Old Age Disability and Limitations Have Declined Over the Last Decade
Though they are not inevitable, physical disabilities and other functional, cognitive, and sensory limitations affect many older adults. In fact, 20% of older adults in the United States have chronic disabilities. In addition, 7–8% have severe cognitive impairments, one-third has mobility limitations, 20% have vision problems, and 33% have hearing impairments. In 2000, $123 billion was spent on long-term care for seniors with disabilities.
While studies have shown that life expectancy among the elderly has been steadily increasing, it remains uncertain whether this decrease in mortality has meant a decrease in morbidity. Although several recent studies have suggested that rates of disability and other limitations have declined, no systematic review of this research had been undertaken thus far.
Researchers from the Polisher Research Institute and other research institutions have filled this gap in an article published in the December 25, 2002 issue of the Journal of the American Medical Association . They found that old-age disability and other limitations have indeed declined in the last decade.
About the Study
The scientists reviewed more than 800 articles about disabilities and other age-associated limitations published from January 1990 through May 2002. From these, they selected 16 articles, based on eight studies, from which to ascertain disability and limitation prevalence among older persons in the United States over the last decade. The study participants were generally 65 years and older.
Physical disability was defined as the inability to independently carry out specific roles or activities within a given environment. Functional, cognitive, and sensory limitations were defined as underlying difficulties with specific physical, memory-related, and vision and hearing-related tasks.
The prevalence of any disability declined significantly during the 1990s; the average decline ranged from 1.55 to 0.92% per year depending on the study. These improvements were strongest for instrumental activities of daily living (IADLs), which include household chores, shopping, managing medication, climbing stairs, and walking. The trends for activities of daily living (ADLs), which include personal-care activities such as bathing, dressing, and using the toilet, were mixed.
Severe cognitive impairment declined significantly over the last decade. The studies on vision trends had mixed results, while rates of hearing impairment had remained constant.
How Does This Affect You?
According to this review certain disabilities associated with higher functioning (IADLs) and severe cognitive impairment have declined over the last decade. However, the fact that there was no clear improvement in ADLs is discouraging. Losing ADLs represents the most serious kind of disability, because without them an older adult requires constant supervision, usually in a nursing home.
Though these findings offer some hope that declining disability may offset some of the financial effects of an aging population, the study authors state that caution is in order. The explanations for the trends observed in this study are unknown, and need to be explored further.
In the future, assistive technologies and modifications to the home are likely to make IADLs, or tasks of independent living, easier for many older adults. However, it is sobering to think that our laudable progress in extending people’s lives has not been matched by our ability to keep them well and living independently. This may have enormous public health implications for a society on the brink of caring for its aging baby boom population.
National Council on the Aging
National Institute on Aging
National Institutes of Health
Freedman VA, Martin LG and RF Schoeni. Recent trends in disability and functioning among older adults in the United States: a systematic review. JAMA . 2002;288:3137-3146.
Last reviewed Dec 27, 2002 by ]]>Richard Glickman-Simon, MD]]>
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