and measures of observed function.

METHODS: We censussed two rural counties in southern Colorado and selected a stratified sample of both Hispanic and non-Hispanic white (NHW) residents; 81.6% completed the protocol.

RESULTS: Among the 1250 subjects aged 65 years and older, Hispanic elderly living in the community had greater ADL disability than NHW subjects, both for any difficulty (p = 0.006), and for needing assistance (p = 0.002). Hispanic persons were less likely to reside in nursing homes (3.4%) compared with NHW persons (9.3%). Hispanic elderly had excess prevalence of dependent ADL tasks (needs assistance or unable to do), (age, gender-adjusted odds ratio = 1.39, 95% CI = 1.01–1.92) in community dwelling and nursing home residents combined. There was no Hispanic excess of less severe difficulty compared with NHW persons, and there was a similar prevalence of limitation on observed functional tasks (timed walk, stooping, rising from a chair) in both groups.

CONCLUSIONS: There was a modest Hispanic excess of reported dependent ADL limitation, and no excess of observed functional difficulties. Hispanics enter older age with much less income and education, yet they do not have a marked excess prevalence of limitations in activities of daily living when compared with NHW persons living in the same area.

Introduction

The Hispanic population in the United States is the fastest growing minority group (1), yet little attention has been paid to understanding disability patterns as this population ages (2). As persons age, the prevalence of functional disability and dependence increases, requiring additional family and health care support (3). Hispanic persons attain older ages with less formal education and lower income levels (4), and they often live in circumstances where the health care system is poorly equipped to deal with chronic debilitating conditions.

The Hispanic population has been considered an “epidemiologic paradox” with socioeconomic conditions favoring selected higher disease rates, yet they have better patterns of infant mortality, cardiovascular disease, and cancer of major sites than non-Hispanic whites (NHWs) 5, 6. Limited data are available on disability and functional limitations among Hispanics. Data from the late 1970s suggests that Hispanic subjects have greater restricted activity days per person per year (46.5 vs. 38.7 for NHWs), and higher bed disability days (20.7 vs. 12.9) (6). Markides and colleagues have recently shown that many chronic conditions (stroke, arthritis, heart attack, hip fracture, etc.) are associated with difficulties performing activities of daily living (ADL) in Hispanic elders (7), similar to majority populations. However, they noted a greater impact from stroke and hip fracture on ADL limitations in their community dwelling Hispanic elders than was reported in the Framingham Disability Study (8). Haan and Weldon recently completed a community-based survey of Hispanic and NHW subjects living in 14 census block groups in Sacramento, California (9). They found somewhat higher mean numbers of ADL limitations among Hispanic women (both English and Spanish speaking) for those with chronic conditions (self-reported diabetes, stroke, and hypertension), but no excesses among Hispanic men. Numbers in the disease subgroups were small, and prevalence of ADL limitations was not reported. These data suggest that the “paradox” may not apply when examining measures of disability in an older population.

There were no available estimates of the prevalence and patterns of ADL limitations and dependency in both a community and institutional setting from population-based studies in Hispanic elderly. Therefore, we designed the San Luis Valley Health and Aging Study (SLVHAS) to fill this void. As one of five studies funded by the National Institute of Aging under RFA AG-91–15 to explore minority health issues, the SLVHAS was the only study set in a rural, biethnic (Hispanic and NHW) population. The goals of the SLVHAS were: 1) to determine the prevalence and two-year incidence of limitation and dependency in ADL and instrumental activities of daily living (IADL) activities in Hispanic and NHW persons over the age of 60 years; 2) to determine the prevalence and impact of cognitive impairment; and 3) to explore risk factors for disability, institutionalization, and medical care use. We report here the methods and prevalence of ADL limitations in this community.