---
title: "Trends in Functional Impairment Trajectories and Incidence Among Middle-Aged Americans"
id: "pubmed-42758739"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42758739"
content_type: "clinical_feed_article"
specialty: "General"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42758739/"
doi: "10.1371/journal.pone.0358337"
published_at: "2026-09-18T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Trends in Functional Impairment Trajectories and Incidence Among Middle-Aged Americans
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42758739
- **Specialty:** [General](https://medichelpline.com/clinical-feed/general.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42758739/)
- **DOI:** [10.1371/journal.pone.0358337](https://doi.org/10.1371%2Fjournal.pone.0358337)
- **Published At:** 2026-09-18T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- Study used the nationally representative **Health and Retirement Study (HRS)** to examine trajectories and incidence of functional impairment in middle-aged adults born between 1935 and 1959. - Sample included 14,707 participants ages 50–56 enrolled between 1992 and 2010 who were independent at baseline in basic activities of daily living (ADLs) and instrumental ADLs (IADLs). - Participants were categorized into four birth cohorts: Pre-War Babies (1935–1941), War Babies (1942–1947), Early Baby Boomers (1948–1953), and Mid Baby Boomers (1954–1959). - Baseline exclusions for prevalent functional impairment varied across cohorts: 13.8%, 9.9%, 9.6%, and 11.7% from earliest to latest cohort, respectively. - Cohort characteristics: mean age 53.2 years, 51.6% women, 9.9% identified as Black, and 8.0% as Latino. - Group-based trajectory modeling identified distinct patterns of change in numbers of ADL and IADL difficulties; multinomial logistic regression tested associations between birth cohort and trajectory group membership. - Over a median follow-up of 7.6 years, average annual incidence rates of new **ADL** impairment were 2.0%, 0.7%, 0.7%, and 1.0% from earliest to latest cohort. - Results for **IADL** impairment followed a similar pattern to ADLs. - Pre-War Babies and War Babies had significantly higher risk of membership in trajectory groups with greater impairment compared with Mid Baby Boomers in both adjusted and unadjusted analyses. - Overall, functional trajectories and incidence of new impairment tended to improve from earlier to later birth cohorts. - Authors note potential differences in risk factors for prevalent mid-life impairment versus incident impairment before age 65; details on those risk factors were not reported in the abstract.
## Clinical Analysis & Structured Key Points
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Crescenz VA Medical Center, Philadelphia, Pennsylvania, United States of America.")[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42758739/#full-view-affiliation-4 "Center for Health Evaluation Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, United States of America."), [Xi Zuo](https://pubmed.ncbi.nlm.nih.gov/?term=Zuo+X&cauthor_id=42758739)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42758739/#full-view-affiliation-5 "Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America."), [Haotian Zheng](https://pubmed.ncbi.nlm.nih.gov/?term=Zheng+H&cauthor_id=42758739)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42758739/#full-view-affiliation-6 "Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America."), [Kira L Ryskina](https://pubmed.ncbi.nlm.nih.gov/?term=Ryskina+KL&cauthor_id=42758739)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42758739/#full-view-affiliation-2 "Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America.")[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42758739/#full-view-affiliation-7 "Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America."), [Anne R Cappola](https://pubmed.ncbi.nlm.nih.gov/?term=Cappola+AR&cauthor_id=42758739)[ 8 ](https://pubmed.ncbi.nlm.nih.gov/42758739/#full-view-affiliation-8 "Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America."), [Irma Elo](https://pubmed.ncbi.nlm.nih.gov/?term=Elo+I&cauthor_id=42758739)[ 9 ](https://pubmed.ncbi.nlm.nih.gov/42758739/#full-view-affiliation-9 "Department of Sociology, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America."), [Norma B Coe](https://pubmed.ncbi.nlm.nih.gov/?term=Coe+NB&cauthor_id=42758739)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42758739/#full-view-affiliation-2 "Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America.")[ 10 ](https://pubmed.ncbi.nlm.nih.gov/42758739/#full-view-affiliation-10 "Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America."), [Dawei Xie](https://pubmed.ncbi.nlm.nih.gov/?term=Xie+D&cauthor_id=42758739)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42758739/#full-view-affiliation-5 "Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America.") Affiliations Expand ### Affiliations * 1 Division of Geriatric Medicine, Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America. * 2 Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America. * 3 Geriatrics and Extended Care Program, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, United States of America. * 4 Center for Health Evaluation Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, United States of America. * 5 Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America. * 6 Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America. * 7 Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America. * 8 Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America. * 9 Department of Sociology, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America. * 10 Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America. * PMID: **42758739** * DOI: [ 10.1371/journal.pone.0358337 ](https://doi.org/10.1371/journal.pone.0358337) Item in Clipboard # Trends in trajectories and incidence of functional impairment in middle-aged Americans Rebecca T Brown et al. PLoS One. 2026. Show details Display options Display options Format Abstract PubMed PMID PLoS One Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22PLoS+One%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22PLoS+One%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42758739/) . 2026 Sep 18;21(9):e0358337. doi: 10.1371/journal.pone.0358337. eCollection 2026. ### Authors [Rebecca T Brown](https://pubmed.ncbi.nlm.nih.gov/?term=Brown+RT&cauthor_id=42758739)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42758739/#short-view-affiliation-1 "Division of Geriatric Medicine, Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42758739/#short-view-affiliation-2 "Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42758739/#short-view-affiliation-3 "Geriatrics and Extended Care Program, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, United States of America.")[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42758739/#short-view-affiliation-4 "Center for Health Evaluation Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, United States of America."), [Xi Zuo](https://pubmed.ncbi.nlm.nih.gov/?term=Zuo+X&cauthor_id=42758739)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42758739/#short-view-affiliation-5 "Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America."), [Haotian Zheng](https://pubmed.ncbi.nlm.nih.gov/?term=Zheng+H&cauthor_id=42758739)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42758739/#short-view-affiliation-6 "Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America."), [Kira L Ryskina](https://pubmed.ncbi.nlm.nih.gov/?term=Ryskina+KL&cauthor_id=42758739)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42758739/#short-view-affiliation-2 "Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America.")[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42758739/#short-view-affiliation-7 "Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America."), [Anne R Cappola](https://pubmed.ncbi.nlm.nih.gov/?term=Cappola+AR&cauthor_id=42758739)[ 8 ](https://pubmed.ncbi.nlm.nih.gov/42758739/#short-view-affiliation-8 "Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America."), [Irma Elo](https://pubmed.ncbi.nlm.nih.gov/?term=Elo+I&cauthor_id=42758739)[ 9 ](https://pubmed.ncbi.nlm.nih.gov/42758739/#short-view-affiliation-9 "Department of Sociology, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America."), [Norma B Coe](https://pubmed.ncbi.nlm.nih.gov/?term=Coe+NB&cauthor_id=42758739)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42758739/#short-view-affiliation-2 "Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America.")[ 10 ](https://pubmed.ncbi.nlm.nih.gov/42758739/#short-view-affiliation-10 "Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America."), [Dawei Xie](https://pubmed.ncbi.nlm.nih.gov/?term=Xie+D&cauthor_id=42758739)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42758739/#short-view-affiliation-5 "Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America.") ### Affiliations * 1 Division of Geriatric Medicine, Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America. * 2 Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America. * 3 Geriatrics and Extended Care Program, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, United States of America. * 4 Center for Health Evaluation Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, United States of America. * 5 Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America. * 6 Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America. * 7 Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America. * 8 Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America. * 9 Department of Sociology, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America. * 10 Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America. * PMID: **42758739** * DOI: [ 10.1371/journal.pone.0358337 ](https://doi.org/10.1371/journal.pone.0358337) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract The prevalence of functional impairment (i.e., difficulty performing daily activities such as bathing and dressing) has increased among middle-aged Americans, but longitudinal data are lacking. The objective of this study was to examine trajectories of functional status and incidence of functional impairment among middle-aged adults across 4 birth cohorts. We conducted a cohort study of 14,707 participants ages 50-56 enrolled between 1992-2010 in the nationally representative Health and Retirement Study (HRS) who were independent at baseline in self- or proxy-reported basic activities of daily living (ADLs, score 0-6) and instrumental ADLs (IADLs, score 0-5). Participants were born in one of four birth cohorts: "Pre-War Babies," 1935-1941; "War Babies," 1942-1947; "Early Baby Boomers," 1948-1953; or "Mid Baby Boomers," 1954-1959. Primary outcomes were trajectories of functional status (number of ADL and IADL difficulties) and incidence of functional impairment (difficulty with ≥1 ADLs or ≥1 IADLs) before age 65. We used group-based trajectory models to identify distinct classes of ADL change and multinomial logistic regression models to examine association of birth cohort with group membership. From the earliest to latest birth cohort, the percentages excluded at baseline due to prevalent functional impairment were 13.8%, 9.9%, 9.6%, and 11.7%. Mean age among participants was 53.2 years, 51.6% were women, 9.9% identified as Black, and 8.0% as Latino. In adjusted and unadjusted analyses, Pre-War Babies and War Babies were at significantly higher risk of belonging to trajectory groups with higher levels of impairment versus Mid Boomers. Over a median follow-up of 7.6 years, average annual incidence rates for ADL impairment from earliest to latest cohort were 2.0%, 0.7%, 0.7%, and 1.0%. Findings were similar for IADLs. Functional trajectories and incidence of functional impairment improved from earlier to later birth cohorts. Findings suggest differing risk factors for mid-life prevalent versus incident functional impairment. Copyright: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement The authors have declared that no competing interests exist. ## MeSH terms * Activities of Daily Living* Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Activities+of+Daily+Living%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Activities+of+Daily+Living) * [ Add to
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