Subjective disability and mortality risk among elderly Mexican Americans with severe physical limitations

Using the disablement process as a framework, we examine the impact of the degree of concordance between objective measures of functional capacity, based on performance oriented mobility assessments (POMAs), and self-assessed disability, based on respondents’ reports of the ability to independently perform similar activities of daily living (ADLs), on mortality for elderly Mexican Americans over a seventeen year period. The analyses are based on the longitudinal Hispanic Established Populations for the Epidemiologic Study of the Elderly (HEPESE). We label respondents with serious POMA’s limitations who also report ADL disability “realists”, while we label those with POMA’s limitations who report no ADL disability “optimists”. Logistic models reveal that mortality rates are higher for “realists” than for “optimists”. The association between optimism and mortality is mediated by more complex measures of disability and reveals the complex cognitive and social construction of self-reported measures of physical functioning. We discuss the implications of the discrepancies for understanding predictors of functional decline in the older Mexican-origin population.