Background: Population-level surveillance of the prevalence and trends of basic self-care limitations will help to identify the magnitude of physical disablement in the rapidly growing older American demographic. We sought to evaluate the prevalence and trends of activities of daily living (ADL) limitations in the United States. Methods: The analytic sample included 30,418 Americans aged ≥50 years from the 2006–2018 waves of the Health and Retirement Study. ADLs were self-reported. Weighted prevalence estimates were presented, and trends analyses were performed. Results: Although overall ADL disability prevalence was 16.5% (95% confidence interval: 15.8–17.2) in 2018, there were no changes in limitations during the study period (p = 0.52). Older adults had a greater ADL disability prevalence than middle-aged adults (p < 0.001). While older persons experienced a declining trend of ADL limitations (p < 0.001), middle-aged persons had an increasing trend (p < 0.001). Males had a lower ADL limitation prevalence than females (p < 0.001). Hispanic and non-Hispanic Black had a higher ADL disability prevalence than non-Hispanic White (p < 0.001). Conclusions: This investigation revealed that while the estimated prevalence of ADL limitations in the United States was substantial, changes in such limitations were not observed. Our findings can help guide ADL screening, target sub-populations with an elevated ADL limitation prevalence, and inform interventions.

The purpose of this study was to evaluate the associations of (1) individual absolute and body size normalized weakness cut-points, and (2) the collective weakness classifications on time to diabetes in Americans. We analyzed data from 9577 adults aged at least 50-years from the Health and Retirement Study. Diabetes diagnosis was self-reported. A handgrip dynamometer measured handgrip strength (HGS). Males with HGS <35.5 kg (absolute), <0.45 kg/kg (normalized to body weight), or <1.05 kg/kg/m² (normalized to BMI) were categorized as weak. Females were classified as weak if their HGS was <20.0 kg, <0.337 kg/kg, or <0.79 kg/kg/m². Compounding weakness included falling below 1, 2, or all 3 cut-points. Persons below the body weight normalized weakness cut-points had a 1.29 (95% confidence interval (CI): 1.15–1.47) higher hazard for incident diabetes, while those below the BMI normalized cut-points had a 1.30 (CI: 1.13–1.51) higher hazard. The association between absolute weakness and incident diabetes was insignificant (hazard ratio: 1.06; CI: 0.91–1.24). Americans below 1, 2, or all 3 collective weakness categories had a 1.28 (CI: 1.10–1.50), 1.29 (CI: 1.08–1.52), and 1.33 (CI: 1.09–1.63) higher hazard for the incidence of diabetes, respectively. Our findings indicate that while absolute weakness, which is confounded by body size, was not associated with time to diabetes, adjusting for the influence of body size by normalizing HGS to body weight and BMI was significantly associated with time to diabetes. This suggests that muscle strength, not body size, may be driving such associations with time to diabetes.