Loss of Independence Among Racially and Ethnically Diverse Older Adults: An ICF-Based Analysis of NHATS

Background: Preventing mobility-related loss of independence (LoI) is a critical public health priority. While the drivers of LoI are complex, this study examines how personal, social, and environmental factors influence these outcomes to identify actionable preven-tive targets. We applied the International Classification of Functioning, Disability, and Health (ICF) framework to treat ethnicity as a dynamic social determinant. Methods: Using 2023 National Health and Aging Trends Study (NHATS) data (n=7,106), conducted path analyses among non-Hispanic (NH) White, NH Black, and Hispanic old-er adults. We assessed associations between health conditions, body function, physical performance, social participation, and environmental factors. Results: The ICF-based model explained 36.6% - 38.2% of LoI variance. While physical performance was the strongest direct predictor of independence across all groups, indirect pathways varied. Social participation restrictions significantly accelerated LoI among NH White and Black adults. For Hispanic adults, limited English proficiency acted as a critical structural barrier im-peding body function and physical performance. Additionally, Additionally, shared liv-ing arrangements among NH Black participants were negatively associated with physical performance. By gender, only NH White females exhibited associations with better physi-cal and social outcomes. Conclusions: Pathways to LoI are deeply mediated by group-specific structural factors. To effectively prevent functional decline, healthcare policies must move beyond generic ser-vices toward culturally responsive interventions. Prioritizing targeted lifestyle behav-iors—specifically social engagement for NH Black populations and linguistic accessibility for Hispanic adults—is essential to reduce health inequities and proactively preserve in-dependence.