Improved versus deteriorated physical functioning among long-term disabled elderly

The usual prognosis for long-term disabled elderly is that they are not likely to improve or regain independent functioning. But computed transition probabilities reveal a significant proportion of improvement. Based on the National Long-Term Care Surveys of 1982 and 1984, this study 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 distinguishes four mutually exclusive statuses of disabled older persons: improved, remaining unchanged, deteriorated-alive, and deteriorated-dead. It shows that cognitive impairment reported in 1982, high-risk medical events that occurred during the year before the 1982 interview, and hospitalization between 1982 and 1984 predict an increased risk of deterioration by 1984. However, similar estimates do not predict improvement. Yet, data compatible with reported improvement suggest that acute medical problems might have caused a temporary worsening of functional status. When the recovery from this status takes more than 3 months, the ensuing change may be recorded as a long-term disability in the initial survey and as an improvement over time. However, long-term disabled elderly seldom improve to such an extent that they regain complete independence in physical functioning. In this study, most of the elderly who improved ended with a functional status similar to that of persons whose ADL disabilities remained unchanged over time.