{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T13:26:19Z","timestamp":1792416379154,"version":"4.4.0"},"reference-count":45,"publisher":"Oxford University Press (OUP)","issue":"8","funder":[{"DOI":"10.13039\/100008069","name":"University of California, San Francisco","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008069","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["K23AG045290"],"award-info":[{"award-number":["K23AG045290"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["K76AG057016"],"award-info":[{"award-number":["K76AG057016"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["P30AG044281"],"award-info":[{"award-number":["P30AG044281"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["K24AG049057"],"award-info":[{"award-number":["K24AG049057"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01AG0478897"],"award-info":[{"award-number":["R01AG0478897"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000965","name":"American Federation for Aging Research","doi-asserted-by":"publisher","award":["K76AG057016"],"award-info":[{"award-number":["K76AG057016"]}],"id":[{"id":"10.13039\/100000965","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,8,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Understanding the hierarchy of functional impairment in older adults has helped illuminate mechanisms of impairment and inform interventions, but little is known about whether hierarchies vary by age. We compared the pattern of new-onset impairments in activities of daily living (ADLs) and instrumental ADLs (IADLs) from middle age through older age.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a cohort study using nationally representative data from 32 486 individuals enrolled in the Health and Retirement Study. The outcomes were new-onset impairment in each ADL and IADL, defined as self-reported difficulty performing each task, assessed yearly for 9 years. We used multistate models and competing risks survival analysis to estimate the cumulative incidence of impairment in each task by age group (ages 50\u201364, 65\u201374, 75\u201384, and 85 or older).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The pattern of incident ADL impairments differed by age group. Among individuals ages 50\u201364 and 65\u201374 who were independent at baseline, over 9 years\u2019 follow-up, difficulties dressing and transferring were the most common impairments to develop. In individuals ages 75\u201384 and 85 or older who were independent at baseline, difficulties bathing, dressing, and walking were most common. For IADLs, the pattern of impairments was similar across age groups; difficulty shopping was most common followed by difficulty managing money and preparing meals. Complementary analyses demonstrated a similar pattern.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>These findings suggest that the hierarchy of ADL impairment differs by age. These findings have implications for the development of age-specific interventions to prevent or delay functional impairment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/gerona\/glab250","type":"journal-article","created":{"date-parts":[[2021,9,8]],"date-time":"2021-09-08T23:03:56Z","timestamp":1631142236000},"page":"1577-1584","source":"Crossref","is-referenced-by-count":22,"title":["Changes in the Hierarchy of Functional Impairment From Middle Age to Older Age"],"prefix":"10.1093","volume":"77","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7483-4137","authenticated-orcid":false,"given":"Rebecca T","family":"Brown","sequence":"first","affiliation":[{"name":"Division of Geriatric Medicine, Perelman School of Medicine of the University of Pennsylvania , Philadelphia , USA"},{"name":"Geriatrics and Extended Care Program, Corporal Michael J. 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Crescenz Veterans Affairs Medical Center , Philadelphia, Pennsylvania , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1621-9309","authenticated-orcid":false,"given":"L Grisell","family":"Diaz-Ramirez","sequence":"additional","affiliation":[{"name":"Division of Geriatrics, Department of Medicine, University of California, San Francisco , USA"},{"name":"Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical Center , California , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W John","family":"Boscardin","sequence":"additional","affiliation":[{"name":"Division of Geriatrics, Department of Medicine, University of California, San Francisco , USA"},{"name":"Department of Epidemiology & Biostatistics, University of California, San Francisco , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne R","family":"Cappola","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Diabetes, and Metabolism, Perelman School of Medicine of the University of Pennsylvania , Philadelphia , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sei J","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Geriatrics, Department of Medicine, University of California, San Francisco , USA"},{"name":"Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical Center , California , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael A","family":"Steinman","sequence":"additional","affiliation":[{"name":"Division of Geriatrics, Department of Medicine, University of California, San Francisco , USA"},{"name":"Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical Center , California , 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