Loss of Independence Among Racially and Ethnically Diverse Older Adults: An ICF-Based Analysis of NHATS

Abstract

Highlights What are the main findings? Physical performance is the strongest direct association with LoI, operationalized using VES-13 across NH White, NH Black, and Hispanic older adults. In contrast, the relative importance of social and environmental factors differed across groups: social participation restriction was particularly prominent among NH Black adults, whereas limited English proficiency was particularly important among Hispanic adults. What are the implications of the main findings? Preventive healthcare policies must move beyond generic, illness-focused models toward culturally responsive interventions tailored to specific community vulnerabilities. The ICF framework provides a useful approach for identifying potential intervention targets, including social engagement and linguistic accessibility, that should be further evaluated in longitudinal research. Abstract Background: Preventing mobility-related loss of independence (LoI) is a critical public health priority. While the drivers of LoI are complex, this study examines how personal, social, and environmental factors influence these outcomes to identify actionable preventive targets. We applied the International Classification of Functioning, Disability, and Health (ICF) framework to examine these pathways across racial and ethnic groups. Methods: Using 2023 National Health and Aging Trends Study (NHATS) data (N = 7106), we conducted path analyses among non-Hispanic (NH) White, NH Black, and Hispanic older adults. We assessed associations between health conditions, body function, physical performance, social participation, and environmental factors. Results: The ICF-based model explained 36.6–38.2% of LoI variance. While physical performance was the strongest direct predictor of independence across all groups, indirect pathways varied. Social participation restrictions are associated with higher LoI score among NH White and Black adults. For Hispanic adults, limited English proficiency functioned as a key environmental variable negatively associated with body function and physical performance. Additionally, shared living arrangements among NH Black participants were negatively associated with physical performance. By gender, only NH White females exhibited associations with better physical and social outcomes. Conclusions: Pathways to LoI are associated with group-specific structural factors. To effectively prevent functional decline, healthcare policies should move beyond generic services toward culturally responsive interventions. Prioritizing targeted lifestyle behaviors—specifically social engagement for NH Black populations and linguistic accessibility for Hispanic adults—may help reduce health inequities and proactively preserve independence.