Abstract
The Disablement Process model proposes a pathway for how chronic diseases in late life can lead to disability, with the variables in the main pathway designated as pathology, impairment, functional limitations, and disability. The model also suggests that psychosocial and contextual variables in the periphery of the model affect disability outcomes. The current study included 149 Swedish adults aged 86, 90, or 94 living in the community or in institutions who answered questions and performed tasks of physical and cognitive ability. A series of regressions were used to test the mediating role of variables within the main pathway of the model, as well as the ability of psychosocial variables to mediate main pathway relationships. Results indicated that physical limitations accounted for between 31 and 52% of the direct effects between impairments and disability, but delayed recall did not mediate these relationships. For the tests of psychosocial variables, mastery was a consistent mediator between impairments and functional limitations, and also mediated several relationships between functional limitations and disability variables. Depression and loneliness also mediated some of the relationships within the main pathway, but explained a smaller percentage of the total effects than mastery. The study concludes that the Disablement Process model is an effective biopsychosocial approach in describing and predicting disability in the oldest-old. In addition, the course of disability seems to be buffered by certain psychosocial variables, particularly feelings of mastery.
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References
Baron RM, Kenny DA (1986) The moderator–mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol 51:1173–1182
Bauco C (1996) Functional status and well-being of centenarians. Arch Gerontol Geriat Suppl 5:363–366
Beckett LA, Brock DB, Lemke JH, Mendes de Leon CF, Guralnik JM, Fillenbaum GG, Branch LG, Wetle TT, Evans DA (1996) Analysis of change in self-reported physical function among older persons in four population studies. Am J Epidemiol 143:766–778
Camacho TC, Strawbridge WJ, Cohen RD, Kaplan GA (1993) Functional ability in the oldest-old: cumulative impact of risk factors from the preceding two decades. J Aging Health 5:439–454
Caplan LJ, Schooler C (2003) The roles of fatalism, self-confidence, and intellectual resources in the disablement process in older adults. Psychol Aging 18(3):551–561
Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383
Cook NR, Evans DA, Scherr PA, Speizer FE, Vedal S, Branch LG, Huntley JC, Hennekens CH, Taylor JO (1989) Peak expiratory flow rate in an elderly population. Am J Epidemiol 130:66–78
Clarke P, George LK (2005) The role of the built environment in the disablement process. Am J Public Health 95(11):11–17
Femia EE, Zarit SH, Johansson B (1997) Predicting change in activities of daily living: a longitudinal study of the oldest-old in Sweden. J Gerontol Ser B Psychol Sci Soc Sci 52(6):1079–5014
Femia EE, Zarit SH, Johansson B (2001) The disablement process in very late life: a study of the oldest-old in Sweden. J Gerontol Ser B Psychol Sci Soc Sci 56:12–23
Gold C, Malmberg B, McClearn GE, Pederson NL, Berg S (2002) Gender and health: a study of older unlike-sex twins. J Gerontol Soc Sci 57B(3):S168–S176
House JS, Landis KR, Umberson D (1988) Social direct effects and health. Science 241:540–545
Johansson B (1988/1989) The MIR-memory in reality test. Psykologiforlaget AB, Stockholm
Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW (1963) Studies of illness and the aged. The index of ADL: a standardized measure of biological and psychosocial function. J Am Med Assoc 185:914–923
Kempen GIJM, van Heuvelen MJG, van Sonderen E, van den Brink RHS, Kooijman AC, Ormel J (1999) The direct effect of functional limitations to disability and the moderating effects of psychological attributes in community dwelling older persons. Soc Sci Med 48:1161–1172
Kobasa SCO, Maddi SR, Puccetti MC, Zola MA (1994) Effectiveness of hardiness, exercise and social support as resources against illness. In: Steptoe A, Wardle J (eds) Psychosocial processes and health: a reader. Cambridge University Press, New York, pp 247–260
Kunkel SR, Appelbaum RA (1992) Estimating the prevalence of long-term disability for an aging society. J Gerontol Soc Sci 47:S253–S260
Lauretani F, Russo CR, Bandinelli S, Bartali B, Cavazzini C, Di Iorio A, Corsi AM, Rantanen T, Guralnik JM, Ferrucci L (2003) Age-associated changes in skeletal muscles and their effect on mobility: an operational diagnosis of sarcopenia. J Appl Physiol 95:1851–1860
Lawrence RH, Jette AM (1996) Disentangling the disablement process. J Gerontol Soc Sci 51B:S173–S182
Lawton MP (1971) The functional assessment of older people. J Am Geriatr Soc 19:465–481
MacKinnon DP, Dwyer JH (1993) Estimating mediated effects in prevention studies. Eval Rev 17:144–158
Malmberg B (1990) Access to resources in different age-cohorts. Implications for activity level, loneliness and life satisfaction. Unpublished dissertation. Linköping University, Linköping, Sweden
Mendes de Leon C, Glass T, Beckett L, Seeman T, Evans D, Berkman L (1999) Social networks and disability transitions across eight intervals of yearly data in the New Haven EPESE. J Gerontol 54:S162–S172
Pearlin L, Schooler C (1978) The structure of coping. J Health Soc Behav 19:2–21
Peek MK, Ottenbacher KJ, Markides KS, Ostir GV (2003) Examining the disablement process among older Mexican American adults. Soc Sci Med 57(3):413–425
Palatini P (2007) Heart rate as an independent risk factor for cardiovascular disease: current evidence and basic mechanisms. Drugs 67 (Suppl 2):3–13
Potter VA (2007) Pulse oximetry in general practice: how would a pulse oximeter influence patient management? Euro J Gen Prac 13(4):216–220
Radloff LS (1977) The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas 1:385–401
Rogers RG, Rogers A, Belanger A (1992) Disability-free life among the elderly in the United States. J Aging Health 4:19–42
Russell D (1982) The measurement of loneliness. In: Peplau LA, Perlman D (eds) Loneliness: a sourcebook of current theory, research and therapy. Wiley, New York
Smits CHM, Deeg DJH, Jonker C (1997) Cognitive and emotional predictors of disablement in older adults. J Aging Health 9:204–221
Sobel ME (1982) Asymptotic intervals for indirect effects in structural equations models. In: Leinhart S (ed) Sociological methodology. Jossey-Bass, San Francisco, pp 290–312
Stuck A, Walthert J, Nikolaus T, Büla C, Hohmann C, Beck J (1999) Risk factors for functional status decline in community-living elderly people: a systematic literature review. Soc Sci Med 48:445–469
Verbrugge LM, Jette AM (1994) The disablement process. Soc Sci Med 38:1–14
Wilcox V, Kasl S, Berkman L (1994) Social support and physical disability in older people after hospitalization: a prospective study. Health Psychol 13:170–179
Acknowledgments
This research was funded in part by grants from the Swedish Council for Working Life and Social Research, by the National Institute of Mental Health, Interdisciplinary Training in Gerontology, 5 T32 MH18904-17, and by the National Institute on Aging, Interdisciplinary Training in Gerontology, 5 T32 AG00048-27.
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Fauth, E.B., Zarit, S.H. & Malmberg, B. Mediating relationships within the Disablement Process model: a cross-sectional study of the oldest-old. Eur J Ageing 5, 161–179 (2008). https://doi.org/10.1007/s10433-008-0092-6
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DOI: https://doi.org/10.1007/s10433-008-0092-6