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Published in: BMC Public Health 1/2013

Open Access 01-12-2013 | Research article

Distribution and determinants of functioning and disability in aged adults - results from the German KORA-Age study

Authors: Ralf Strobl, Martin Müller, Rebecca Emeny, Annette Peters, Eva Grill

Published in: BMC Public Health | Issue 1/2013

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Abstract

Background

Today industrialized countries face a burgeoning aged population. Thus, there is increasing attention on the functioning and disabilities of aged adults as potential determinants of autonomy and independent living. However, there are few representative findings on the prevalence and determinants of disability in aged persons in the German population.
The objective of our study is to examine the frequency, distribution and determinants of functioning and disability in aged persons and to assess the contribution of diseases to the prevalence of disability.

Methods

Data originate from the MONICA/KORA study, a population-based epidemiological cohort. Survivors of the original cohorts who were 65 and older were examined by telephone interview in 2009. Disability was assessed with the Health Assessment Questionnaire Disability Index (HAQ-DI). Minimal disability was defined as HAQ-DI > 0. Logistic regression was used to adjust for potential confounders and additive regression to estimate the contribution of diseases to disability prevalence.

Results

We analyzed a total of 4117 persons (51.2% female) with a mean age of 73.6 years (SD = 6.1). Minimal disability was present in 44.7% of all participants. Adjusted for age and diseases, disability was positively associated with female sex, BMI, low income, marital status, physical inactivity and poor nutritional status, but not with smoking and education. Problems with joint functions and eye diseases contributed most to disability prevalence in all age groups.

Conclusions

In conclusion, this study could show that there are vulnerable subgroups of aged adults who should receive increased attention, specifically women, those with low income, those over 80, and persons with joint or eye diseases. Physical activity, obesity and malnutrition were identified as modifiable factors for future targeted interventions.
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Literature
2.
go back to reference Hammar T, Rissanen P, Perala ML: Home-care clients’ need for help, and use and costs of services. Eur J Ageing. 2008, 5: 147-160. 10.1007/s10433-008-0078-4.CrossRef Hammar T, Rissanen P, Perala ML: Home-care clients’ need for help, and use and costs of services. Eur J Ageing. 2008, 5: 147-160. 10.1007/s10433-008-0078-4.CrossRef
3.
go back to reference World Health Organisation (WHO): International Classification of Functioning, Disability and Health: ICF. 2001, Geneva: WHO World Health Organisation (WHO): International Classification of Functioning, Disability and Health: ICF. 2001, Geneva: WHO
4.
go back to reference Scheidt-Nave C, Richter S, Fuchs J, Kuhlmey A: [Challenges to health research for aging populations using the example of “multimorbidity”]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2010, 53: 441-450. 10.1007/s00103-010-1052-9.CrossRefPubMed Scheidt-Nave C, Richter S, Fuchs J, Kuhlmey A: [Challenges to health research for aging populations using the example of “multimorbidity”]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2010, 53: 441-450. 10.1007/s00103-010-1052-9.CrossRefPubMed
5.
go back to reference Menning S, Hoffmann E: Funktionale Gesundheit und Pflegebedürftigkeit. Gesundheitsberichterstattung des Bundes: Gesundheit und Krankheit im Alter. 2009, Berlin: Robert-Koch-Institut Menning S, Hoffmann E: Funktionale Gesundheit und Pflegebedürftigkeit. Gesundheitsberichterstattung des Bundes: Gesundheit und Krankheit im Alter. 2009, Berlin: Robert-Koch-Institut
6.
go back to reference Balzi D, Lauretani F, Barchielli A, Ferrucci L, Bandinelli S, Buiatti E, Milaneschi Y, Guralnik JM: Risk factors for disability in older persons over 3-year follow-up. Age Ageing. 2010, 39: 92-98. 10.1093/ageing/afp209.CrossRefPubMed Balzi D, Lauretani F, Barchielli A, Ferrucci L, Bandinelli S, Buiatti E, Milaneschi Y, Guralnik JM: Risk factors for disability in older persons over 3-year follow-up. Age Ageing. 2010, 39: 92-98. 10.1093/ageing/afp209.CrossRefPubMed
7.
go back to reference Stuck AE, Walthert JM, Nikolaus T, Bula CJ, Hohmann C, Beck JC: Risk factors for functional status decline in community-living elderly people: a systematic literature review. Soc Sci Med. 1999, 48: 445-469. 10.1016/S0277-9536(98)00370-0.CrossRefPubMed Stuck AE, Walthert JM, Nikolaus T, Bula CJ, Hohmann C, Beck JC: Risk factors for functional status decline in community-living elderly people: a systematic literature review. Soc Sci Med. 1999, 48: 445-469. 10.1016/S0277-9536(98)00370-0.CrossRefPubMed
8.
go back to reference Tas U, Verhagen AP, Bierma-Zeinstra SM, Hofman A, Odding E, Pols HA, Koes BW: Incidence and risk factors of disability in the elderly: the Rotterdam Study. Prev Med. 2007, 44: 272-278. 10.1016/j.ypmed.2006.11.007.CrossRefPubMed Tas U, Verhagen AP, Bierma-Zeinstra SM, Hofman A, Odding E, Pols HA, Koes BW: Incidence and risk factors of disability in the elderly: the Rotterdam Study. Prev Med. 2007, 44: 272-278. 10.1016/j.ypmed.2006.11.007.CrossRefPubMed
9.
go back to reference Vermeulen J, Neyens JC, van Rossum E, Spreeuwenberg MD, de Witte LP: Predicting ADL disability in community-dwelling elderly people using physical frailty indicators: a systematic review. BMC Geriatr. 2011, 11: 33-10.1186/1471-2318-11-33.CrossRefPubMedPubMedCentral Vermeulen J, Neyens JC, van Rossum E, Spreeuwenberg MD, de Witte LP: Predicting ADL disability in community-dwelling elderly people using physical frailty indicators: a systematic review. BMC Geriatr. 2011, 11: 33-10.1186/1471-2318-11-33.CrossRefPubMedPubMedCentral
10.
go back to reference Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA: Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001, 56: M146-M156. 10.1093/gerona/56.3.M146.CrossRefPubMed Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA: Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001, 56: M146-M156. 10.1093/gerona/56.3.M146.CrossRefPubMed
11.
go back to reference Boyd CM, Fortin M: Future of Multimorbidity Research: How Should Understanding of Multimorbidity Inform Health System Design?. Public Health Reviews. 2010, 32: 451-474. 10.1093/pubmed/fdq057. Boyd CM, Fortin M: Future of Multimorbidity Research: How Should Understanding of Multimorbidity Inform Health System Design?. Public Health Reviews. 2010, 32: 451-474. 10.1093/pubmed/fdq057.
12.
go back to reference Marengoni A, Rizzuto D, Wang HX, Winblad B, Fratiglioni L: Patterns of chronic multimorbidity in the elderly population. J Am Geriatr Soc. 2009, 57: 225-230. 10.1111/j.1532-5415.2008.02109.x.CrossRefPubMed Marengoni A, Rizzuto D, Wang HX, Winblad B, Fratiglioni L: Patterns of chronic multimorbidity in the elderly population. J Am Geriatr Soc. 2009, 57: 225-230. 10.1111/j.1532-5415.2008.02109.x.CrossRefPubMed
13.
go back to reference Klijs B, Nusselder WJ, Looman CW, Mackenbach JP: Contribution of chronic disease to the burden of disability. PLoS One. 2011, 6: e25325-10.1371/journal.pone.0025325.CrossRefPubMedPubMedCentral Klijs B, Nusselder WJ, Looman CW, Mackenbach JP: Contribution of chronic disease to the burden of disability. PLoS One. 2011, 6: e25325-10.1371/journal.pone.0025325.CrossRefPubMedPubMedCentral
14.
go back to reference Nusselder WJ, Looman CW: Decomposition of differences in health expectancy by cause. Demography. 2004, 41: 315-334. 10.1353/dem.2004.0017.CrossRefPubMed Nusselder WJ, Looman CW: Decomposition of differences in health expectancy by cause. Demography. 2004, 41: 315-334. 10.1353/dem.2004.0017.CrossRefPubMed
15.
go back to reference Holle R, Happich M, Lowel H, Wichmann HE: KORA–a research platform for population based health research. Gesundheitswesen. 2005, 67 (Suppl 1): S19-S25.CrossRefPubMed Holle R, Happich M, Lowel H, Wichmann HE: KORA–a research platform for population based health research. Gesundheitswesen. 2005, 67 (Suppl 1): S19-S25.CrossRefPubMed
16.
go back to reference Fries JF, Spitz PW, Young DY: The dimensions of health outcomes: the health assessment questionnaire, disability and pain scales. J Rheumatol. 1982, 9: 789-793.PubMed Fries JF, Spitz PW, Young DY: The dimensions of health outcomes: the health assessment questionnaire, disability and pain scales. J Rheumatol. 1982, 9: 789-793.PubMed
17.
go back to reference Bruce B, Fries JF: The stanford health assessment questionnaire: a review of its history, issues, progress, and documentation. J Rheumatol. 2003, 30: 167-178.PubMed Bruce B, Fries JF: The stanford health assessment questionnaire: a review of its history, issues, progress, and documentation. J Rheumatol. 2003, 30: 167-178.PubMed
18.
go back to reference Bruce B, Fries JF: The health assessment questionnaire (HAQ). Clin Exp Rheumatol. 2005, 23: S14-S18.PubMed Bruce B, Fries JF: The health assessment questionnaire (HAQ). Clin Exp Rheumatol. 2005, 23: S14-S18.PubMed
19.
go back to reference Krishnan E, Sokka T, Hakkinen A, Hubert H, Hannonen P: Normative values for the health assessment questionnaire disability index: benchmarking disability in the general population. Arthritis Rheum. 2004, 50: 953-960. 10.1002/art.20048.CrossRefPubMed Krishnan E, Sokka T, Hakkinen A, Hubert H, Hannonen P: Normative values for the health assessment questionnaire disability index: benchmarking disability in the general population. Arthritis Rheum. 2004, 50: 953-960. 10.1002/art.20048.CrossRefPubMed
20.
go back to reference Bruehlmann P, Stucki G, Michel BA: Evaluation of a German version of the physical dimensions of the health assessment questionnaire in patients with rheumatoid arthritis. J Rheumatol. 1994, 21: 1245-1249. Bruehlmann P, Stucki G, Michel BA: Evaluation of a German version of the physical dimensions of the health assessment questionnaire in patients with rheumatoid arthritis. J Rheumatol. 1994, 21: 1245-1249.
21.
go back to reference Chaudhry S, Jin L, Meltzer D: Use of a self-report-generated charlson comorbidity index for predicting mortality. Med Care. 2005, 43: 607-615. 10.1097/01.mlr.0000163658.65008.ec.CrossRefPubMed Chaudhry S, Jin L, Meltzer D: Use of a self-report-generated charlson comorbidity index for predicting mortality. Med Care. 2005, 43: 607-615. 10.1097/01.mlr.0000163658.65008.ec.CrossRefPubMed
22.
go back to reference Wildner M, Doring A, Meisinger C, Clark DE: [Fractures in the elderly–a challenge for prevention and health promotion–results from the KORA fracture study Augsburg]. Gesundheitswesen. 2005, 67 (Suppl 1): S180-S186.CrossRefPubMed Wildner M, Doring A, Meisinger C, Clark DE: [Fractures in the elderly–a challenge for prevention and health promotion–results from the KORA fracture study Augsburg]. Gesundheitswesen. 2005, 67 (Suppl 1): S180-S186.CrossRefPubMed
24.
go back to reference Mader U, Martin BW, Schutz Y, Marti B: Validity of four short physical activity questionnaires in middle-aged persons. Med Sci Sports Exerc. 2006, 38: 1255-1266. 10.1249/01.mss.0000227310.18902.28.CrossRefPubMed Mader U, Martin BW, Schutz Y, Marti B: Validity of four short physical activity questionnaires in middle-aged persons. Med Sci Sports Exerc. 2006, 38: 1255-1266. 10.1249/01.mss.0000227310.18902.28.CrossRefPubMed
25.
go back to reference Meisinger C, Lowel H, Thorand B, Doring A: Leisure time physical activity and the risk of type 2 diabetes in men and women from the general population. The MONICA/KORA Augsburg Cohort Study. Diabetologia. 2005, 48: 27-34. 10.1007/s00125-004-1604-3.CrossRefPubMed Meisinger C, Lowel H, Thorand B, Doring A: Leisure time physical activity and the risk of type 2 diabetes in men and women from the general population. The MONICA/KORA Augsburg Cohort Study. Diabetologia. 2005, 48: 27-34. 10.1007/s00125-004-1604-3.CrossRefPubMed
26.
go back to reference Keller HH, Goy R, Kane SL: Validity and reliability of SCREEN II (Seniors in the community: risk evaluation for eating and nutrition, Version II). Eur J Clin Nutr. 2005, 59: 1149-1157. 10.1038/sj.ejcn.1602225.CrossRefPubMed Keller HH, Goy R, Kane SL: Validity and reliability of SCREEN II (Seniors in the community: risk evaluation for eating and nutrition, Version II). Eur J Clin Nutr. 2005, 59: 1149-1157. 10.1038/sj.ejcn.1602225.CrossRefPubMed
27.
go back to reference Cleveland WS: LOWESS: A program for smoothing scatterplots by robust locally weighted regression. Am Stat. 1981, 35: 54-CrossRef Cleveland WS: LOWESS: A program for smoothing scatterplots by robust locally weighted regression. Am Stat. 1981, 35: 54-CrossRef
28.
go back to reference Bautista D, Arana E, Marti-Bonmati L, Paredes R: Validation of logistic regression models in small samples: application to calvarial lesions diagnosis. J Clin Epidemiol. 1999, 52: 237-241. 10.1016/S0895-4356(98)00165-6.CrossRefPubMed Bautista D, Arana E, Marti-Bonmati L, Paredes R: Validation of logistic regression models in small samples: application to calvarial lesions diagnosis. J Clin Epidemiol. 1999, 52: 237-241. 10.1016/S0895-4356(98)00165-6.CrossRefPubMed
29.
go back to reference Lemeshow S, Hosmer DW: A review of goodness of fit statistics for use in the development of logistic regression models. Am J Epidemiol. 1982, 115: 92-106.PubMed Lemeshow S, Hosmer DW: A review of goodness of fit statistics for use in the development of logistic regression models. Am J Epidemiol. 1982, 115: 92-106.PubMed
30.
go back to reference Yee TW, Hastle TJ: Reduced-rank vector generalized linear models. Stat Model. 2003, 3: 15-41. 10.1191/1471082X03st045oa.CrossRef Yee TW, Hastle TJ: Reduced-rank vector generalized linear models. Stat Model. 2003, 3: 15-41. 10.1191/1471082X03st045oa.CrossRef
31.
go back to reference Efron B: Better bootstrap confidence-intervals. J Am Stat Assoc. 1987, 82: 171-185. 10.1080/01621459.1987.10478410.CrossRef Efron B: Better bootstrap confidence-intervals. J Am Stat Assoc. 1987, 82: 171-185. 10.1080/01621459.1987.10478410.CrossRef
32.
33.
go back to reference Wilms HU, Riedel-Heller SG, Angermeyer MC: Limitations in activities of daily living and instrumental activities of daily living capacity in a representative sample: disentangling dementia- and mobility-related effects. Compr Psychiatry. 2007, 48: 95-101. 10.1016/j.comppsych.2006.04.001.CrossRefPubMed Wilms HU, Riedel-Heller SG, Angermeyer MC: Limitations in activities of daily living and instrumental activities of daily living capacity in a representative sample: disentangling dementia- and mobility-related effects. Compr Psychiatry. 2007, 48: 95-101. 10.1016/j.comppsych.2006.04.001.CrossRefPubMed
34.
go back to reference Murtagh KN, Hubert HB: Gender differences in physical disability among an elderly cohort. Am J Public Health. 2004, 94: 1406-1411. 10.2105/AJPH.94.8.1406.CrossRefPubMedPubMedCentral Murtagh KN, Hubert HB: Gender differences in physical disability among an elderly cohort. Am J Public Health. 2004, 94: 1406-1411. 10.2105/AJPH.94.8.1406.CrossRefPubMedPubMedCentral
35.
go back to reference Virues-Ortega J, de Pedro-Cuesta J, Seijo-Martinez M, Saz P, Sanchez-Sanchez F, Rojo-Perez F, Rodriguez F, Mateos R, Martinez-Martin P, Mahillo I: Prevalence of disability in a composite [greater than or equal to]75 year-old population in Spain: A screening survey based on the International Classification of Functioning. BMC Publ Health. 2011, 11: 176-10.1186/1471-2458-11-176.CrossRef Virues-Ortega J, de Pedro-Cuesta J, Seijo-Martinez M, Saz P, Sanchez-Sanchez F, Rojo-Perez F, Rodriguez F, Mateos R, Martinez-Martin P, Mahillo I: Prevalence of disability in a composite [greater than or equal to]75 year-old population in Spain: A screening survey based on the International Classification of Functioning. BMC Publ Health. 2011, 11: 176-10.1186/1471-2458-11-176.CrossRef
36.
go back to reference Vita AJ, Terry RB, Hubert HB, Fries JF: Aging, health risks, and cumulative disability. N Engl J Med. 1998, 338: 1035-1041. 10.1056/NEJM199804093381506.CrossRefPubMed Vita AJ, Terry RB, Hubert HB, Fries JF: Aging, health risks, and cumulative disability. N Engl J Med. 1998, 338: 1035-1041. 10.1056/NEJM199804093381506.CrossRefPubMed
37.
go back to reference Wray LA, Blaum CS: Explaining the role of Sex on disability. Gerontologist. 2001, 41: 499-510. 10.1093/geront/41.4.499.CrossRefPubMed Wray LA, Blaum CS: Explaining the role of Sex on disability. Gerontologist. 2001, 41: 499-510. 10.1093/geront/41.4.499.CrossRefPubMed
38.
go back to reference Guralnik JM, Fried LP, Salive ME: Disability as a public health outcome in the aging population. Annu Rev Public Health. 1996, 17: 25-46. 10.1146/annurev.pu.17.050196.000325.CrossRefPubMed Guralnik JM, Fried LP, Salive ME: Disability as a public health outcome in the aging population. Annu Rev Public Health. 1996, 17: 25-46. 10.1146/annurev.pu.17.050196.000325.CrossRefPubMed
39.
go back to reference Coppin AK, Ferrucci L, Lauretani F, Phillips C, Chang M, Bandinelli S, Guralnik JM: Low socioeconomic status and disability in old age: evidence from the InChianti study for the mediating role of physiological impairments. J Gerontol A Biol Sci Med Sci. 2006, 61: 86-91. 10.1093/gerona/61.1.86.CrossRefPubMed Coppin AK, Ferrucci L, Lauretani F, Phillips C, Chang M, Bandinelli S, Guralnik JM: Low socioeconomic status and disability in old age: evidence from the InChianti study for the mediating role of physiological impairments. J Gerontol A Biol Sci Med Sci. 2006, 61: 86-91. 10.1093/gerona/61.1.86.CrossRefPubMed
40.
go back to reference Katzmarzyk PT, Janssen I, Ardern CI: Physical inactivity, excess adiposity and premature mortality. Obes Rev. 2003, 4: 257-290. 10.1046/j.1467-789X.2003.00120.x.CrossRefPubMed Katzmarzyk PT, Janssen I, Ardern CI: Physical inactivity, excess adiposity and premature mortality. Obes Rev. 2003, 4: 257-290. 10.1046/j.1467-789X.2003.00120.x.CrossRefPubMed
41.
go back to reference Lee IM, Shiroma EJ, Lobelo F, Puska P, Blair SN, Katzmarzyk PT: Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet. 2012, 380: 219-229. 10.1016/S0140-6736(12)61031-9.CrossRefPubMedPubMedCentral Lee IM, Shiroma EJ, Lobelo F, Puska P, Blair SN, Katzmarzyk PT: Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet. 2012, 380: 219-229. 10.1016/S0140-6736(12)61031-9.CrossRefPubMedPubMedCentral
42.
go back to reference Popescu ML, Boisjoly H, Schmaltz H, Kergoat MJ, Rousseau J, Moghadaszadeh S, Djafari F, Freeman EE: Age-related eye disease and mobility limitations in older adults. Invest Ophthalmol Vis Sci. 2011, 52: 7168-7174. 10.1167/iovs.11-7564.CrossRefPubMed Popescu ML, Boisjoly H, Schmaltz H, Kergoat MJ, Rousseau J, Moghadaszadeh S, Djafari F, Freeman EE: Age-related eye disease and mobility limitations in older adults. Invest Ophthalmol Vis Sci. 2011, 52: 7168-7174. 10.1167/iovs.11-7564.CrossRefPubMed
43.
go back to reference Knudtson MD, Klein BE, Klein R, Cruickshanks KJ, Lee KE: Age-related eye disease, quality of life, and functional activity. Arch Ophthalmol. 2005, 123: 807-814. 10.1001/archopht.123.6.807.CrossRefPubMed Knudtson MD, Klein BE, Klein R, Cruickshanks KJ, Lee KE: Age-related eye disease, quality of life, and functional activity. Arch Ophthalmol. 2005, 123: 807-814. 10.1001/archopht.123.6.807.CrossRefPubMed
44.
go back to reference Buchman AS, Boyle PA, Leurgans SE, Evans DA, Bennett DA: Pulmonary function, muscle strength, and incident mobility disability in elders. Proc Am Thorac Soc. 2009, 6: 581-587. 10.1513/pats.200905-030RM.CrossRefPubMedPubMedCentral Buchman AS, Boyle PA, Leurgans SE, Evans DA, Bennett DA: Pulmonary function, muscle strength, and incident mobility disability in elders. Proc Am Thorac Soc. 2009, 6: 581-587. 10.1513/pats.200905-030RM.CrossRefPubMedPubMedCentral
45.
go back to reference Chien MY, Kuo HK, Wu YT: Sarcopenia, cardiopulmonary fitness, and physical disability in community-dwelling elderly people. Phys Ther. 2010, 90: 1277-1287. 10.2522/ptj.20090322.CrossRefPubMed Chien MY, Kuo HK, Wu YT: Sarcopenia, cardiopulmonary fitness, and physical disability in community-dwelling elderly people. Phys Ther. 2010, 90: 1277-1287. 10.2522/ptj.20090322.CrossRefPubMed
46.
go back to reference Fried LP, Ferrucci L, Darer J, Williamson JD, Anderson G: Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol A Biol Sci Med Sci. 2004, 59: 255-263. 10.1093/gerona/59.3.M255.CrossRefPubMed Fried LP, Ferrucci L, Darer J, Williamson JD, Anderson G: Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol A Biol Sci Med Sci. 2004, 59: 255-263. 10.1093/gerona/59.3.M255.CrossRefPubMed
47.
go back to reference Rantanen T: Muscle strength, disability and mortality. Scand J Med Sci Sports. 2003, 13: 3-8. 10.1034/j.1600-0838.2003.00298.x.CrossRefPubMed Rantanen T: Muscle strength, disability and mortality. Scand J Med Sci Sports. 2003, 13: 3-8. 10.1034/j.1600-0838.2003.00298.x.CrossRefPubMed
48.
go back to reference Jellesmark A, Herling SF, Egerod I, Beyer N: Fear of falling and changed functional ability following hip fracture among community-dwelling elderly people: an explanatory sequential mixed method study. Disabil Rehabil. 2012, 34: 2124-2131. 10.3109/09638288.2012.673685.CrossRefPubMed Jellesmark A, Herling SF, Egerod I, Beyer N: Fear of falling and changed functional ability following hip fracture among community-dwelling elderly people: an explanatory sequential mixed method study. Disabil Rehabil. 2012, 34: 2124-2131. 10.3109/09638288.2012.673685.CrossRefPubMed
49.
go back to reference Meisinger C, Wildner M, Doring A, Sangha O: Validity and reliability of proband recall of fractures. Soz Praventivmed. 2000, 45: 203-207. 10.1007/BF01306014.CrossRefPubMed Meisinger C, Wildner M, Doring A, Sangha O: Validity and reliability of proband recall of fractures. Soz Praventivmed. 2000, 45: 203-207. 10.1007/BF01306014.CrossRefPubMed
50.
go back to reference Holle R, Hochadel M, Reitmeir P, Meisinger C, Wichmann HE: Prolonged recruitment efforts in health surveys: effects on response, costs, and potential bias. Epidemiology. 2006, 17: 639-643. 10.1097/01.ede.0000239731.86975.7f.CrossRefPubMed Holle R, Hochadel M, Reitmeir P, Meisinger C, Wichmann HE: Prolonged recruitment efforts in health surveys: effects on response, costs, and potential bias. Epidemiology. 2006, 17: 639-643. 10.1097/01.ede.0000239731.86975.7f.CrossRefPubMed
51.
go back to reference Maier W, Fairburn J, Mielck A: [Regional deprivation and mortality in Bavaria. Development of a community-based index of multiple deprivation]. Gesundheitswesen. 2012, 74: 416-425.CrossRefPubMed Maier W, Fairburn J, Mielck A: [Regional deprivation and mortality in Bavaria. Development of a community-based index of multiple deprivation]. Gesundheitswesen. 2012, 74: 416-425.CrossRefPubMed
Metadata
Title
Distribution and determinants of functioning and disability in aged adults - results from the German KORA-Age study
Authors
Ralf Strobl
Martin Müller
Rebecca Emeny
Annette Peters
Eva Grill
Publication date
01-12-2013
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2013
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-13-137

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