Workshop on Disability in America A New Look: Summary and Background Papers (2006) / Chapter Skim
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Appendix E Late-Life Disability Trends: An Overview of Current Evidence--Vicki A. Freedman
Appendix E Late-Life Disability Trends: An Overview of Current Evidence--Vicki A. Freedman
Pages 101-112
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From page 101... ...
A fundamental question in population aging research has been whether mortality declines in late life have been accompanied by a compression or an expansion of periods of morbidity and disability1–3. Gruenberg's theory2 portends pandemic increases in chronic disease and disability, whereas Fries1 suggested that as morbidity onset is postponed and more adults reach the limit to human life, aggregate declines will occur.
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From page 102... ...
Since these theories of population aging have been proposed, understanding of disability has evolved from a classic medical model, which attributes disability to underlying chronic conditions and impairments, to one that recognizes the fundamentally social and environmental components of disability9,10. As such, recent hypotheses as to the reasons for latelife disability trends have included the influence of chronic disease trends and related medical care; shifts in underlying physical, cognitive, and sensory functioning; changes to the environment, such as technological aids and rehabilitation technologies; and demographic shifts.
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From page 103... ...
The answer was sorted out by a technical working group that analyzed five national surveys conducted from the early 1980s through 200119. The 12-person panel prepared estimates using identical methodologies and investigated sources of the inconsistencies among the population ages 70 years and older.
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From page 104... ...
For example, using data from the NLTCS, researchers found increasing racial disparities in the prevalence of chronic ADL or IADL disabilities during the 1980s and diminishing disparities during the 1990s22,23. Three studies of the NHIS (from 1982 to 1996 and from 1982 to 2002)
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From page 105... ...
Four distinct realms have been explored to date: demographic and socioeconomic shifts; changes in chronic disease and related treatments; trends in underlying physical, cognitive, and sensory functioning; and environmental changes, particularly growth in the use of assistive devices.
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From page 106... ...
It could be that earlier diagnosis and better management of such conditions has led to lower reported rates of disabilities; however, one investigation of the role of medication use in recent declines among the pre-retirement-age population did not demonstrate a link31, and an investigation of medical procedures for cardiovascular disease provided only weak evidence 30. A third area of focus has been on trends in underlying physical, cognitive, and sensory functioning.
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From page 107... ...
In that study, between 1982 and 1989, equipment use without personal assistance increased among older people with mild chronic impairments and equipment use as a supplement to personal assistance increased among those with severe chronic impairments. During the same period, reliance on personal care without any supplemental equipment declined.
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From page 108... ...
A number of common chronic conditions appear to be less debilitating, and underlying physical functioning has improved. At least some of the declines in the use of help appear to be offset by increases in the use of assistive technologies.
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From page 109... ...
Socioeconomic and demographic disparities in trends in old-age disability. University of Michigan Center for Demography of Aging Trends Network Working Paper Series 05-01.
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From page 110... ...
Estimates of change in chronic disability and insti tutional incidence and prevalence rates in the U.S. elderly population from the 1982, 1984, and 1989 National Long Term Care Survey.
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From page 111... ...
University of Michigan Center for Demography of Aging Trends Network Work ing Paper Series 05-02. Ann Arbor: University of Michigan Center for Demography of Aging Trends Network; 2004.
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From page 112... ...
The effects of health changes on projections of health service needs for the elderly population of the United States. Proceedings of the National Academy of Sciences USA 1998;95(26)
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