Effect of Subclinical Status in Functional Limitation and Disability on Adverse Health Outcomes 3 Years Later

BACKGROUND: This article examines the effect of self-reported, baseline subclinical status (i.e., independent but adaptive performance) for functional limitation and disability on adverse health outcomes. METHODS: Nine hundred ninety-eight African-American men and women aged 49-65 years received in-home evaluations at baseline, and 853 were re-evaluated 3 years later. Baseline subclinical status was ascertained for five lower body tasks and seven activities of daily living (ADLs)/instrumental ADLs (IADLs). Outcomes included difficulty with lower body limitations, ADLs/IADLs, physical performance, physician visits, hospitalization, nursing home placement, and mortality. RESULTS: The baseline proportion of subclinical status evidence for the five lower body items was 0.33 (standard deviation [SD] = 0.20), and for the seven ADLs/IADLs was 0.20 (SD = 0.30). Significant independent effects of subclinical status for lower body limitations were observed on physician visits and hospitalization. Significant independent effects of subclinical status for ADLs/IADLs were observed on ADLs/IADLs and physician visits. CONCLUSIONS: Subclinical status for functional limitation and disability independently predicts several subsequent adverse health outcomes, although the effects of the latter (ADLs/IADLs) are stronger. Interventions to reduce frailty should focus on self-reported subclinical status as an early warning system.