Defining disability in MAP2030

Rationale

• Disability is used as an input to or output from every WP

• A variety of data sources (surveys) are used by each WP

• Not complete overlap between disability items in each of the surveys

Aim: to agree definition of disability that is comparable between surveys and therefore WPs

Disease>Impairment>Functional limitation>Disability

(Nagi, 1965,1976, 1991)

Disease>Impairment>Functional >Activity Restriction>Handicap

limitation

(Wood, 1975)

Disease>Impairment>Disability>Handicap

(ICIDH, 1980)

Models of the disablement process

What is disability?What is disability?

Components

Functional limitations • Reaching, stretching, lifting, dexterity

Household Activities (IADL)• Shopping, cooking, housework, managing affairs

Personal Care Activities (ADL)• Bathing, dressing, feeding, getting in and out of bed, using

toilet

Mobility• Getting up and down stairs/steps, walking across a room,

walking half a mile, getting around outside

Surveys

General Household Survey (GHS)• A multi-purpose continuous survey of people living in private households (approx

13,000 household sampled) in Great Britain. Started in 1971 and has been carried out continuously since then, except for breaks in 1997/98 and 1999/2000. All adults aged 16 and over are interviewed in each responding household. Demographic and health information is also collected about children in the household.

English Longitudinal Study of Ageing (ELSA) • A panel study of 11,500 people aged 50 and older, drawn from the Health Survey for

England and interviewed every two years (since 2002) with a nurse visit every four years.

British Household Panel Study (BHPS)• Annual survey consisting of nationally representative sample of about 5,500

households recruited in 1991. Individuals re-interviewed each year, still followed if they split off from original households, new members to household included as are all adult members of the household so the sample remains representative. Additional samples recruited later mean the study now covers the whole UK. Now contains total of approximately 10,000 interviewed individuals.

MRC Cognitive Function and Ageing Study (CFAS)• Longitudinal study of 13,004 aged 65+ in 5 centres 1991-2001 includes

institutionalised

Comparison of items in surveysComparison of items in surveys

GHS BHPS ELSA CFAS Functional limitations Carrying heavy bags Reaching a shelf Tying a knot IADLs Shopping Heavy housework Cooking a hot meal Laundry Vacuuming Managing personal affairs ADLs Bathing Washing hands and face Dressing Putting on shoes and socks Getting in and out of bed Cutting toenails Using the toilet Feeding Mobility Getting up and down stairs/steps Using public transport Getting on and off a bus Getting around the house Walking down road/outside

Standardised prevalence of disability (difficulty) age 65+Standardised prevalence of disability (difficulty) age 65+

Men

0 10 20 30 40 50 60

Toilet

Hot meal

Bathing

Stairs

Dressing

Bed

Mobility in house/room

Feeding oneself

Cut toenails

Using transport

Shoes/socks

BHPS

ELSA

GHS

Women

0 10 20 30 40 50 60

Toilet

Hot meal

Bathing

Stairs

Dressing

Bed

Mobility in house/room

Feeding oneself

Cut toenails

Using transport

Shoes/socks

BHPS

ELSA

GHS

Standardised prevalence of disability (difficulty) age 75+Standardised prevalence of disability (difficulty) age 75+

Men

0 10 20 30 40 50 60

Toilet

Hot meal

Bathing

Stairs

Dressing

Bed

Mobility in house/room

Feeding oneself

Cut toenails

Using transport

Shoes/socks

CFAS

BHPS

ELSA

GHS

Women

0 20 40 60 80

Toilet

Hot meal

Bathing

Stairs

Dressing

Bed

Mobility in house/room

Feeding oneself

Cut toenails

Using transport

Shoes/socks

CFAS

BHPS

ELSA

GHS

Standardised prevalence of disability (help) age 75+Standardised prevalence of disability (help) age 75+

Men

0 10 20 30 40 50 60

Toilet

Hot meal

Bathing

Stairs

Dressing

Bed

Mobility in house/room

Feeding oneself

Cut toenails

Using transport

Shoes/socks

CFAS

BHPS

GHS

Women

0 10 20 30 40 50 60

Toilet

Hot meal

Bathing

Stairs

Dressing

Bed

Mobility in house/room

Feeding oneself

Cut toenails

Using transport

Shoes/socks

CFAS

BHPS

GHS

Hierarchy of items (CFAS) - longitudinalHierarchy of items (CFAS) - longitudinal

ALL

Median age of first difficulty

Toilet

Tieknot

Hotmeal

Shoes

Bathing

Bus

Reachshelf

Heavyhwk

Stairs

Toenail

Bags

65 70 75 80 85 90 95 100

Hierarchy of items (CFAS) by genderHierarchy of items (CFAS) by gender

MEN

Median age of first difficulty

Toilet

Tieknot

Shoes

Bathing

Bus

Reachshelf

Hotmeal

Heavyhwk

Stairs

Toenail

Bags

65 70 75 80 85 90 95 100

WOMEN

Median age of first difficulty

Toilet

Tieknot

Hotmeal

Shoes

Bathing

Bus

Reachshelf

Toenail

Heavyhwk

Stairs

Bags

65 70 75 80 85 90 95 100

Why differences might occur

Filters• ‘If cannot manage steps/stairs can ….’ (GHS)

Effect of filtering by difficulty with stairs women aged 75+Effect of filtering by difficulty with stairs women aged 75+

With filtering

0 5 10 15 20 25

Toilet

Dressing

Bed

Mobility inhouse/room

Feedingoneself

CFAS

ELSA

GHS

Without filtering

0 5 10 15 20 25

Toilet

Dressing

Bed

Mobility inhouse/room

Feedingoneself

CFAS

ELSA

GHS

Why differences might occur

Filters• ‘If cannot manage steps/stairs can ….’ (GHS)

Question wording• ‘Because of a health or memory problem’ (ELSA)

Responses• Very easy, fairly easy, fairly difficult, very difficult

(GHS, BHPS)• No difficulty, some difficulty (CFAS)

Position of question in survey

Next steps

• Obtain standardised prevalence (help) for BHPS items

• Review cross-sectional hierarchy for each survey – is ordering the same regardless of items?

• Explore longitudinal hierarchy for BHPS?

• Try to find equivalent arrangement across surveys for difficulty with 1 or more items