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.