The progression of disability among older adults in Mexico

Abstract

Purpose: This paper seeks to document the progression of disability in a developing country and to examine gender differences in this process.

Methods: The data come from the Mexican Health and Aging Study (MHAS), a nationally representative sample of older adults. An ordinal logistic regression (n = 3283) is used to measure the progression of disability that considers: (1) no disability, (2) mobility problems, (3) mobility problems with IADLs limitations, (4) mobility problems with ADLs limitations, (5) combinations of the latter three and (6) death.

Results: Approximately 43% of the sample remained in the same level of disability after 2 years. The patterns of progression with two disabilities differ for men and women.

Conclusions: Our model reflects the importance of separating ADLs and IADLs in the study of disability progression in Mexico. Varying risk profiles and cultural differences might influence the divergent disability paths followed by each gender.

Implications for Rehabilitation

• The disablement process involving transitions from mobility impairments to IADL and ADL limitations seen in developed countries differs for older adults in Mexico.

• Cultural differences may influence the progression from non-disabled to becoming disabled in different ways for females in developing countries like Mexico.

• One-fifth of individuals showed greater function and independence over time, suggesting that the disablement process is reversible. This finding highlights the need to focus on improving mobility, ADL, and IADL skills to facilitate successful aging.

• Although disability is often conceptualised as a combination of ADL and IADL limitations, gender differences seen in Mexico indicate the need to separate ADL and IADL when developing approaches to prevent or ameliorate disability.

Keywords:

• Gender differences
• Mexico
• MHAS
• older adults
• paths of disablement
• progression of disability

Acknowledgements

We sincerely thank Dr Kenneth Ottenbacher for his invaluable feedback in earlier drafts.

Declaration of interest

The authors have no conflict of interest to report. This work was supported in part by the National Institute on Aging of the National Institutes of Health (grant number R01 AG018016), by the National Institute of Child Health and Human Development of the National Institutes of Health (grant number K01 HD068513), by the Institute for Translational Sciences at UTMB with support in part by a National Centre for Advancing Translational Sciences Award (UL1RR029876), by the Advanced Rehabilitation Research Training Programme of the National Institute on Disability and Rehabilitation Research (postdoctoral training grant H133P110012), and infrastructure support from the Sealy Centre on Aging at the University of Texas Medical Branch.