Document Type


Publication Date

Summer 7-2014

Journal / Book Title

The journals of Gerontology



Few longitudinal studies compare changes in instrumental activities of daily living (IADLs) among stroke-free adults to prospectively document IADL changes among adults who experience a stroke. We contrast annual declines in IADL independence for older individuals who remain stroke-free to those for individuals who experienced a stroke. We also assess whether these patterns differ by sex, race, or Southern birthplace. Methods.

Health and Retirement Study participants who were stroke-free in 1998 (n = 17,741) were followed through 2010 (average follow-up = 8.9 years) for self- or proxy-reported stroke. We used logistic regressions to compare annual changes in odds of self-reported independence in six IADLs among those who remained stroke-free throughout follow-up (n = 15,888), those who survived a stroke (n = 1,412), and those who had a stroke and did not survive to participate in another interview (n = 442). We present models adjusted for demographic and socioeconomic covariates and also stratified on sex, race, and Southern birthplace. Results.

Compared with similar cohort members who remained stroke-free, participants who developed stroke had faster declines in IADL independence and a lower probability of IADL independence prior to the stroke. After a stroke, independence declined at an annual rate similar to those who did not have a stroke. The black-white disparity in IADL independence narrowed poststroke. Conclusion.

Racial differences in IADL independence are apparent long before stroke onset. Poststroke differences in IADL independence largely reflect pre stroke disparities.


Published Citation

Capistrant, Benjamin D., Nicte I. Mejia, Sze Y. Liu, Qianyi Wang, and M. Maria Glymour. "The disability burden associated with stroke emerges before stroke onset and differentially affects blacks: results from the health and retirement study cohort." Journals of Gerontology Series A: Biomedical Sciences and Medical Sciences 69, no. 7 (2014): 860-870.