Mid-Life Adults with Functional Limitations: Comparison of Adults Aging into and with Disability

Purpose: This study examined how the onset of disability affected mid-life individuals with activity limitations from arthritis, one of the most common causes of physical disabilities in the U.S. The onset of disability affects the course of disability processes, which, in turn, differentially affect individuals’ psychological distress, financial conditions, and interactions with healthcare providers. It was hypothesized that mid-life adulthood is more challenging for individuals with late-onset disabilities because they need to adjust to aging-related changes, as well as disability-related changes at the same time as they transition to older adulthood. Using the 2014 and 2015 National Health Interview Survey (NHIS), this study compared three groups of mid-life adults (ages 50-64) based on their disability status and disability onset: (1) individuals without any physical limitations (n=13,779); (2) individuals with early-onset arthritis that has limited their physical activities for more than 20 years (aging with disability, n=330); (3) individuals who has experienced late-onset disability due to arthritis for less than five years (aging into disability, n=299).   

Methods: The dependent variables included: (1) financial worries (e.g., retirement, medical expenses), (2) ease of access to healthcare (e.g., trouble finding a doctor), (3) affordability of necessary medical services (e.g., prescription medicine, dental care), (4) physical functioning (e.g., climbing 10 steps, participating with social activities), and (5) psychological distress (e.g., hopeless, sad). The STATA SVY procedures were used for descriptive statistics and multivariate regression models to account for the complex sampling design of the NHIS. Covariates included demographic and socio-economic characteristics, employment and insurance status, and health conditions.         

Results: The results indicate significant group differences by disability status. Compared with the two groups with disability, mid-life adults without any physical limitations were more likely to be married, college educated, high income, and currently employed. They also experienced considerably lower levels of financial worries, financial barriers to necessary healthcare, functional limitations, and psychological distress. On the other hand, mid-life adults with disability in both groups displayed vulnerability in all areas. However, the two groups were different in significant ways. Compared with mid-life individuals with early-onset disability, those with a short history of disability were more likely to worry about their finance in general and were more likely to report that the doctor’s office did not accept their health insurance. On the other hand, mid-life individuals with early-onset disability had significantly higher levels of activity limitations. The two groups with disability were not different in terms of their psychological distress and experience of financial barriers to necessary healthcare.

Implications: This study clearly indicates how experiencing disability on top of aging is challenging for mid-life adults. This study also clearly demonstrates that considering the duration of disability among mid-life adults is important for practitioners and researchers. Individuals aging with disability may have had more time to prepare for their older ages and have established the relationship with their healthcare providers, while individuals aging into disability appear to experience more challenges with their finances and navigating medical services.