Unmet need for ADL assistance is associated with mortality among older adults with mild disability

Shuang He, Bruce A. Craig, Huiping Xu, Kenneth E. Covinsky, Eric Stallard, Joseph Thomas, Zach Hass, Laura P. Sands

Research output: Contribution to journalArticle

19 Scopus citations


Background. 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. Methods. 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. Results. 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. Conclusion. 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.

Original languageEnglish (US)
Pages (from-to)1128-1132
Number of pages5
JournalJournals of Gerontology - Series A Biological Sciences and Medical Sciences
Issue number9
StatePublished - Jan 1 2015


  • Activities of daily living
  • Mortality
  • Unmet need

ASJC Scopus subject areas

  • Aging
  • Geriatrics and Gerontology

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