The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #53459

Shuanglin You, PhD, Health Policy and Administration, University of North Carolina at Chapel Hill, CB# 7411, McGavran-Greenberg Hall, University of North Carolina, Chapel Hill, NC 27599-7411, 919-672-7209, shuanglin_you@hotmail.com, R. Gary Rozier, DDS, Department of Health Policy and Administration, University of North Carolina at Chapel Hill, 1105F McGavran-Greenberg,CB #7411, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7411, Sally C. Stearns, Dept. of Health Policy and Administration, University of North Carolina at Chapel Hill, CB# 7400, McGavran-Greenberg, Chapel Hill, NC 27599, Jianwen cai, PhD, Biostatistics, University of North Carolina-Chapel Hill, CB#7420, 3103D McGavran-Greenberg Hall, Chapel Hill, NC 27599-7420, and Shulamit Bernard, PhD, Health Care Quality Program, RTI International, 3040 Cornwallis Road, PO Box 12194, Research Triangle Park, NC 27709.

Objectives.Improvements in the public health of the elderly are most closely tied to understanding functional status trajectories and simple summary statistical indicators are sorely needed. A framework was postulated to disentangle the inter-relationships among sociomedical constructs and indicators of physical functional status and select representative indicators. Methods. Analyzing and synthesizing existing constructs and principles in one theoretical-empirical framework, we used exploratory/confirmatory factor analyses to identify the clustering of 21 indicators and derived parsimonious indicators using Medicare Current Beneficiary Survey 1991-93. Results. An invariant factor structure emerged over three waves with good validity and reliability, loadings and Chronbach Alpha (.80s and .70s), Root Mean Residues (.02), Goodness-of-fitness index (.94), and Root Mean Squared Error of Approximation (.058 with CI of .056 to .059). For the first time, Balance added to the logical series of factors: lower- and upper-body functioning and the redefined transferring-1 and -2. Discussions. The findings confirmed the well-established but reinterpreted factors and representative indicators. Only parsimonious dynamic indicators can quantify the qualitative aspects of changes at the individual event level and revealed the essential system structure-function in functional status decline. The natural sequence of the five factors was re-interpreted from a unifying theme of gravitation to seamlessly match the five domains of competence of human bodily parts (the driving force of change) with their manifestation in performance under the structured contextual environment (from human body to the household etc.), which corroborated the unifying theme of physical functioning and gravity in generic frailty and life-time morbidity, and modern physical therapy.

Learning Objectives:

At the conclusion of the session, the participant (learner) in this session will be able to:
• survey the existing physical functional constructs, principles and related issues, understand the motivation for synthesis of, and improvements, in studies of functional status.
• guided by the comprehensive framework, compare and select the commonly-used indicators for general use or their specific objectives
• appreciate innovative ways to develop new constructs and associated indicators and to derive dynamic indicators in order to understand functional status change.

Keywords: Aging, Disability

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.