IMPROVED VERSUS DETERIORATED PHYSICAL FUNCTIONING AMONG LONG-TERM DISABLED ELDERLY

The usual prognosis for long-term disabled elderly is that they are no t likely to improve or regain independent functioning. But computed tr ansition probabilities reveal a significant proportion of improvement. Based on the National Long-Term Care Surveys of 1982 and 1984, this s tudy identifies the personal characteristics that are associated with changed functional status between these 2 years and estimates how much each characteristic contributes to this change. The study distinguish es four mutually exclusive statuses of disabled older persons: improve d, remaining unchanged, deteriorated-alive, and deteriorated-dead. It shows that cognitive impairment reported in 1982, high-risk medical ev ents that occurred during the year before the 1982 interview, and hosp italization between 1982 and 1984 predict an increased risk of deterio ration by 1984. However, similar estimates do not predict improvement. Yet, data compatible with reported improvement suggest that acute med ical problems might have caused a temporary worsening of functional st atus. When the recovery from this status takes more than 3 months, the ensuing change may be recorded as a long-term disability in the initi al survey and as an improvement over time. However, long-term disabled elderly seldom improve to such an extent that they regain complete in dependence in physical functioning. In this study, most of the elderly who improved ended with a functional status similar to that of person s whose ADL disabilities remained unchanged over time.