Trajectories of ADL disability among community-dwelling frail older persons

This study examines how activity of daily living (ADL) disability of community-living frail elders changes in a two-year period and how the pattern of change varies between those who subsequently died or were institutionalized and those who continued to live in the community. Multiple waves of data from a cohort of older participants (N = 3,161) in Michigan's Medicaid Waiver Program were analyzed using the hierarchical linear modeling (HLM) approach. The results suggest that changes in ADL disability were nonlinear and the pattern of change varied by their subsequent status. Participants who subsequently died or were institutionalized exhibited a steep increase in ADL disability during the last few months before the events, whereas continued community residents were relatively stable in ADL disability during the two-year study period. Within each group, substantial individual variation in ADL disability trajectories exists. Implications of the findings to research and practice are discussed.