New Trends in Late-Life Disability
By Richard Shank
New research published in The Milbank Quarterly investigates the reasons why rates of late-life disability have been declining since the 1980s, a topic that has been largely unexamined until now.
In 1983, nearly 22% of the population aged 70 and better had a disability. By 2005, the disability rate for this age group had fallen to 14%. In this study, the evidence demonstrates that measures of physical limitations, cognitive impairment, and sensory deficits (e.g. vision loss) have all decreased within the past two decades. These declines have occurred irrespective of trends in chronic diseases, which are uneven since some chronic diseases have declined while others have become more prevalent.
It is commonly agreed that the decreased prevalence of late-life disability will increase the number of older adults who remain socially and economically active into old age. However, without knowledge of why the decrease in disability rates has occurred, policymakers and clinicians will have a hard time capitalizing on opportunities for further eliminating disability and its associated costs.
Health and disability are impacted by competing factors. Despite the benefits of advancing medical technologies, researchers have found that health care is responsible for only minor variations in the levels of a population's health. In order to fully understand relative changes, researchers have had to outline a complex conjunction of factors that influence medical care, as well as the economic, social, and environmental factors that have been shown to drive population health more directly.
The conclusions presented by these researchers are complex. Overall, they suggest that advances in medical care have helped improve the disability rates in the United States. However, they also found that disability rates vary widely among occupational and demographic groups and are further impacted by environmental factors (e.g. pollution, climate, and neighborhood/city health resources). Some of these factors have an immediate impact on health and disability (i.e., medical care, diet, exercise, etc.), and others have a more indirect long-term impact that operates through “the accumulation of advantages and disadvantages” throughout the lifespan (i.e. the strong association between income and health).
For example, advances in medical care have reduced the impact of chronic disease on daily living, making full recovery more likely. However, the availability of advanced medical care is rationed proportionally by the economic means needed to access them, leaving rates of disability significantly higher for individuals with lower economic means.
Furthermore, those with access to medical care utilize it in highly variable ways. Women are far more likely than men to access the health resources available to them, and it is unsurprising that they experience enhanced longevity as a consequence. The same is true for individuals with high levels of education.
In short, these findings imply that a targeted approach will help to strengthen the decrease in rates of disability. This approach should ensure access to medical care and expand health promotion activities for the underserved individuals who face barriers to care and, therefore, the highest rates of disability.
Source: Schoeni, R., Freedman, V., Martin, L. 2008. Why is late-life disability declining? The Milbank Quarterly 86(1): 47-89.
