Racial and Ethnic Differences in Functional Disability for Older Americans
This paper examines the measurement of physical functioning for a large-scale sample of White, Latino, African American and Asian elders. Because of inherent differences in language, cultural practices, migration history and support systems, it is hypothesized that the measurement properties of physical functioning would vary among these racial/ethnic groups.
Methods: This paper used data from the 2011 California Health Interview Survey (CHIS), the largest state health survey in the US. Five functional disability items chosen for analysis include 1) Have severe vision or hearing problems, 2) Have condition substantially limit physical activities, 3) Difficulty learning, remembering, or concentrating, 4) Difficulty dressing or bathing, or getting around inside the home, and 5) Difficulty going outside alone to shop or visit a doctor’s office.
Internal consistency, tau-equivalent and confirmatory factor analysis were conducted separately on the items for each aggregated race group. The overall sample consisted of 14,115 individuals aged 65 and older.
Results: Initial analysis on the dimensionality of the five-item scale measuring functional disability indicated a poor fit with the data. Separate CFA models with different factor patterns for each of the major race groups yielded improved goodness of fit statistics. Results from reliability indicated reasonably good internal consistency for the items with all groups (α >= 0.60). CFA results indicated that overall, the factor loadings were strongest (λ=0.80 and up) for 4) Dressing and 5) Going Out. The item 1) Vision/Hearing Problems varied the most, where the loadings were fairly weak for Whites (λ=0.34) and Blacks (λ=0.26), while it was much stronger for Asians (λ=0.42) and Latinos (λ=0.50).
Conclusions and Implications: Results suggest that the five item scale for disability reasonably captures physical functioning for the overall older population. For all race/ethnic groups of elders, functional disability is most strongly represented by being able to care for oneself independently inside the home and going outside to run errands. However, evidence of differences in factor patterns across groups suggests that this measure may not be appropriate for cross-racial comparison. Findings also indicate that for Latino and Asian elders who straddle multiple cultures, visual and hearing impairments can be especially problematic in negotiating one’s needs later in life. Public policy regarding funding for services should take into account how physical functioning, particularly visual and auditory impairment, may be perceived differently among Asian and Latino race groups due to language and social capital resources. Future research should also establish a meaningful clinical cutoff score of physical functioning for both clinical services and interventions.