Health and Function in the Old and Very Old

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Abstract
This report advocates conceptual separation and parallel assessment of medically diagnosed health conditions and functional disability in clinical and epidemiological studies of the aged. Data from a study of urban elderly are presented to demonstrate how this can be done and to reexamine the meaning of self-reported illness and disability. One hundred thirteen subjects 74 to 95 years old, recruited from a longitudinal study of a representative sample of the elderly population of Cleveland, Ohio, participated in structured interviews and epidemiologically based medical examinations, conducted by a physician-nurse team at the place of residence. The presence or absence of 11 common chronic conditions was determined according to preestablished criteria, by self-report and, separately, by medical diagnostic evaluation. Functional disability was estimated by self-report and by physician-nurse assessment, using established measures of mobility and activities of daily living. Results indicate that interview self-report can provide useful estimates of the prevalence of medical conditions and functional disabilities in elderly populations, although self-report alone is not a sufficiently sensitive measure to be used for case-finding or diagnosis. When functional disabilities are matched against the specific medical conditions that cause them and disease-specific mortality is also taken into account, a three-dimensional classification results that has implications for future clinical and survey work with the elderly.