Disability and Care Needs of Older Americans by Dementia Status: An Analysis of the 2011 National Health and Aging Trends Study. Activity Limitations and Assistance by Dementia Status

04/29/2014

Activity Limitations and Assistance by Dementia Status

Table 1 shows the percentage and number of adults 65 and older living outside of nursing homes with self-care or mobility limitations, with household activity limitations, and with any limitations by dementia status. Overall, we estimate that 9.7% (3.6 million) have probable dementia, 10.8% have possible dementia (4 million), and 79.5% have no dementia (29.4 million).

  TABLE 1. Self-Care, Mobility, and Household Activity Limitations by Dementia Status in the Non-Nursing Home Population Ages 65 and Older  
(%)
  Probable
  Dementia  
Possible
  Dementia  
No
  Dementia  
Total % 9.7 10.8 79.5
Population estimates (in millions) 3.6 4.0 29.4
Self-care or mobility limitationsa*
   No difficulty and no help 25.0 49.9 69.6
   Difficulty, but no help 15.7 23.3 18.8
   Help 59.3 26.8 11.6
Household activity limitationsb*
   No difficulty and no help 18.1 51.6 71.8
   Difficulty, but no help 7.4 11.2 13.7
   Help for health or functioning reasons   74.5 37.2 14.5
Any limitations*
   No difficulty and no help 12.8 37.9 60.0
   Difficulty, but no help 9.1 20.3 21.6
   Help 78.1 41.8 18.4
SOURCE: 2011 NHATS; N=7069.
NOTES:
  1. Bathing, dressing, eating, toileting, getting out of bed, getting around inside one's home or building, or leaving one's home or building.
  2. Laundry, hot meals, shopping for personal items, paying bills/banking, or handling medications.

* Levels of limitations differ by dementia status at p<0.001.

Activity limitations differed significantly by dementia status. Among persons with probable dementia, 59.3% received help with self-care or mobility, and only 25.0% had no help or difficulty with these activities. By contrast, among those with no dementia 11.6% received help, and 69.6% had no self-care or mobility help or difficulty. Those with possible dementia were more likely to have received self-care or mobility help than those with no dementia (26.8%) but the percentage was well below that for persons with probable dementia.

For household activities, an even higher proportion--about three-quarters--of persons with probable dementia received help. Similarly, persons with possible dementia were more likely to have received help with household activities than with self-care or mobility (37% vs. 27% respectively). By contrast, the proportion of persons with no dementia who received help with household activities was similar (14.5%) to the proportion receiving help with self-care or mobility tasks.

Taking all limitations into account, there is a strong gradient by dementia status for help, difficulty but no help, and no difficulty or help. Among persons with probable dementia, 78% received help, compared with 42% of those with possible and 18% with no dementia. For those with probable dementia, 87% received help or had difficulty, in contrast to 62% of persons with possible dementia and 40% of those with no dementia.

Types and Levels of Assistance by Dementia Status. Table 2 provides a mutually exclusive hierarchy of assistance levels for the non-nursing home population by dementia status. Over one-third of persons with probable dementia were receiving help with three or more self-care or mobility activities. Another 23% received help with 1-2 of these types of activities, and 19% received no help with self-care or mobility activities but received help with household activities for health or functioning reasons. The percentage of those with possible dementia receiving help with three or more self-care or mobility activities was substantially lower (9%) than for persons with probable dementia although proportions receiving assistance with 1-2 activities, and household activities, were closer to levels for those with probable dementia. Only 3.4% of persons with no dementia received assistance with three or more self-care or mobility activities; another 8% received help with 1-2, and 7% received help with household activities only.

TABLE 2. Types and Levels of Assistance by Dementia Status in the Non-Nursing Home Population Ages 65 and Older
Assistance Level Probable Dementia Possible Dementia No Dementia
%   millions   %   millions   %   millions  
3+ self-care or mobility activitiesa   36.3   1.3 8.8 0.4 3.4 1.0
1-2 self-care or mobility activitiesa 23.0 0.8   18.0   0.7 8.1 2.4
Household activitiesb 18.8 0.7 15.0 0.6 6.9 2.0
Any self-care, mobility, or household activity   78.1 2.8 41.8 1.7   18.4   5.4
No assistancec 21.9 0.8 58.2 2.3 81.6 24.0
SOURCE: 2011 NHATS; N=7069.
NOTES:
  1. Assistance with bathing, dressing, eating, toileting, getting out of bed, getting around inside one's home or building, or leaving one's home or building.
  2. Assistance for health or functioning reasons with laundry, hot meals, shopping for personal items, paying bills/banking, handling medications and no assistance with self-care or mobility.
  3. No assistance with self-care, mobility or household activities for health or functioning reasons.

Among the 2.7 million older people not residing in nursing homes who received assistance with three or more self-care or mobility activities, 1.3 million or close to half were persons with probable dementia. Among all persons receiving help, those with probable dementia accounted for 28% (2.8 million out of 9.9 million) and those with probable or possible dementia comprised 45%. These estimates underscore the significant role dementia plays in who receives assistance with daily activities among older people.

Table 3 shows the mutually exclusive hierarchy of levels of assistance by age group and dementia status for those living in the community and supportive care settings other than nursing homes. As expected, percentages reporting help increased with age regardless of dementia status: for those with probable dementia from 61% in the youngest, to 92% in the oldest age group, and among persons with no dementia from 13% to 44%, respectively. Among those with probable dementia, however, levels of assistance were high at all ages, and from about one-quarter of the youngest age group to almost half of the oldest received assistance with three or more self-care or mobility activities. Among those with no dementia, only 2% of the youngest and 10% of the oldest received this level of assistance.

TABLE 3. Types and Levels of Assistance by Dementia Status and Age in the Non-Nursing Home Population Ages 65 and Older
(%)
    65-74     75-79     80-84     85 or  
Older
Probable dementia
   3+ self-care or mobility activitiesa 25.8 34.1 30.2 47.3
   1-2 self-care or mobility activitiesa   14.9 16.9 26.0 29.0
   Household activitiesb 20.5 9.6 22.5 15.2
   Any self-care, mobility, or household activity 61.2 70.6 78.7 91.5
   No assistance 38.8 29.4 21.3 8.5
Possible dementia
   3+ self-care or mobility activitiesa 6.9 6.5 12.0 10.9
   1-2 self-care or mobility activitiesa 13.3 15.4 18.9 27.3
   Household activitiesb 12.0 15.5 11.4 22.7
   Any self-care, mobility, or household activity 32.2 37.4 42.3 60.9
   No assistance 67.8 62.6 57.7 39.1
No dementia
   3+ self-care or mobility activitiesa 2.0 4.6 3.7 10.3
   1-2 self-care or mobility activitiesa 6.9 6.5 10.5 16.4
   Household activitiesb 4.1 7.5 10.8 17.5
   Any self-care, mobility, or household activity 13.0 18.6 25.0 43.8
   No assistance 87.0 81.4 75.0 56.2
SOURCE: 2011 NHATS; N=7609.
NOTES:
  1. Assistance with bathing, dressing, eating, toileting, getting out of bed, getting around inside one's home or building, or leaving one's home or building.
  2. Assistance for health or functioning reasons with laundry, hot meals, shopping for personal items, paying bills/banking, handling medications and no assistance with self-care or mobility.

Differences in levels of assistance within age group by dementia status are striking. Among 65-74 year olds with no dementia, only 13% received any assistance, and only 2% were persons receiving the most intense levels of help, whereas 61% of 65-74 year olds with probable dementia received assistance, and 26% were persons who received help with three or more self-care or mobility activities. Among persons 85 or older with probable dementia, 92% received assistance compared with 44% of persons in this age group with no dementia. Persons with possible dementia fall between those with probable dementia and no dementia at each age group in terms of levels of assistance.

Demographic Characteristics. Table 4 shows demographic characteristics by dementia status for all persons living outside of nursing homes and among only those receiving assistance with any self-care, mobility or household activities for health or functioning reasons.

TABLE 4. Demographic Characteristics by Dementia Status Among Persons Receiving Any Assistance in the Non-Nursing Home Population Ages 65 and Older
(%)
  Any Self-Care, Mobility,
or Household Activity Assistancea
Total Non-Nursing
Home Population
  Total  
  Probable     Possible   No
  Dementia  
  Probable     Possible   No
  Dementia  
Gender
   Male 34.4 39.0 28.2 39.5 49.3 43.1 43.4
   Female 65.6 61.0 71.8 60.5 50.7 56.9 56.6
Income
   Lowest quartile 46.1 44.9 32.6 44.9 36.2 19.5 23.8
   2nd quartile 28.9 27.8 29.0 29.9 25.9 23.3 24.3
   3rd quartile 16.6 17.3 22.2 17.0 22.6 28.5 26.7
   Highest quartile 8.4 10.1 16.2 8.2 15.3 28.7 25.2
Race/ethnicity
   White 69.8 69.1 79.7 67.6 70.0 83.6 80.5
   Black 12.1 11.5 8.5 12.4 10.6 7.2 8.1
   Hispanic/other 18.1 19.4 11.8 20.0 19.4 9.2 11.4
Marital statusb
   Married 37.4 39.4 48.3 39.3 48.1 60.4 57.0
   Divorced/separated   9.7 10.7 12.0 10.2 12.8 12.4 12.2
   Widowed 47.1 46.1 34.9 44.1 35.3 23.8 27.1
SOURCE: 2011 NHATS; N=7609.
NOTES:
  1. Assistance with bathing, dressing, eating, toileting, getting out of bed, getting around inside one's home or building, or leaving one's home or building or, for health or functioning reasons, with laundry, hot meals, shopping for personal items, paying bills/banking, handling medications.
  2. Never married not shown.

Gender. Women were a similar proportion of persons with probable and no dementia (60% and 57% respectively). Among persons who received assistance, they were a somewhat higher percentage (72%) of those with no dementia compared to those with probable dementia (66%).

Income. Among persons with probable dementia, 45% were in the lowest income quartile and only 8% were in the highest quartile. By contrast among those with no dementia 19% were in the lowest quartile and 29% were in the highest. Among those who received assistance, this pattern held although the differences were somewhat smaller: 46% were in the lowest quartile among those with probable dementia, and 33% were in the lowest quartile among those with no dementia. Overall, among persons receiving assistance, a much higher percentage were in the lowest income quartile (from 33% to 46%) than the highest quartile (from 8% to 16%), regardless of dementia status.

Race/ethnicity. Although the proportion of persons who are White was lower among those with probable dementia (68%) than those with no dementia (84%), the majority of persons with dementia are White. The proportion of Black, Hispanic, and persons of other races was higher among persons with probable dementia and lower among those with no dementia (e.g., 12% of persons with probable dementia were Black, and 7% of those with no dementia were Black). These patterns by dementia status held among persons who received assistance.

Marital status. Widowed persons were a higher proportion of persons with probable dementia (44%) than of persons with no dementia (24%), likely due in part to the older age of many widowed individuals. Married persons accounted for 39% of those with probable dementia and 60% of those with no dementia. Differences were narrower among persons who received help. Married persons were 37% of persons with probable dementia who received assistance and 48% of persons with no dementia who received assistance.

Demographic Characteristics by Levels of Assistance for Persons with Probable Dementia. Table 5 shows demographic characteristics by levels of assistance among persons with probable dementia. Women, persons in the lowest income quartile, White persons and those who were widowed, were a larger proportion of persons with probable dementia who were receiving help across all levels of assistance. For the most part, these patterns mirror those for persons with possible or no dementia who are receiving help.

TABLE 5. Demographic Characteristics by Levels of Assistance for Persons with Probably Dementia in the Non-Nursing Home Population Ages 65 and Older
(%)
  3+ Self-Care
  or Mobility Activitiesa  
1-2 Self-Care
  or Mobility Activitiesa  
Household
  Activitiesb  
Any Self-Care,
Mobility, or
  Household Activities  
Gender
   Male 33.4 31.5 39.7 34.4
   Female 66.6 68.5 60.3 65.6
Income
   Lowest quartile 46.1 47.3 44.5 46.1
   2nd quartile 31.2 27.9 25.7 28.9
   3rd quartile 14.6 19.1 17.5 16.6
   Highest quartile 8.0 5.7 12.3 8.4
Race/ethnicity
   White 69.9 67.7 72.2 69.8
   Black 13.1 13.9 7.8 12.1
   Hispanic/other 16.9 18.4 20.0 18.1
Marital Statusc
   Married 37.2 35.5 40.1 37.4
   Divorced/separated   7.9 10.2 12.5 9.7
   Widowed 48.8 48.3 42.4 47.1
SOURCE: 2011 NHATS; N=838.
NOTES:
  1. Assistance with bathing, dressing, eating, toileting, getting out of bed, getting around inside one's home or building, or leaving one's home or building.
  2. Assistance for health or functioning reasons with laundry, hot meals, shopping for personal items, paying bills/banking, handling medications (but not self-care, mobility, or household activities).
  3. Never married not shown.

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