ArticleFunctional limitations in women at midlife: the role of health conditions, behavioral and environmental factors
Introduction
Predictions of increasing survival and disability rates have motivated a shift in national health care attention from quantity to quality, from extending years of life to increasing years of healthy life, and reducing functional limitations of older adults.1, 2, 3 With this shift in focus from disease to functioning, physical functioning has gained acceptance as a definition of health.1 As an essential component of quality of life, physical functioning serves as an indicator of the aging process,4, 5 and can be used as a measure of the overall impact of disease and environmental influences.6
The majority of epidemiological research on functional status has focused on the relationship of functioning with age, gender, and disease conditions.7, 8, 9 Functional limitations in populations under 65 years of age are infrequently examined, although many adults over 65 years who are functionally limited report that their limitations began between the ages of 40 and 55 years.10 In cross-sectional studies that have examined functional limitations in younger adults, almost 45% of adults between the ages of 45 and 64 years report moderate or severe limitations.10 Examining the relationship between functioning and modifiable risk factors is particularly important in younger populations, when programs for prevention of functional impairments can be implemented.
The higher prevalence of functional limitations in women,11 coupled with the longer life span of women compared to men, highlights the need to examine risk factors for functional limitations in women. This paper describes an exploration of the association between risk factors and physical functioning in a community-based sample of women aged 40–55 years.
Section snippets
Methods and procedures
This sample included 16,065 women enrolled in the cross-sectional component of the Study of Women’s Health Across the Nation (SWAN), a study of women in seven U.S. geographic areas. SWAN was developed to provide information and understanding of women of diverse ethnicity as they transition through the menopause. Interviewers collected data by telephone and occasionally in person to determine the health status of women at midlife and to screen for eligibility for the longitudinal SWAN cohort.
Results
Characteristics of women in this sample are described in Table 1. Almost half of the sample self-identified as Caucasian, 27% African American, 15% Hispanic, 4% Chinese American, and 5% Japanese American. The age range spanned from 40 to 55 years, with a mean age of 47 years (standard deviation [SD] = 4.3). Almost 10% of the sample had less than a high school degree, 26% had a high school degree or GED, 32% had some college or post high school training, and 32% had a college degree or higher.
Discussion
Consistent with what has been shown in older women, numerous risk factors are associated with physical functioning limitations in women at midlife. In addition, the magnitudes of these associations are similar to what has been seen for older samples of men or women.9, 14 Our analyses support the relationship of numerous health conditions with functional limitations, and the relationships between these health conditions and substantial limitations were stronger in all comparisons than between
Acknowledgements
This work was supported by the National Institutes of Health grant no. NR04061 (Sowers, P.I.). The authors thank the SWAN faculty and staff, whose invaluable assistance made this study possible.
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