Unmet Need for ADL Assistance Is Associated With Mortality Among Older Adults With Mild Disability.

Journal Article (Journal Article)


Unmet need for assistance with activities of daily living (ADLs) disability is associated with increased risk for future hospitalization. To further explore the association between unmet ADL need and future health outcomes, we examined the association between unmet need for ADL assistance and 1-year mortality.


A prospective study of 6,730 community-living Medicare recipients was conducted among respondents to the 1994, 1999, and/or 2004 National Long Term Care Survey. Only those who reported having one or more ADL disabilities were included. Time to death within 1 year after the community survey was determined from Centers for Medicare and Medicaid Services vital statistics records. The community interviews provided demographic, health, and ADL information.


Unadjusted 1-year death rates were 8.7%, 10.6%, 11.4%, 19.2%, and 27.3%, respectively, for respondents with disabilities in 1, 2, 3, 4, and 5 ADLs. Overall, 21.3% reported unmet need for assistance for one or more ADL disabilities. After controlling for demographic and health characteristics, we found a significant interaction between unmet ADL need and level of ADL disability (p = .018). Post hoc analyses revealed that unmet ADL need was associated with increased risk for mortality only for those with one (hazard ratio = 1.96; 95% CI = 1.29-2.87) or two ADL disabilities (hazard ratio = 1.37; 95% CI = 1.07-1.75), but not for those with three or more ADL disabilities.


Future studies are needed to determine whether these findings are replicable and, if so, whether physiologic or process of care variables explain why ADL is associated with mortality only for those with mild disability.

Full Text

Duke Authors

Cited Authors

  • He, S; Craig, BA; Xu, H; Covinsky, KE; Stallard, E; Thomas, J; Hass, Z; Sands, LP

Published Date

  • September 2015

Published In

Volume / Issue

  • 70 / 9

Start / End Page

  • 1128 - 1132

PubMed ID

  • 25834196

Pubmed Central ID

  • PMC4841172

Electronic International Standard Serial Number (EISSN)

  • 1758-535X

International Standard Serial Number (ISSN)

  • 1079-5006

Digital Object Identifier (DOI)

  • 10.1093/gerona/glv028


  • eng