• C Barrett Bowling, Luqin Deng, Swati Sakhuja, Miriam C Morey, Byron C Jaeger, and Paul Muntner.
• Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham Veterans Affairs Health Care System, Durham, NC, USA. barrett.bowling@duke.edu.
• J Gen Intern Med. 2019 Nov 1; 34 (11): 2390-2396.

BackgroundFunctional limitations may be more common in middle-aged adults than previously recognized. However, there are few published data on the prevalence of activity limitations, and their association with multimorbidity, among adults 50 to 64 years old.ObjectiveTo describe the prevalence of activity limitations and the association with multimorbidity in middle-aged adults.DesignCross-sectional analysis of US population-based National Health and Nutrition Examination Survey (NHANES) 2011-2016.ParticipantsThe total number of community-dwelling NHANES participants aged 50-64 years old is 4217.Main MeasuresChronic conditions included hypertension, high cholesterol, diabetes mellitus, obesity, chronic kidney disease, cancer, stroke, coronary heart disease, heart failure, chronic obstructive pulmonary disease/asthma, arthritis, and depression. Activity limitations were defined as any difficulty within each of four International Classification of Functioning (ICF) domains: functional limitations (kneeling, carrying, standing, sitting, reaching, grasping, pulling), mobility (walking ¼ mile, climbing 10 steps), basic activities of daily living (BADLs; walking, transferring, eating, dressing), and instrumental activities of daily living (IADLs; finances, chores, cooking). We calculated prevalence ratios for activity limitations using generalized estimating equations.Key ResultsThe prevalence of functional limitations, mobility limitations, BADL difficulty, and IADL difficulty was 34%, 11%, 15%, and 17%, respectively. Seventy-two percent of participants had two or more chronic conditions; 23% had two, 18% had three, 15% had four, and 16% had five or more. Multivariable adjusted prevalence ratios (95% CI) for functional limitations among those with 2, 3, 4, and 5 or more chronic conditions, compared with 0-1 conditions, were 1.94 (1.43-2.63), 2.50 (1.93-3.23), 3.26 (2.48-4.27), and 4.54 (3.48-5.93), respectively (p trend < 0.001). Larger prevalence ratios at a higher number of chronic conditions were present for mobility limitations, BADL difficulty, and IADL difficulty.ConclusionsProblems with function are not limited to older adults and multimorbidity may be helpful for identifying middle-aged adults with a high prevalence of activity limitations.

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