PHYSICAL DISABILITY TRAJECTORIES FROM MIDLIFE TO OLDER AGE IN ADULTS WITH AND WITHOUT DIABETES: THE ROLE OF BIOBEHAVIORAL, PSYCHOSOCIAL, AND CULTURAL MECHANISMS
Open Access
- Author:
- Chiu, Ching-Ju
- Graduate Program:
- Biobehavioral Health
- Degree:
- Doctor of Philosophy
- Document Type:
- Dissertation
- Date of Defense:
- May 08, 2009
- Committee Members:
- Linda Ann Wray, Dissertation Advisor/Co-Advisor
Patricia Barthalow Koch, Committee Member
Linda Ann Wray, Committee Chair/Co-Chair
Sheila Grace West, Committee Member
Mosuk Chow, Committee Member - Keywords:
- Diabetes
Longitudinal Research
Cross-national comparison
Physicla disability - Abstract:
- The impact of diabetes on physical function from midlife to older adulthood is intuitively important but not well defined. As the number and proportion of older adults with diabetes grows within populations, there is an increasing need to understand the difficulties faced by these adults beyond the basic measure of mortality. The purpose of this three-paper thesis was to illuminate the impact of diabetes on physical function for adults from midlife to older age. The first study employed an accelerated longitudinal design and multilevel modeling growth curve models to identify physical function trajectories for nationally representative samples of middle-aged adults with and without diabetes in the U.S. and Taiwan. Results demonstrated that adults living with diabetes experienced more physical limitations and faster rates of change in aging than did those without diabetes. In addition, U.S. women, minority group adults, and those of lower education suffered more adverse impacts of diabetes than did men, Whites, and those of higher education. The second study employed structural equation modeling to examine hypothesized mechanisms underlying gender differences in physical disability for adults with type 2 diabetes. Findings indicated that gender-related biological (e.g., BMI, HbA1c, blood pressure, early complications) and behavioral (e.g., exercise) factors directly and completely mediated the gender differences in physical function; psychosocial factors (e.g., perceived control, self-efficacy, coping, and depressive symptoms), contributed indirectly to the link. The third study investigated if the physical function trajectories experienced by adults living with diabetes in the U.S. were shaped by body weight trajectories earlier in life, using a group-based trajectory modeling approach. Results identified four distinct body weight trajectories (stable normal weight, iv 29.0%; stable overweight, 46.5%; loss and regain obese, 17.6%; and weight cumulating morbidly obese, 6.9%) and three disability trajectories (little or low increase, 34.6%; moderate increase, 45.4%; and chronic high, 20.1%). Various relationships among these two sets of trajectories were found. Importantly, the results strongly supported recommendations for weight control in adults with diabetes in order to prevent future disability. In conclusion, the three studies in this thesis highlighted the heterogeneity of adults living with diabetes in midlife and older age and underscored the importance of taking a multidimensional approach to providing diabetes care.