for technological change—for instance, individuals who previously were considered to have IADL disability because they could not shop or pay bills can now do these things online—and are more sensitive to the impact of the environment on functional capacity, including factors that restrict participation in activities. There has been interest as well in measuring a broader range of functional ability. Accordingly, a set of new self-reported measures has been developed and validated and will first be deployed in the emerging National Health and Aging Trends Study (Freedman et al., 2011). In addition, the Census Bureau’s Survey of Income and Program Participation has recently updated its module on disability, adding new measures related to communication, ability to function independently, and a variety of measures of physical functioning.

With respect to disease states, depression is by far the most common mental disorder that influences work and home life. Over 4 percent of Americans are estimated to suffer clinically significant depression during their life, with the disorder being twice as common in women as in men and peaking in prevalence in the 25–44 year age group (Elinson et al., 2004).

Databases

With some exceptions, analyses of functional status in community-based populations have relied on one or more of the following five nationally representative longitudinal survey-based datasets:

  • The Health and Retirement Study (HRS), a panel survey conducted every 2 years beginning in 1992, focuses on people aged 51 and older living in the community. Functional measures include ADL, IADL, and mobility.
  • The Medicare Current Beneficiary Survey (MCBS), a panel survey of Medicare beneficiaries, includes measures of ADL and IADL.
  • The National Health Interview Survey (NHIS), an annual cross-sectional household survey (one person responds with information on all household members) of the community-dwelling population, includes measures of ADL and IADL.
  • The National Long Term Care Survey (NLTCS), a nationally representative panel study of the population aged 65 and older living in the community or in institutions. The survey, which began in 1982 and was repeated at regular intervals until its termination in 2004, included measures of ADL and IADL.
  • The National Health and Nutrition Examination Survey (NHANES), an annual (since 1999) survey of about 5,000 adults and children, includes questions about the difficulty of performing ADL and IADL for those aged 60 and older.


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