• Qiushi Feng, Helen M Hoenig, Danan Gu, Zeng Yi, and Jama L Purser.
• Division of Physical Therapy, Department of Community and Family Medicine, Duke University Medical Center, Durham, North Carolina, USA.
• J Am Geriatr Soc. 2010 Oct 1; 58 (10): 1952-8.

ObjectivesTo examine a new method of classifying disability subtypes by combining self-reported and performance-based tools to predict mortality in older Chinese adults.DesignProspective cohort study.SettingCommunity-dwelling older adults.ParticipantsSixteen thousand twenty Chinese adults aged 65 and older from the Chinese Longitudinal Healthy Longevity Survey (CLHLS).MeasurementsSelf-reported activities of daily living (ADLs) and physical performance (PP) tests (chair standing, lifting a book from floor, turning 360°) cross-classified to create mutually exclusive disability subtypes: subtype 0 (no limitations in PP or ADLs), subtype 1 (limitations in PP, no limitations in ADLs), subtype 2 (no limitations in PP, limitations in ADLs), and subtype 3 (limitations in PP and ADLs). Outcome was mortality over 3 years.ResultsCox proportional hazard models, controlling for sociodemographic variables, living situation, healthcare access, social support, health status, and life-style, showed that older adults without any limitations in ADLs or PP had significantly lower mortality risk than those with other disability subtypes and that there was a graded pattern of greater mortality according to subtype 1 (hazard ratio (HR)=1.31, 95% confidence interval (CI)=1.20-1.42), 2 (HR=1.39, 95% CI=1.23-1.59), and 3 (HR=1.88, 95% CI=1.72-2.05). When compared with the average survival curve in the cohort, subtypes of isolated performance deficits or self-reported disability did not substantially discriminate risks of death over 3 years.ConclusionCombined use of self-reported and PP tools is necessary when screening for mutually exclusive disability subtypes that confer significantly higher or lower mortality risks on a population of older adults.© 2010, Copyright the Authors. Journal compilation © 2010, The American Geriatrics Society.

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