Refining pathways to disability in urban Black older adults: The roles of cognition, health, health behaviors and depression

Disability in later life is heterogeneous. While some adults will experience preserved functioning into their later years, approximately 20-30% of adults aged 70 years or greater will experience some form of disability (Fried, Ferrucci, Darer, Williamson & Anderson, 2004). According to the International Classification of Functioning, Health and Disability (ICF), disbility is the outcome of many processes including declines in cognition, health and psychological functioning. These factors differentially contribute to prediction of disability onset; however, it is unclear what factors may be most related to early changes toward disability (i.e., preclinical disability) in older adults.;This study sought to examine disability within a sample of community-dwelling Black older adults. This sample was chosen because disparities in disability exist such that Blacks have higher rates of disability than their White, same-aged peers. Black older adults experience a greater number of years exposed to the negative impacts of chronic disease and functional disability making disability intervention especially important for this minority group.;Changes in physical performance, particularly lower-extremity functioning, lead to disability, institutionalization and, ultimately, mortality in older adults. Physical performance tasks such as walking, standing up from a chair and holding a standing balance pose, are very sensitive to slight changes in ability. As such, these physical tasks may act as early indicators of disability as they are able to detect changes in functioning often before older adults report these changes. While the relationship between cognition, affect, health, health behavior sand self-reported level of disability is relatively established, it is unclear how changes in physical performance may be related to such factors. Specifically, executive functioning has been shown to be integral to maintenance of independence in later life. Less is known about how executive functioning may be related to physical performance.;The ICF was used as a framework to examine how cognition, health, exercise and depression contribute to physical performance in a sample of urban Black older adults. Another aim was to examine cognitive domains most related to physical performance; specifically, identification of areas of executive functioning most implicated in physical performance.;The sample included 117 Black adults, ages 56-91, living in the Detroit metropolitan area. The ICF model was tested using structural equation modeling. A hierarchical regression examined contributions of cognition, health behaviors, health, depression and demographics to physical performance, as measured by the Short Physical Performance Battery (Guralnik et al., 1994). Multiple regression analyses were conducted to examine contributions of cognition, specifically executive function, to physical performance.;Results partially validated the ICF model indicating that cognition, exercise, depression, health and demographics are interrelated. Differences were found in the way these domains were associated with physical performance versus self-reported disability. In the regression analysis, executive function was the only cognitive domain significantly associated with physical performance; however, no single area of executive functioning was identified as the best predictor of physical performance.;These results indicate that disability in later life is the outcome of many interrelated processes, specifically health, depression and cognition. They support the use of integrated assessment to ensure consistent and thorough treatment across healthcare settings and communication among healthcare providers. Additionally, results indicate that executive function is integral to maintenance of independence in later life. Measures of executive functioning should be included, in conjunction with general cognition, in disability risk assessment for older adults.