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Effect of Subclinical Status in Functional Limitation and Disability on Adverse Health Outcomes 3 Years Later

¹ Iowa City VAMC, Iowa.
² Indiana University, Indianapolis.
³ Regenstrief Institute, Inc., Indianapolis, Indiana.
⁴ Gainesville VAMC, Florida.
⁵ University of Florida, Gainesville.
⁶ Saint Louis University, Missouri.
⁷ Washington University in St. Louis, Missouri.
⁸ The University of Iowa, Iowa City.

Address correspondence to Fredric D. Wolinsky, PhD, The John W. Colloton Chair in Health Management and Policy, College of Public Health, The University of Iowa, 200 Hawkins Dr., E-205 General Hospital, Iowa City, IA 52242. E-mail: fredric-wolinsky{at}uiowa.edu

Background. This article examines the effect of self-reported, baseline subclinical status (i.e., independent but adaptive performance) for functional limitation and disability on adverse health outcomes.

Methods. Nine hundred ninety-eight African-American men and women aged 49–65 years received in-home evaluations at baseline, and 853 were re-evaluated 3 years later. Baseline subclinical status was ascertained for five lower body tasks and seven activities of daily living (ADLs)/instrumental ADLs (IADLs). Outcomes included difficulty with lower body limitations, ADLs/IADLs, physical performance, physician visits, hospitalization, nursing home placement, and mortality.

Results. The baseline proportion of subclinical status evidence for the five lower body items was 0.33 (standard deviation [SD] = 0.20), and for the seven ADLs/IADLs was 0.20 (SD = 0.30). Significant independent effects of subclinical status for lower body limitations were observed on physician visits and hospitalization. Significant independent effects of subclinical status for ADLs/IADLs were observed on ADLs/IADLs and physician visits.

Conclusions. Subclinical status for functional limitation and disability independently predicts several subsequent adverse health outcomes, although the effects of the latter (ADLs/IADLs) are stronger. Interventions to reduce frailty should focus on self-reported subclinical status as an early warning system.

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