Ageing International

, Volume 30, Issue 3, pp 278–295 | Cite as

A psychosocial model of functional disability

  • Lisa M. Fiksenbaum
  • Esther R. Greenglass
  • Sandra R. Marques
  • Judy Eaton
Professional Issues: Research Findings


With advancing age, many older adults are vulnerable to a decline in physical functioning. Functional disability has been shown to affect the subjective well-being of the individual, and has been associated with increased morbidity and mortality. Social support is commonly assumed to protect people from the experience of psychological distress and enhance well-being. Other studies have demonstrated that satisfaction with social support, rather than the frequency with which support was received, is a powerful predictor of self-reported health status. The present study tests a psychosocial model of functional disability in two elderly populations (61 years of age and older): 178 seniors living in the community (136 females and 42 males) and 168 in-patients in a rehabilitation hospital following total hip and knee arthroplasty (118 females and 50 males). Predictors of functional disability were age, gender, and satisfaction with support. In this model, functional disability, with its related loss of independent functioning, was expected to lead to depression. Results indicated that the two samples differed slightly. Specifically, the elderly in the community sample were significantly older than the rehabilitation patients, whereas the hospital sample reported greater functional disability and were more satisfied with their social relations than the community-residing elderly. Results of path analysis in both samples showed that women reported more functional disability than men and satisfaction with support was associated with lower functional disability. Furthermore, functional disability led directly to depression in both samples. Practical implications for the maintenance and enhancement of daily functioning, as well as well-being in later life are discussed.


Social Support Beck Depression Inventory Functional Disability Rehabilitation Hospital Rehabilitation Patient 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Antonucci, T.C., Fuhrer, R., & Dartigues, J.F. (1997). Social relations and depressive symptomatology in a sample of community-dwelling French older adults. Psychology and Aging, 12, 189–195.CrossRefGoogle Scholar
  2. Antonucci, T.C., & Jackson, J.S. (1987). Social support, interpersonal efficacy, and health: A life course perspective. In B. Edelstein & L. Carstensen, (Eds.), Handbook of Clinical Gerontology. (pp. 291–311). Elmsford, NY: Pergamon Press, Inc.Google Scholar
  3. Arbuckle, J.L., & Wothke, W. (1999). Amos 4.0 User’s Guide. Chicago: SPSS Inc.Google Scholar
  4. Bebbington, P.E. (1996). The origins of sex differences in depressive disorder: Bridging the gap. International Review of Psychiatry, 8, 295–332.Google Scholar
  5. Brandt, E.N., & Pope, A.M. (Eds.). (1997). Enabling America: Assessing the role of rehabilitation science and engineering. Washington, DC: National Academy Press.Google Scholar
  6. Carstensen, L.L. (1992). Social and emotional patterns in adulthood: Support for socioemotional selectivity theory. Psychology and Aging, 7, 331–338.CrossRefGoogle Scholar
  7. Chiu, H.C., Hsieh, Y.H., Mau, L.W., & Lee, M.L. (2005). Associations between socioeconomic status measures and functional change among older people in Taiwan. Ageing and Society, 25, 377–395.CrossRefGoogle Scholar
  8. Cummings, S.M., & Cockerham, C. (2004). Depression and life satisfaction in assisted living residents: Impact of health and social support. Clinical Gerontologist, 27, 25–42.CrossRefGoogle Scholar
  9. Derogatis, L. (1993). Brief Symptom Inventory: Administration, scoring and procedural manual. Minneapolis, MN: National Computer Systems.Google Scholar
  10. Dunlop, D.D., Hughes, S.L., & Manheim, L.M. (1997). Disability in activities of daily living: Patterns of chance and a hierarchy of disability. American Journal of Public Health, 87, 378–383.CrossRefGoogle Scholar
  11. Femia, E.E., Zarit, S.H., & Johansson, B. (2001). The disablement process in very late life: A study of the oldest-old in Sweden. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 56B, 12–23.Google Scholar
  12. Ferrucci, L., Guralnik, J.M., Simonsick, E., Salive, M.E., Corti, C., & Langlois, J. (1996). Progressive versus catastrophic disability: A longitudinal view of the disablement process. Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 51A, M123-M130.Google Scholar
  13. Fry, P.S. (2000). Religious involvement, spirituality and personal meaning for life: Existential predictors of psychological well-being in community-residing and institutional care elders. Aging and Mental Health, 4, 375–387.CrossRefGoogle Scholar
  14. Guralnik, J.M., Leveille, S.G., Hirsch, R., Ferrucci, L., & Fried, L.P. (1997). The impact of disability in older women. Journal of American Medical Women’s Association, 52, 113–120.Google Scholar
  15. Hawker, G.A., Wright, J.G., Coyte, P.C., Williams, I., Harvey, B., Glazier, R., & Badley, E.M. (2000). Differences between men and women in the rate of use of hip and knee arthroplasty. New England Journal of Medicine, 342, 1016–1023.CrossRefGoogle Scholar
  16. Hebert, R., Brayne, C., & Spiegelhalter, D. (1997). Incidence of functional decline and improvement in a community-dwelling, very elderly population. American Journal of Epidemiology, 145, 935–944.Google Scholar
  17. House, J., Robbins, C., & Metzner, H.L. (1982). The association of social relationships and activities with mortality: Prospective study from the Tecumseh Community Health Center. American Journal of Epidemiology, 116, 123–140.Google Scholar
  18. Jang, Y., Haley, W.E., Mortimer, J., & Small, B.J. (2002). The role of mastery and social resources in the associations between disability and depression in later life. The Gerontologist, 42, 807–813.Google Scholar
  19. Johnson, R. J., & Wolinsky, F.D. (1999). Functional status, receipt of help, and perceived health. Journal of Clinical Geropsychology, 5, 105–125.CrossRefGoogle Scholar
  20. Kandrack, M., Grant, K.R., & Seagall, A. (1991). Gender differences in health related behavior: Some unanswered questions. Social Science and Medicine, 32, 579–590.CrossRefGoogle Scholar
  21. Katz, J.N. (2001). Preferences, quality and the (under) utilization of total joint arthroplasty. Medical Care, 39, 203–205.CrossRefGoogle Scholar
  22. Kendell, K., Saxby, B., Farrow, M., & Naisby, C. (2001). Psychological factors associated with short-term recovery from total knee replacement. British Journal of Health Psychology, 6, 41–52.CrossRefGoogle Scholar
  23. Keppen, G.I.J.M., van Heuvelen, M.J.G., van Sonderen, E., van den Brink, R.H.S., Kooijman, A.C., & Ormel, J. (1999). The relationship of functional limitations to disability and the moderating effects of psychosocial attributes in community-dwelling older persons. Social Science and Medicine, 48, 1161–1172.CrossRefGoogle Scholar
  24. Kim, J. M., Shin, I.S., & Yoon, J.S. (2002). Apolipoprotein E among Korean Alzheimer’s disease patients in community-dwelling and hospitalized elderly samples. Dementia and Geriatric Cognitive Disorders, 13, 119–124.CrossRefGoogle Scholar
  25. Knol, H.R., Haken, L., & Kempen, G.I.J.M. (2003). Disablement process and the utilization of home care among non-institutionalized elderly people: Contrasting results between cross-sectional and panel data. Disability and Rehabilitation, 25, 845–855.CrossRefGoogle Scholar
  26. Krause, N. (1998). Elderly parental loss, recent life events, and changes in health among older adults. Journal of Aging and Health, 10, 395–421.CrossRefGoogle Scholar
  27. Kuehner, C. (2003). Gender differences in unipolar depression: An update of epidemiological findings and possible explanations. Acta Psychiatrica Scandinavica, 108, 163–174.CrossRefGoogle Scholar
  28. Lawrence, R.H., & Jette, A.M. (1996). Disentangling the disablement process. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 51B, S173-S182.Google Scholar
  29. Leveille, S.G., Penninx, B.W., Melzer, D., Izmirlian, G., & Gurainik, J.M. (2000). Sex differences in the prevalence of morbidity disability in old age: The dynamics of incidence, recovery, and mortality. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 55, S41-S50.Google Scholar
  30. Liang, J. (1990). The national survey of Japanese elderly. Ann Arbor, MI: Institute of Gerontology.Google Scholar
  31. Liu, X., Liang, J., Muramatsu, N., & Sugisaea, H. (1995). Transitions in functional status and active life expectancy among older people in Japan. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 50, S383-S394.Google Scholar
  32. Magni, E., Frisoni, G.B., Rozzini, R., & De-Leo, D. (1996). Depression and somatic symptoms in the elderly: The role of cognitive function. International Journal of Geriatric Psychiatry, 11, 517–522.CrossRefGoogle Scholar
  33. Manton, K.G. (1997). Demographic trends for the aging female population. Journal of the American Medical Women’s Association, 52, 99–105.Google Scholar
  34. Marcus, S.M., Young, E.A., Kerber, K.B., Kornstein, S., Farabaugh, A.H., Mitchell, J., Wisniewski, S.R., Balasubramani, G.K., Trivedi, M.H., & Rush, A.J. (2005). Gender differences in depression: Findings from the STAR*D study. Journal of Affective Disorders, 87, 141–150.CrossRefGoogle Scholar
  35. McNair, D. M., Loor, M., & Droppleman, L. (1992). Profile of Mood States. San Diego, CA: EdITS/Educational and Industrial Testing Service, Inc.Google Scholar
  36. Melchior, M., Berkman, L.F., Niedhammer, I., Chea, M., & Goldberg, M. (2003). Social relations and self-reported health: A prospective analysis of the French Gazel cohort. Social Science and Medicine, 56, 1817–1830.CrossRefGoogle Scholar
  37. Murtagh, K., & Hubert, H.B. (2004). Gender differences in physical disability among an elderly cohort. American Journal of Public Health, 94, 1406–1411.Google Scholar
  38. Nyenhuis, D.L., Yamamoto, C., Luchetta, T., Terrien, A., & Parmentier, A. (1999). Adult and geriatric normative data and validation of the Profile of Mood States. Journal of Clinical Psychology, 55, 79–86.CrossRefGoogle Scholar
  39. Oman, D., Reed, D., & Ferrara, A. (1999). Do elderly women have more physical disability than men do? American Journal of Epidemiology, 150, 834–842.Google Scholar
  40. Oxman, T.E., & Hull, J.G. (1997). Social support, depression, and activities of daily living in older heart surgery patients. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 52B, P1-P14.Google Scholar
  41. Peek, M.K., Ottenbacher, K.J., Markides, K.S., & Ostir, G.V. (2003). Examining the disablement process among older Mexican American adults. Social Science and Medicine, 57, 413–425.CrossRefGoogle Scholar
  42. Peres, K., Verret, C., Alioum, A., & Barberger-Gateau, P. (2005). The disablement process: Factors associated with progression and disability and recovery in French elderly people. Disability and Rehabilitation, 27, 263–276.CrossRefGoogle Scholar
  43. Peterson, R.A., & Headen, S.W. (1984). Profile of Mood States. In D.J. Keyser & R.C. Sweetland (Eds.), Test Critiques Vol. 1, pp. 522–529. Kansas City, MO: Test Corporation of America.Google Scholar
  44. Piccinelli, M., & Simon, G. (1997). Gender and cross-cultural differences in somatic symptoms associated with emotional distress: An international study in primary care. Psychological Medicine, 27, 433–444.CrossRefGoogle Scholar
  45. Piccinelli, M., & Wilkinson, G. (2000). Gender differences in depression: Critical review. British Journal of Psychiatry, 177, 486–492.CrossRefGoogle Scholar
  46. Rathouz, P.J., Kasper, J.D., & Zeger, S.L. (1998). Short term consistency in self-reported physical functioning among elderly women. American Journal of Epidemiology, 147, 764–773.Google Scholar
  47. Reker, G.T. (1997). Personal meaning, optimism, and choice: Existential predictors of depression in community and institutional elderly. The Gerontologist, 37, 709–716.Google Scholar
  48. Rinaldi, P., Mecocci, P., Benedetti, C., Ercolani, S., Bregnocchi, M., Menculini, G., Catani, M., Senin, U., & Cherubini, A. (2003). Validation of the five-item Geriatric Depression Scale in elderly subjects in three different settings. Journal of the American Geriatrics Society, 51, 694–698.CrossRefGoogle Scholar
  49. Rissanen, P., Aro, S., & Sintonen, H. (1996). Quality of life and functional ability in hip and knee replacements: A prospective study. Quality of Life Research, 5, 56–64.CrossRefGoogle Scholar
  50. Schoenbach, V.J., Kaplan, B.H., Freedman, L., & Kleinbaum, D.G. (1986). Social ties and mortality in Evans County, Georgia. American Journal of Epidemiology, 123, 577–591.Google Scholar
  51. Scocco, P., Meneghel, G., Dello-Buono, M., & De-Leo, D. (2001). Hostility as a feature of elderly suicidal ideators. Psychological Reports, 88, 863–868.CrossRefGoogle Scholar
  52. Sprock, J., & Yoder, C.Y. (1997). Women and depression: An update on the report of the APA Task Force. Sex Roles, 36, 269–303.Google Scholar
  53. Stuck, A.E., Walthert, J.M., Nikolaus, T., Büla, C.J., Hohmann, C., & Beck, J.C. (1999). Risk factors for functional status decline in community-dwelling elderly people: A systematic literature review. Social Science and Medicine, 48, 445–469.CrossRefGoogle Scholar
  54. Stukenberg, K.W., Dura, J.R., & Kiecolt-Glaser, K. (1990). Depression screening scale validation in an elderly, community dwelling population. Journal of Consulting and Clinical Psychology, 2, 134–138.Google Scholar
  55. Verbrugge, L.M., & Jette, A.M. (1994). The disablement process. Social Science and Medicine, 38, 1–14.CrossRefGoogle Scholar
  56. Verbrugge, L.M., & Wingard, D.I. (1987). Sex differentials in health and mortality. Women and Health, 12, 103–147.CrossRefGoogle Scholar
  57. Wray, L.A., & Blaum, C.S. (2001). Explaining the role of sex on disability: A population-based study. The Gerontologist, 41, 499–510.Google Scholar
  58. Zeiss, A.M., Lewinsohn, P.M., “Rohde, P., & Seeley, J.R. (1996). Relationship of physical disease and functional impairment to depression in older people. Psychology and Aging, 11, 572–581.CrossRefGoogle Scholar

Copyright information

© Springer 2006

Authors and Affiliations

  • Lisa M. Fiksenbaum
    • 1
  • Esther R. Greenglass
    • 1
  • Sandra R. Marques
    • 1
  • Judy Eaton
    • 1
  1. 1.Department of PsychologyYork UniversityTorontoCanada

Personalised recommendations