This research will test a causal model of """"""""disablement,""""""""in which impairment (low scores on tests of motor or cognitive performance) and functional limitation (inefficient or unsafe performance of daily tasks) result in disability (recognition of difficulty or need for help in instrumental and basic activities of daily living [IADL/BADL]). We will follow 360 elders recruited from an existing multi-ethnic community-based study, the Washington Heights-Inwood Columbia Aging Project (WHICAP), all of whom will have mild-to-moderate disability and not meet criteria for dementia. They will be assessed 3 times, 18 months apart. Within disability groups (1, 2, or 3 domains based on self-reports), half of the subjects will be cognitively normal and half will have mild cognitive impairment or questionable dementia. We will assess the direct and indirect effects of impairment and functional limitation on disability in groups defined by self-reported disability status and cognitive performance, in different race-ethnic groups (African-American, Hispanic, white), and longitudinally. In addition, we will assess the accuracy of self- and proxy-reports of disability using a clinical diagnosis (established in a clinical consensus conference) as a gold standard, and alternatively through use of latent class models that do not assume a gold standard. An important feature of this research is its use of the assessment of Motor and Process Skills (AMPS) , an occupational assessment tool for rating functional limitation in the activities of daily living. AMPS evaluations yield scores for motor and cognitive/process limitations that interfere with efficient and safe performance of IADL/BADL tasks. OT's will conduct AMPS evaluations in subject homes, along with detailed assessments of physical impairment (as well as measures of home and neighborhood environment). The parent WHICAP study will provide data on cognitive performance and neurologic-medical status. Our major goal is to test a causal (structural equations) model of disablement. We hypothesize that impairment is related to disability directly but also indirectly through observed motor and cognitive/process limitations. We will test whether this indirect effect is stronger for some groups of elders (e.g., mild disabled) than others. This finding would suggest that disability may be reduced through remediation of motor and cognitive/process skills, as well as by efforts to reduce impairment.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Research Project (R01)
Project #
5R01AG018234-02
Application #
6509753
Study Section
Special Emphasis Panel (ZRG1-BBBP-7 (01))
Program Officer
Elias, Jeffrey W
Project Start
2001-03-01
Project End
2006-02-28
Budget Start
2002-03-01
Budget End
2003-02-28
Support Year
2
Fiscal Year
2002
Total Cost
$321,152
Indirect Cost
Name
Columbia University (N.Y.)
Department
Neurology
Type
Schools of Medicine
DUNS #
167204994
City
New York
State
NY
Country
United States
Zip Code
10032
Albert, Steven M; Bear-Lehman, Jane; Anderson, Stewart J (2015) Declines in mobility and changes in performance in the instrumental activities of daily living among mildly disabled community-dwelling older adults. J Gerontol A Biol Sci Med Sci 70:71-7
Albert, Steven M; Bear-Lehman, Jane; Burkhardt, Ann (2012) Mild depressive symptoms, self-reported disability, and slowing across multiple functional domains. Int Psychogeriatr 24:253-60
Albert, Steven M; Bear-Lehman, Jane; Burkhardt, Ann (2009) Lifestyle-adjusted function: variation beyond BADL and IADL competencies. Gerontologist 49:767-77
Albert, Steven M; Musa, Donald; Kwoh, Kent et al. (2008) Defining optimal self-management in osteoarthritis: racial differences in a population-based sample. J Cross Cult Gerontol 23:349-60
Nieto, Maria L; Albert, Steven M; Morrow, Lisa A et al. (2008) Cognitive status and physical function in older african americans. J Am Geriatr Soc 56:2014-9
Albert, Steven M; Musa, Donald; Kwoh, C Kent et al. (2008) Self-care and professionally guided care in osteoarthritis: racial differences in a population-based sample. J Aging Health 20:198-216
Spencer, S Melinda; Albert, Steven M; Bear-Lehman, Jane et al. (2008) Relevance of race and ethnicity for self-reported functional limitation. J Am Geriatr Soc 56:553-7
Albert, Steven M; Bear-Lehman, Jane; Burkhardt, Ann et al. (2006) Variation in sources of clinician-rated and self-rated instrumental activities of daily living disability. J Gerontol A Biol Sci Med Sci 61:826-31
Albert, Steven M; Bear-Lehman, Jane; Burkhardt, Ann (2006) Disparities between ambient, standard lighting and retinal acuities in community-dwelling older people: Implications for disability. J Am Geriatr Soc 54:1713-8
Albert, Steven M; Simone, Bridget; Brassard, Andrea et al. (2005) Medicaid home care services and survival in New York City. Gerontologist 45:609-16

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