Explaining the Effect of Gender on Functional Transitions in Older Persons

Abstract

Background: Women live longer but experience greater disability than men. The reasons for this gender difference in disability are not well understood. Objective: Our objectives were to determine if the higher prevalence of disability in women is due to greater incidence of disability, longer duration of disability, or both, and to identify factors that potentially explain these gender differences. Methods: 754 community-living persons aged 70 and older who were non-disabled (required no personal assistance) in four essential activities of daily living (ADLs) were assessed monthly for disability for up to 6 years. A multi-state extension of the proportional hazards model was used to determine the effects of gender on transitions between states of no disability, mild disability, severe disability, and death, and to evaluate potential mediators of these effects. Results: Women were more likely to make the transition from no disability to mild disability and less likely to make the transitions from mild to no disability and from both mild and severe disability to death. The gender difference in the transitions between no disability and mild disability was largely explained by differences in gait speed and physical activity, but gender difference in transitions to death persisted despite adjustment for multiple potential mediators. Conclusion: The higher prevalence of disability in women versus men is due to a combination of higher incidence and longer duration, resulting from lower rates of recovery and mortality among disabled women.

Gender and incidence of functional disability in the elderly: a systematic review

“…Cognitive deficit was a predictor of incidence of functional disability in both genders in one study 28 , in women in another study 9 , and in two studies that did not evaluate gender as a risk factor 7,33 . Depression was a predictor of incidence of functional disability in both genders according to two studies 9,21 and according to two other studies that did not evaluate gender as a risk factor 7,26 . Slow gait, defined as taking more than ten seconds to walk approximately three meters, increased the likelihood of incidence of functional disability in two studies that did not adjust for gender 25,26 .…”

“…Depression was a predictor of incidence of functional disability in both genders according to two studies 9,21 and according to two other studies that did not evaluate gender as a risk factor 7,26 . Slow gait, defined as taking more than ten seconds to walk approximately three meters, increased the likelihood of incidence of functional disability in two studies that did not adjust for gender 25,26 . Sedentary lifestyle increased the risk of incidence of functional disability in two studies 26,33 that did not evaluate gender in their analyses.…”

“…As shown in this Table, functional disability in basic activities of daily living was evaluated in 14 studies 5,8,21,22,23,24,25,26,28,29,30,31,32,33 . Of these, two observed higher incidence of functional disability in women 5,22 and 12 found no difference in the incidence between genders 8,21,23,24,25,26,28,29,30,31,32,33 . Disability in instrumental activities of daily living was examined in three studies 29,30,32 ; one found a higher incidence of functional disability in women 30 and two found no difference in incidence between the genders 29,32 .…”

“…Diabetes was a risk factor for functional disability according to two studies, regardless of gender 23,32 . Arthritis was a risk factor for functional disability in three studies: two that did not evaluate gender as a predictor of functional disability 26,32 and one study only in women 9 . Visual impairment was a risk factor for functional disability in two studies 7,23 , regardless of gender.…”

“…Slow gait, defined as taking more than ten seconds to walk approximately three meters, increased the likelihood of incidence of functional disability in two studies that did not adjust for gender 25,26 . Sedentary lifestyle increased the risk of incidence of functional disability in two studies 26,33 that did not evaluate gender in their analyses. Tiredness while performing activities of daily living increased the likelihood of functional disability in both genders in one study 34 and in another study that did not evaluate gender as a predictor of functional disability 33 .…”