Online Program

More education may limit the impact of cognitive impairment on disability and life expectancy for older Americans

Monday, November 4, 2013

Sarah Laditka, PhD, Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC
James N. Laditka, DA, PhD, MPA, Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC
Cognitive impairment in older age is a major cause of disability. We examined effects of education on life expectancy and life-course disability associated with cognitive impairment. We followed a cohort ages 55+ in 1992 (mean 67.4) for 17 years using the U.S. Panel Study of Income Dynamics (n=2,165). The outcome measure was disability in activities of daily living, such as bathing, dressing, and eating. Cognitive health was repeatedly measured by asking, “Has a doctor ever told you that you have permanent loss of memory or mental ability?” Focusing on individuals with cognitive impairment, we estimated monthly probabilities of disability transitions and death with multinomial logistic Markov models with seven levels of education, adjusting for age, gender, income and other confounders. Most measures were updated at each wave. Random effects adjusted for multiple observations for individuals. The disability probabilities were used to conduct microsimulations, creating large populations with monthly disability records from age 55 to death for each individual. Bootstrapping addressed survey design. There was a strong gradient associating education with disability. Given survival to age 55, average total years lived and years with disability among women with cognitive impairment were 90.8/9.6 for the highest education group (>16 years), 81.9/13.0 for the lowest (<8 years), with a linear trend between these end-points (p<0.0001). Corresponding results for men were 89.9/7.7, 80.5/10.7. Thus, the proportion of remaining life with disability comparing low to high education was 81.4% greater for women, 91.9% for men. Education may substantially limit disability associated with cognitive impairment.

Learning Areas:

Public health or related research
Social and behavioral sciences

Learning Objectives:
Compare associations between levels of educational attainment and both life expectancy and life course disability in activities of daily living for individuals with cognitive impairment. Evaluate the public health concern that extending life through healthy behaviors, which are associated with educational attainment, might increase disability as a result of the greater prevalence of cognitive impairment at older ages. Analyze the health disparities in life expectancy and disabled life associated with low educational attainment.

Keyword(s): Disability, Education

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the co-principal investigator on several federally funded grants focused on limiting disability through healthy behaviors, promoting cognitive health, and measuring active life expectancy. My research emphasizes life course methods and longitudinal data analysis, and the development of new applications of active life expectancy research methods to better understand causes of disability, poor health, and health disparities.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.