In this study, we found that among initially high-functioning older women, those with less than 9 years of education had a higher incidence of subsequent PCD independent of disease status, race, income, self-efficacy, and living arrangements. Our findings suggest that PCD may be important to understanding the manifestations of socioeconomic disparities in disability in late life. Furthermore, it offers insight into the early natural history and rapid trajectory of functional decline in those with low education. Previous published studies have documented the association between low education and activities of daily living (23
), physical vulnerability (24
), and disability (2
), but no prior studies have shown an association with PCD. Education level may have its most important effect during the early stages of the disablement process. The higher education group may be more likely to alter this slope of decline using additional resources. For example, this group is more likely to access diagnostic screening and preventive measures compared with low-education groups (26
The relationship between education and PCD may be best explained by the socioeconomic implications of low-education attainment. Those with lower education may be at higher risk of functional decline due to comorbidity and fewer resources with which to compensate. PCD reflects the attempt to compensate for impairments to preserve function and is a marker of early decline when people may benefit from interventions more than when disability in one or more domains is established.
Participants in the lowest educational status represent a phenotype at great risk for steep transitions to disability and death. This is a group that could benefit from early identification and disability prevention interventions, which could start with simple questions such as, “Have you changed the way you walk ½ mile or walk up steps?”
Limitations include that our study includes only African Americans and whites. It is unclear whether these findings might apply to other races or ethnicities. This cohort is concentrated in an urban/suburban section of Baltimore City and County. These results thus may not generalize to more rural areas. Strengths of the current study include a well-characterized community-based sample, easily reportable measures of disability, and longitudinal design from high functioning to disability.
In conclusion, among a cohort of previously high- functioning older women, low-education attainment was independently associated with incident PCD. Future studies should address interventions among these vulnerable women that focus on increasing access to resources to prevent functional loss.