Participation and the Well-Being of Older Adults with ADL Disabilities: A Longitudinal Application of the International Classification of Functioning, Health, and Disability.

Introduction: Applying the International Classification of Functioning, Disability, and Health (ICF) framework, this study examined longitudinal associations among activities of daily living (ADL) limitations, participation, and well-being among community-dwelling older adults with ADL difficulty. Methods: We used five waves (2015-2019; Waves 5-9) of the National Health and Aging Trends Study (NHATS; baseline n = 5346). Well-being was measured using 11 NHATS items spanning affect, life satisfaction, and perceived control/self-efficacy. Participation was operationalized using five dichotomous indicators of engagement in common social and community activities. Autoregressive cross-lagged structural equation models were estimated using full-information maximum likelihood, and indirect associations were assessed with bootstrap standard errors. Results: We found that ADL limitations were associated with lower subsequent participation, while greater participation was associated with higher subsequent well-being across waves. Indirect associations linking ADL limitations to later well-being through participation were small and time-dependent. Discussion: Overall, the findings are consistent with an ICF-informed perspective in which participation is part of the longitudinal context linking activity limitations and well-being over time, although effect sizes were modest.