{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T23:32:10Z","timestamp":1787700730745,"version":"build-2784847793"},"reference-count":30,"publisher":"American Public Health Association","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Public Health"],"published-print":{"date-parts":[[2014,2]]},"abstract":"<jats:p>Objectives. To inform public health efforts to promote independent functioning among older adults, we have provided new national estimates of late-life disability that explicitly recognize behavioral adaptations.<\/jats:p>\n                  <jats:p>Methods. We analyzed the 2011 National Health and Aging Trends Study, a study of Medicare enrollees aged 65 years and older (n\u2009=\u20098077). For 7 mobility and self-care activities we identified 5 hierarchical stages\u2014fully able, successful accommodation with devices, activity reduction, difficulty despite accommodations, and receipt of help\u2014and explored disparities and associations with quality of life measures.<\/jats:p>\n                  <jats:p>Results. Among older adults, 31% were fully able to complete self-care and mobility activities. The remaining groups successfully accommodated with devices (25%), reduced their activities (6%), reported difficulty despite accommodations (18%), or received help (21%). With successive stages, physical and cognitive capacity decreased and symptoms and multimorbidity increased. Successful accommodation was associated with maintaining participation in valued activities and high well-being, but substantial disparities by race, ethnicity, and income existed.<\/jats:p>\n                  <jats:p>Conclusions. Increased public health attention to behavioral adaptations to functional change can promote independence for older adults and may enhance quality of life.<\/jats:p>","DOI":"10.2105\/ajph.2013.301687","type":"journal-article","created":{"date-parts":[[2013,12,12]],"date-time":"2013-12-12T16:04:02Z","timestamp":1386864242000},"page":"e88-e94","source":"Crossref","is-referenced-by-count":105,"title":["Behavioral Adaptation and Late-Life Disability: A New Spectrum for Assessing Public Health Impacts"],"prefix":"10.2105","volume":"104","author":[{"given":"Vicki A.","family":"Freedman","sequence":"first","affiliation":[{"name":"Vicki A. Freedman is with the Institute for Social Research, University of Michigan, Ann Arbor. Judith D. Kasper is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Brenda C. Spillman is with the Health Policy Center, the Urban Institute, Washington, DC. Emily M. Agree is with the Department of Sociology, Johns Hopkins University. Vincent Mor is with the Department of Health Services, Policy and Practice, Brown University, Providence, RI..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judith D.","family":"Kasper","sequence":"additional","affiliation":[{"name":"Vicki A. Freedman is with the Institute for Social Research, University of Michigan, Ann Arbor. Judith D. Kasper is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Brenda C. Spillman is with the Health Policy Center, the Urban Institute, Washington, DC. Emily M. Agree is with the Department of Sociology, Johns Hopkins University. Vincent Mor is with the Department of Health Services, Policy and Practice, Brown University, Providence, RI..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brenda C.","family":"Spillman","sequence":"additional","affiliation":[{"name":"Vicki A. Freedman is with the Institute for Social Research, University of Michigan, Ann Arbor. Judith D. Kasper is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Brenda C. Spillman is with the Health Policy Center, the Urban Institute, Washington, DC. Emily M. Agree is with the Department of Sociology, Johns Hopkins University. Vincent Mor is with the Department of Health Services, Policy and Practice, Brown University, Providence, RI..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily M.","family":"Agree","sequence":"additional","affiliation":[{"name":"Vicki A. Freedman is with the Institute for Social Research, University of Michigan, Ann Arbor. Judith D. Kasper is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Brenda C. Spillman is with the Health Policy Center, the Urban Institute, Washington, DC. Emily M. Agree is with the Department of Sociology, Johns Hopkins University. Vincent Mor is with the Department of Health Services, Policy and Practice, Brown University, Providence, RI..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent","family":"Mor","sequence":"additional","affiliation":[{"name":"Vicki A. Freedman is with the Institute for Social Research, University of Michigan, Ann Arbor. Judith D. Kasper is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Brenda C. Spillman is with the Health Policy Center, the Urban Institute, Washington, DC. Emily M. Agree is with the Department of Sociology, Johns Hopkins University. Vincent Mor is with the Department of Health Services, Policy and Practice, Brown University, Providence, RI..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert B.","family":"Wallace","sequence":"additional","affiliation":[{"name":"Vicki A. Freedman is with the Institute for Social Research, University of Michigan, Ann Arbor. Judith D. Kasper is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Brenda C. Spillman is with the Health Policy Center, the Urban Institute, Washington, DC. Emily M. Agree is with the Department of Sociology, Johns Hopkins University. Vincent Mor is with the Department of Health Services, Policy and Practice, Brown University, Providence, RI..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas A.","family":"Wolf","sequence":"additional","affiliation":[{"name":"Vicki A. Freedman is with the Institute for Social Research, University of Michigan, Ann Arbor. Judith D. Kasper is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Brenda C. Spillman is with the Health Policy Center, the Urban Institute, Washington, DC. Emily M. Agree is with the Department of Sociology, Johns Hopkins University. Vincent Mor is with the Department of Health Services, Policy and Practice, Brown University, Providence, RI..."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"844","reference":[{"key":"bib2","volume-title":"Chronic Conditions Among Medicare Beneficiaries, Chart Book","author":"Centers for Medicare and Medicaid Services","year":"2011"},{"key":"bib3","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2011.10.018"},{"key":"bib4","doi-asserted-by":"publisher","DOI":"10.1007\/s13524-012-0167-z"},{"key":"bib5","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2011.300602"},{"key":"bib6","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2012.0533"},{"key":"bib7","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2004.048744"},{"key":"bib8","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2011.300617"},{"key":"bib9","doi-asserted-by":"publisher","DOI":"10.1146\/annurev.pu.17.050196.000325"},{"key":"bib10","volume-title":"Public Health and Aging: Maximizing Functioning and Wellbeing","author":"Albert SA","year":"2010","edition":"2"},{"key":"bib11","volume-title":"Older Americans 2012: Key Indicators of Well-Being","author":"Federal Interagency Forum on Aging-Related Statistics","year":"2012"},{"key":"bib12","volume-title":"The State of Aging and Health in America 2007","author":"Centers for Disease Control and Prevention","year":"2007"},{"key":"bib13","doi-asserted-by":"publisher","DOI":"10.1097\/00003727-200310000-00004"},{"key":"bib14","doi-asserted-by":"publisher","DOI":"10.1093\/geront\/46.1.124"},{"key":"bib15","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.24.4.1140"},{"key":"bib16","doi-asserted-by":"publisher","DOI":"10.1016\/S0895-4356(01)00357-2"},{"key":"bib17","doi-asserted-by":"publisher","DOI":"10.1177\/089826430101300402"},{"key":"bib18","volume-title":"The Future of Disability in America","author":"Institute of Medicine","year":"2007"},{"key":"bib19","volume-title":"National Health and Aging Trends Study Development of Round 1 Survey Weights","author":"Montaquila J","year":"2012"},{"key":"bib20","volume-title":"National Health and Aging Trends Study Round 1 User Guide: Final Release","author":"Kasper J","year":"2012"},{"key":"bib21","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1963.03060120024016"},{"key":"bib22","author":"Freedman VA","year":"2013","journal-title":"Gerontologist"},{"key":"bib23","doi-asserted-by":"publisher","DOI":"10.1093\/gerona\/glr087"},{"key":"bib24","doi-asserted-by":"publisher","DOI":"10.1093\/geronj\/49.2.M85"},{"key":"bib25","volume-title":"Construction of Performance-Based Summary Measures of Physical Capacity in the National Health and Aging Trends Study","author":"Kasper JD","year":"2012"},{"key":"bib26","doi-asserted-by":"publisher","DOI":"10.1002\/9780470316696"},{"issue":"6","key":"bib28","first-page":"613","volume":"50","author":"Kroenke K","year":"2009","journal-title":"Psychosomatics"},{"key":"bib29","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2009.06.019"},{"key":"bib30","volume-title":"National Health and Aging Trends Study. 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