Sample Article Review on Long-term Declines in ADLs, IADLs, and Mobility among Older Medicare Beneficiaries

Research Question

A number of studies have been done regarding short-term functional declines associated with age. However, because of participants aging equally, the comparisons made in those studies have arguably failed to concentrate on effects of aging. This study was therefore, designed to evaluate long-term decline in functionality of the beneficiaries of Medicare. Participants were followed for varying time lengths while the researchers identified any risk factors associated with the observed decline.

Problem under Investigation

There is an observed decrease with age in IADLs, ADLS, as well as mobility (Wolinsky et al., 2011). The objective of the study is to identify and evaluate the factors that lead to a functional decline in the older beneficiaries of the Medicare.

 Data and Methods

The study sample comprised 5871 self- and proxy-respondents (Wolinsky et al., 2011). The sample was selected either from household screening conducted during a multi-stage cluster sampling process in 1992 or from a sample of 80 or more years old people (Wolinsky et al., 2011). Survey data collected was linked to Medicare claims between 1993 and 2007. AHEAD study measures were applied during the study.

Outcome Assessment

Baseline and follow-up data at two years from the survey on AHEAD were utilized in the study (Wolinsky et al., 2011). Three standard dimensional measures were used to assess functional status, limitations in daily activities (ADLs), mobility, and instrumental ADLs (IADLs). The Limitation of IADL assessment included an estimation of difficulties or inability to perform five activities, taking medication, going for shopping, using the telephone, handling money, and preparing meals. ADL limitation was assessed by measuring the difficulties to dress, bathe, get across a room, get in and out of bed, and eat. Mobility limitation included measuring the inability to push or pull heavy objects, walk several blocks, lift or carry 10 or more pounds, climb up and down a flight of stairs (Wolinsky et al., 2011).

The development of inabilities was defined as a decline in ADL, IADL, and mobility (Wolinsky et al., 2011). Multivariable logistic regression models were used to evaluate the relationship between the overall status of the respondents, their lifestyle, health shocks, managed care, and continued care status (Wolinsky et al., 2011). Moreover, four baseline measures of the participants’ lifestyle were included. These were smoking cigarettes, physical exercise, alcohol consumption, and body mass index measurement (Wolinsky et al., 2011).

A previously validated continuity measure was used to determine the continuity of care. Continuity of care was considered to be when no office visitations were made to physician for a period of less than eight months. Three additional binary indicators were used to determine terminal drop (Wolinsky et al., 2011). Indicator one reflected whether the final follow-up interview of the participant took place within a year of death. The second indicator reflected whether the death of participants took place at least one year and one day after their last follow-up interview. The last indicator reflected on the participants followed up until the end of the study. These participants were used as a reference category for the entire sample.

Findings and Conclusions

The declines that were observed for ADLs, IADLs and mobility were 36.6%, 32.3% and 30.7%, respectively (Wolinsky et al., 2011). Proxy reports recorded a functional decline and a decline in the effects of baseline function. Vigorous and consistent physical exercise and activities proved to work against functional decline. Accordingly, mobility decline was associated with obesity, and smoking of cigarettes, as well as alcohol consumption (Wolinsky et al., 51). Post-baseline hospitalizations were the predictors most strongly associated with functional decline (Wolinsky et al., 2011). Moreover, Wolinsky et al., (2011) established that the people who did the final interview died one year later and were more likely to have experienced a decline of functional status

If proxy reports are utilized, it is important to consider additive and interactive impacts associated with the respondent’s status. Older beneficiaries of Medicare are advised to engage in vigorous and consistent physical exercise to reduce the risk of functional decline in ALDs, IADLs, and mobility. It is also advisable to reduce alcohol consumption and cigarette smoking, which can bring about a decline in mobility.

Critical Analysis

Functional decline and aging is inevitable (Wolinsky et al., 2011). People grow old with time. It becomes difficult to carry on with certain activities like vigorous physical exercise. In their old age, most people have less or no work at all (Wolinsky et al., 2011). Some elderly individuals live far from their families and thereby become more prone to indulge in alcohol and smoking cigarettes. The elderly often find difficulty in gaining access to care or get trouble when they try to reassert their autonomy. Either way, a functional decline, as evident in ADL and IADLS as well as mobility, will invariably occur (Wolinsky et al., 2011). However, aged people are a very important segment of the population, and efforts should be directed towards maximizing their health and comfort for as long as possible.



Wolinsky, F. D., Bentler, S. E., Hockenberry, J., Jones, M. P., Obrizan, M., Weigel, P. A., … & Wallace, R. B. (2011). Long-term declines in ADLs, IADLs, and mobility among older Medicare beneficiaries. BMC geriatrics11(1), 43-55.