Sample Article Review on mobility among older Medicare beneficiaries

Research Question

There have been quite a number of prior studies that only focused on the functional declines for a short period of time. However, as much as all the participants would have aged equally, those studies do not indicate the effects of aging. This study was therefore designed to evaluate long-term decline in functionality of the beneficiaries of Medicare. The study was conducted with varying time length while identifying any risk factors associated with the decline. The results of the study will answer the question; “What are the factors that lead to long-term functional decline?”

Problem under Investigation

This objective of the study understands the factors that lead to a functional decrease in the older beneficiaries of the Medicare. There is an observed decrease in IADLs, ADLS, as well as mobility (Wolinsky et al. 43). What are some of the factors that contribute to this and how can they be addressed.

Data and Methods

The study sample comprised of 5871 respondents. The latter were either proxy or self (Wolinsky et al. 43). The sample was selected from either household screening conducted during the multi-stage cluster sampling process in 1992 or from a sample of 80-year-old people or older who were identified from the CMS file. Survey data collected was linked to Medicare claims between 1993 and 2007. AHEAD study measures were applied during the study.


Outcome Assessment

Similar procedures and outcome assessments were applied at the waves of date collection in the AHEAD (Wolinsky et al. 43). Three standard dimensional measures were used to assess functional status; limitations in daily activities (ADLs), mobility and instrumental ADLs (IADLs). Limitation of IADL assessment included an count of difficulties or inability to perform five activities; taking medication, going for shopping, using the telephone, handling money and preparing meals. ADL limitation was assessed by an count of the difficulties or the inability to dress, bathe, and get across a room, get in and out of bed and eating. Mobility limitation included an count of difficulties or inability to push or pull heavy objects, walk several blocks, left or carry 10 or more pounds, climb up and down a flight or stair.

Development inabilities were defined as a decline in ADL, IADL and mobility (Wolinsky et al. 43). Analysis of multiple logistic regressions was used to evaluate the relationship between the status of the respondent, their lifestyle, health shocks, managed care status, continued care and the terminal drop in the three variables.

Note that the last interview for the follow-up was either conducted after they completed the 2006 interviews or after death (Wolinsky et al. 43). Four baseline measures of the participants’ lifestyle aspects were included. These were; smoking cigarette, physical exercises, alcohol consumption body mass index measurement (Wolinsky et al. 43).

A previously validated continuity measure was used to determine the continuity of care. Continuity of care was considered to be when no office visitations were made to physician for a period of less than eight months. Three additional binary indicators were used to determine terminal drop (Wolinsky et al. 43). Indicator one reflected on whether the final follow-up interview of the participant took place within a year of death. The second indicator reflected on whether the death of participants took place after one year and one day after their last follow-up interview. The last indicator depicted the members used till the end of the study. These participants were used as reference.

Findings and Conclusions

The declines that were observed for ADLs, IADLs and mobility were 36.6%, 32.3% and 30.9% respectively. Proxy reports recorded a functional decline and a decline in the effects of baseline function. Vigorous and consistent physical exercises and activities proved to work against functional decline. Accordingly, mobility decline was associated with obesity, smoking of cigarette as well as alcohol consumption (Wolinsky et al. 43). The predictors allied to functional decline or decrease was identified as post-baseline hospitalizations (Wolinsky et al. 43). Additionally, it was found out that the participants whose final follow-up interview was followed by their death one year or less than a year later, had greater odds of decline of functional status (Wolinsky et al. 43).

If proxy reports are utilized, it is important to consider additive and interactive impacts associated with the respondent’s status. Older beneficiaries of Medicare are advised to engage in vigorous and consistent physical exercises, to reduce the risk of functional decline in ALDs, IADLs and mobility. It is also advisable to reduce alcohol consumption and cigarette smoking, which can bring about a decline in mobility. Hospitalization and re-hospitalization should also be reduced to lower the risks of decline in the three variables. 

Critical Analysis

Functional decline and aging is at times investable (Wolinsky et al. 43). As time surpasses, people grow old. It becomes difficult to accomplish things like vigorous physical exercise. In their old age, most people have less or no work at all (Wolinsky et al. 43). Sometimes some live far from their families. The remaining option is drinking alcohol and smoking cigarette. The aged people either find it difficult to care of them or have people doing everything for them. Either way, there are many chances of functional decrease in ADL, IADLS as well as mobility (Wolinsky et al. 43). However, aged people are a very important section of every society’s population. A lot should be done to make sure they are healthy, comfortable and even live longer.










Wolinsky, F. D., Bentler, S. E., Hockenberry, J., Jones, M. P., Obrizan, M., Weigel, P. A., … & Wallace, R. B. (2011). Long-term declines in ADLs, IADLs, and mobility among older Medicare beneficiaries. BMC geriatrics11(1), 43.


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