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Study: Chronic disability in older Americans overestimated
Scripps Howard News Service


December 13, 2005

The rate of chronic disability in older Americans may have been overestimated by as much as 40 percent in government surveys, a new study suggests.

Researchers at Yale University's School of Medicine used data from an eight-year study of more than 750 people aged 70 and older living in the greater New Haven, Conn., area. During the study, the seniors shared their experiences during home assessments and monthly telephone interviews, focusing on such essential activities of daily living as bathing, dressing and walking.

Patients were classified as chronically disabled based on the presence of a disability during consecutive monthly interviews immediately before or after the fourth comprehensive assessment. The researchers found that between 16.1 percent and 17.2 percent met the criteria for chronic disability, which translates to 4.9 million to 5.3 million disabled seniors nationwide.

"Our projections yielded about 2 million fewer chronically disabled older Americans in 1999, relative to the published estimate of 7 million," said Dr. Thomas Gill, co-author, along with Dr. Evelyne Gahbauer, of the study published Monday in the Archives of Internal Medicine.



Government-sponsored surveys define chronic disability in terms of a person either being in a long-term-care facility or not being able to perform at least one activity of daily living - like bathing or dressing, or being able to wash clothes or shop for groceries - for three months or longer. Those surveys show a disability rate among the elderly of about 20 percent.

Generally, government and academic studies have noted a steady decline in disability rates - about 1.7 percent a year - in the elderly over the past two decades, and particularly since the late 1990s and among those older than 85. The improvements have been driven both by better health among the elderly and by improvements in technology that allow people with disabilities to live without outside help.

The estimates have huge implications, because the number of Americans over 65 is expected to double in the next 25 years, to more than 70 million.

The steady decline in disability rates has been cited by analysts as reason for some optimism about the future demand, and costs, for senior health care and long-term care, as well as for the solvency of the Social Security and Medicare programs.

Many experts say that with healthier, more able seniors making up the majority of the elderly, more people will be in a position to stay in the work force and be less of a drain on social programs. But there's concern that behaviors contributing to the rise in obesity and other unhealthy conditions could reverse the disability trend over the coming decades.

Gill noted that good policy decisions about health programs and other social issues demand more accurate estimates of disability, and suggested that the perceived rates of decline might not actually be as impressive if the baseline of disability is lower.

In contrast to a short-term disability, such as recovery from an operation or brief disease, those with chronic disabilities are at greater risk of suffering further illness or injury and even death, Gill said.

"Given the dynamic nature of disability, new strategies are needed to adequately capture the true burden of chronic disability among elderly persons," he said.


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