A 3-D model of health decline: disease, disability, and depression among Black and White older adults.

Much of the research on health decline in older adulthood has specified a single causal direction between two health domains, often measured at the same time point, making it difficult to disentangle the mechanisms of health decline over time. Using three waves of data over seven years from older residents of North Carolina, a 3-D model is used to examine the temporal ordering of general health decline and the pathways of influence across three health domains (disease, disability, and depression). In addition, we test whether the 3-D model of health decline is similar for Black and White older adults. Results indicate that both prevalent and incident disease lead to increases in depression and that prevalent disease leads to greater disability three years later. Depression, in turn, leads to disease, identifying a cycle of health decline that is, for the most part, similar for Black and White older adults. The effect of widowhood is more deleterious to the health of Black older adults than for their White counterparts.