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Americans Living Longer Lives, But Most Live With a Disability


Posted on Jul 30, 2013

Ideally, we’d all live long, active, and healthy lives. Yet, while modern medicine and healthcare breakthroughs are helping us live longer, many Americans are still suffering significant disability and decreased quality of life during their final years.

Researchers at the University of California at San Francisco examined 15 years of data from the national Health and Retirement Study, a survey sponsored by the National Institute on Aging. Doctors reviewed interviews with more than 8,200 adults over the age of 50 who died between 1995 and 2010 in order to gather information about quality of life and disability rates during the final two years of life.

The following definitions were used for this study:

  • Disabled: Needing help with at least one activity of daily life, such as bathing, dressing, using the toilet, mobility, or preparing meals.
  • Severely disabled: Needing help with three or more activities of daily life.

How common are end of life disabilities?

More than 28 percent of participants in the study were disabled during the last two years of life. Twelve percent had severe disabilities. The percentage of disabled increased with age. Only 15 percent of those who died at ages 50 to 69 were disabled two years before death, while half of those who died after the age of 90 suffered from a disability during their last two years of life.

Mobility issues were a major concern for the oldest participants in the study. Sixty-nine percent of those surveyed were unable to walk more than a few blocks two years before their death. Forty-five percent were unable to walk one block, and just over half were unable to climb a flight of stairs.

Disability took a greater toll on women. Women were more likely to be disabled and had longer periods of disability than men. Women tend to live longer, so they are more likely to survive to an age where disability is common. However, an older woman is also likely to have a longer period of disability than a man of the same age.

Why? First of all, disabling disorders like depression, arthritis, or osteoporosis are more common in women. Additionally, a man who has a disability usually has a wife to take care of him. Women are more likely to live alone and on a fixed income.

Does this mean we are all doomed to a poor quality of life during our final years? Not at all.

The U.C.S.F. researchers also studied the quality of life of 62 elderly adults with significant disabilities. These adults needed help with everyday activities and would have been eligible for nursing home care. Instead, they chose to remain in their communities with support from the Program of All-Inclusive Care for the Elderly (PACE). Most of the adults in the program rated their quality of life as fair to very good.

The doctors who conducted the study say that we can slow down or delay disability, but we can’t eradicate it. Understanding disability rates can help government agencies better plan for the needs of our aging nation, including the allocation of funding for accessible transportation, housing and benefit programs like Social Security Income (SSI) and Social Security Disability Insurance (SSDI).

The research was published in the July 8, 2013 issue of JAMA Internal Medicine.

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John L. Keefe
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