INNER-CITY OLDER BLACKS HAVE HIGH-LEVELS OF FUNCTIONAL DISABILITY

OBJECTIVES: To describe the frequency and severity of functional probl ems in two groups of noninstitutionalized inner-city blacks aged 70 ye ars and older contrasted with results from appropriate groups of white and black older adults and with the goals of the Healthy People 2000 program. DESIGN: Cross-sectional descriptive study. SETTING: Community -based samples. PARTICIPANTS: A population-based sample of 416 older a dults living in a 3.5-square mile catchment area in north St. Louis (N SL), Missouri, and a sample of 197 older residents living in public ho using in East St. Louis (ESL), Illinois;MEASUREMENTS: Health status, p reventive health activities, health services utilization, and risks fo r progressive frailty were assessed by self report and observation usi ng well validated, standardized instruments. Whenever possible, compar ison data were derived from national datasets, original samples used t o validate the measures, and other useful comparison groups. RESULTS: The NSL sample had somewhat better health status and risk for progress ive disability than the ESL sample. However, compared with national or regional reference groups using age-gender adjustments, both study gr oups demonstrated increased levels of dependence in intermediate activ ities of daily living, restricted activity days, inability to walk one -half mile without assistance, reported poor vision, living alone, and limited income compared with both older whites and blacks, and increa sed levels of worsening health, inability to perform heavy work around the house, never walking a mile or more, and currently unmarried vers us whites with variable decrements versus blacks. Contrasted with othe r comparison groups, the two samples bad increased body fat; consisten t decrements in gait speed, timed chair stands, timed one-leg balance, and frequency of preventive exercise; and lower levels of dental care ; results relative to physician visits and hospital days were mixed. T hey also had high levels of measured visual and hearing impairments, u nmet needs for home delivered meals, and problems with false teeth. De ficiencies compared with the goals of Healthy People 2000 were large. CONCLUSIONS: The special attributes of inner-city blacks, including po verty and access to and acceptance of remedial programs, will have to be considered if the goals of Healthy People 2000 are to be met in thi s important and growing segment of older Americans.