Abstract
OBJECTIVE: Little is known about disability progression in very old age despite this being vital for care planning. We investigate whether distinct trajectories of disability are evident from age 85 to 90 and their association with socio-economic status (SES). METHODS: The Newcastle 85+ Study recruited people born in 1921 through participating general practices in Newcastle and North Tyneside. Participants underwent a health assessment (HA) at baseline, 18, 36 and 60 months and a GP record review (GPRR) at baseline, 36 and 60 months. Disability was measured via difficulty in 17 Activities of Daily Living. Trajectory identification was assessed by gender stratified, mortality adjusted, group-based trajectory modelling (GBTM) and the impact of life-course SES (level of education; occupational class; deprivation) on trajectory membership evaluated (adjusting for confounding variables). RESULTS: 851 participants agreed to HA and GPRR, 840 (98.7%) with complete disability data. Four distinct trajectories were evident for both sexes. A disability-free trajectory between age 85 and 90 was identified in men only (9% of the sample). The most disabled trajectories had severe disability at age 85 progressing to profound disability by age 90. After adjusting for confounders education remained significant; men and women with most education being less likely to be in the most disabled trajectory (Men: OR=0.80, 95% CI 0.65-0.98; women: OR=0.59, 95% CI 0.42-0.83). CONCLUSION: Distinct disability trajectories are evident in the very old and these are influenced by education, suggesting SES disadvantages cumulate throughout the life-course to create health and mortality inequalities later.