INCOME AND SEVERITY OF FUNCTIONAL IMPAIRMENT IN FUNCTIONALLY IMPAIRED ELDERLY LIVING IN THE COMMUNITY

Salam  J. SEMAAN

This thesis examines the relationship between income and number and type of functional impairments in a national sample of community‑resident functionally impaired elderly aged 65 years and over. Data from the 1982 National Long‑Term Care Survey were analyzed to investigate the relationship (n=4410). The specific research questions which the study addresses are: 1) the distribution of income and functional impairment among community‑resident functionally impaired elderly, 2) the differences in functional impairment among different income groups of community‑resident functionally impaired elderly, 3) the attributes associated with differences in functional impairment among different income groups of community‑resident functionally impaired elderly, and 4) the factors associated with functional impairment which would be amenable to intervention.

Functional impairment is assessed in terms of "basic activities of daily living" (BADL) and in terms of instrumental activities of daily living (IADL). More specifically, the study analyses two relationships: one, between income and number of functional impairments in BADL; and two, between income and probability of impairment in each of the 7 activities referred to as BADL and the 10 activities referred to as IADL. The study results do not support the hypothesis that poor community‑resident functionally impaired elderly have a statistically significantly higher number of BADL function impairments or have a statistically significantly higher odds of functional impairment in any of the 7 BADL or 10 IDAL than do higher income elderly.

The study results indicated that certain health conditions (hip fracture, stroke, and neurological conditions), living with spouse or others, advanced age, having Medicare/Medicaid health insurance, and infrequent phone contacts with friends and relatives, were associated with a statistically significantly higher number or higher odds of functional impairments.

This study is based on cross‑sectional data. It does not take into consideration the effects of differential institutionalization and mortality rates by income groups on the relationship between income and functional impairment in the community‑resident functionally impaired elderly population. Further research is also needed to clarify the relationship between income prior to age 65 and functional impairment after age 65. Policy implications of the study address eligibility for and program components of community‑based long‑term care programs.