As proposed by several investigators, a substantial decrease in disability among older persons might be achieved by identifying, and then focusing preventive efforts at, modifiable impairments that have been shown to adversely effect a range of geriatric disability-related outcomes. The necessary first step is to identify such impairments. The primary aim of this project is, therefore, to determine whether impairments in four potentially modifiable domains, namely affect , sensory (vision and hearing), upper extremity ability, and lower extremity ability are associated with decline in mobility and social/productive activities and with the onset of falls, incontinence, and disability in self-care ADLs among three cohorts of community-living older persons over three years. The secondary aim is to determine if the relationship between these four impairment domains and the outcomes is modified by cognitive status and/or social supports. The three cohorts include: 1) Project Safety, a probability sample of 1,103 persons greater than or equal to 72 years of age; 2) MacArthur, a sample of 1,189 """"""""above average"""""""" persons aged 70-90 at initiation; and 3) PEP-a stratified random sample of 750 members of a large general group practice. Baseline data available on the three cohorts include: 1) measures of the four targeted impairments: depressive symptoms, sensory (vision + hearing), upper extremity ability, and lower extremity ability; 2) potential modifying variables-cognitive status, emotional and instrumental social support; and 3) other covariates-demographic, psychosocial, and health variables. Outcomes ascertained over three years of follow-up include: 1) decline in mobility; 2) decline in social-productive activities; 3) onset of self-care disability; 4) occurrence of more than two falls; and 5) onset of weekly incontinence. Analyses will be structured to determine whether the targeted impairments are independently and additively related to the outcomes, and whether the relationships between the targeted impairments and the outcomes are modified by cognitive status or social supports. The goal is to determine whether there exists the epidemiologic evidence to suggest that these four, potentially modifiable, impairments should serve as targets in a shared impairment intervention strategy aimed at reducing the risk of geriatric syndromes and disability.
