Abstract
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.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
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.
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.
Arbuckle, J.L., & Wothke, W. (1999). Amos 4.0 User’s Guide. Chicago: SPSS Inc.
Bebbington, P.E. (1996). The origins of sex differences in depressive disorder: Bridging the gap. International Review of Psychiatry, 8, 295–332.
Brandt, E.N., & Pope, A.M. (Eds.). (1997). Enabling America: Assessing the role of rehabilitation science and engineering. Washington, DC: National Academy Press.
Carstensen, L.L. (1992). Social and emotional patterns in adulthood: Support for socioemotional selectivity theory. Psychology and Aging, 7, 331–338.
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.
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.
Derogatis, L. (1993). Brief Symptom Inventory: Administration, scoring and procedural manual. Minneapolis, MN: National Computer Systems.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Johnson, R. J., & Wolinsky, F.D. (1999). Functional status, receipt of help, and perceived health. Journal of Clinical Geropsychology, 5, 105–125.
Kandrack, M., Grant, K.R., & Seagall, A. (1991). Gender differences in health related behavior: Some unanswered questions. Social Science and Medicine, 32, 579–590.
Katz, J.N. (2001). Preferences, quality and the (under) utilization of total joint arthroplasty. Medical Care, 39, 203–205.
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.
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.
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.
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.
Krause, N. (1998). Elderly parental loss, recent life events, and changes in health among older adults. Journal of Aging and Health, 10, 395–421.
Kuehner, C. (2003). Gender differences in unipolar depression: An update of epidemiological findings and possible explanations. Acta Psychiatrica Scandinavica, 108, 163–174.
Lawrence, R.H., & Jette, A.M. (1996). Disentangling the disablement process. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 51B, S173-S182.
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.
Liang, J. (1990). The national survey of Japanese elderly. Ann Arbor, MI: Institute of Gerontology.
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.
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.
Manton, K.G. (1997). Demographic trends for the aging female population. Journal of the American Medical Women’s Association, 52, 99–105.
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.
McNair, D. M., Loor, M., & Droppleman, L. (1992). Profile of Mood States. San Diego, CA: EdITS/Educational and Industrial Testing Service, Inc.
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.
Murtagh, K., & Hubert, H.B. (2004). Gender differences in physical disability among an elderly cohort. American Journal of Public Health, 94, 1406–1411.
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.
Oman, D., Reed, D., & Ferrara, A. (1999). Do elderly women have more physical disability than men do? American Journal of Epidemiology, 150, 834–842.
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.
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.
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.
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.
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.
Piccinelli, M., & Wilkinson, G. (2000). Gender differences in depression: Critical review. British Journal of Psychiatry, 177, 486–492.
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.
Reker, G.T. (1997). Personal meaning, optimism, and choice: Existential predictors of depression in community and institutional elderly. The Gerontologist, 37, 709–716.
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.
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.
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.
Scocco, P., Meneghel, G., Dello-Buono, M., & De-Leo, D. (2001). Hostility as a feature of elderly suicidal ideators. Psychological Reports, 88, 863–868.
Sprock, J., & Yoder, C.Y. (1997). Women and depression: An update on the report of the APA Task Force. Sex Roles, 36, 269–303.
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.
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.
Verbrugge, L.M., & Jette, A.M. (1994). The disablement process. Social Science and Medicine, 38, 1–14.
Verbrugge, L.M., & Wingard, D.I. (1987). Sex differentials in health and mortality. Women and Health, 12, 103–147.
Wray, L.A., & Blaum, C.S. (2001). Explaining the role of sex on disability: A population-based study. The Gerontologist, 41, 499–510.
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.
Author information
Authors and Affiliations
Corresponding author
Additional information
Her research interests include social functioning among the elderly, organizational issues, stress, and coping. Ms. Fiksenbaum has published papers in these areas and presented research papers at international psychology conferences.
Her research interests include gender, job stress, burnout and coping, psychosocial factors and aging, and psychological effects of SARS on nurses. Professor Greenglass serves on numerous academic journal editorial boards and does extensive reviewing for journals, academic conferences, and granting agencies.
Sandra R. Marques is currently completing her second year of a Master’s program in Social and Personality Psychology at Queen’s University in Kingston, Ontario, Canada. Her present interests include self-conscious emotions—particularly guilt and shame—and their influence on intentions and condom use.
Judy Eaton recently received her Ph.D. from York University, and is currently assistant professor at Wilfrid Laurier University Brantford Campus in Brantford, Ontario, Canada. Her research interests include apology, forgiveness, and interpersonal transgressions.
Rights and permissions
About this article
Cite this article
Fiksenbaum, L.M., Greenglass, E.R., Marques, S.R. et al. A psychosocial model of functional disability. Ageing Int. 30, 278–295 (2005). https://doi.org/10.1007/s12126-005-1016-9
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s12126-005-1016-9