Disabilities decline unequally for older Americans
The prevalence of disabilities among older Americans declined substantially during the past two decades, according to a U-M study published in the November issue of the American Journal of Public Health.
But the declines were not as large among the nation's most vulnerable eldersthe less affluent and less educated.
In 1982, about 23 percent of the population age 70 years and older reported some kind of health problem or physical limitation that affected their ability to live independently and take care of themselves. By 2002, the rate had dropped to 16 percent.
The percentage of elderly needing help with shopping, household chores and transportation declined most sharply, from about 15 percent to about 8 percent.
But the study found substantial differences in the magnitude of these declines among more and less advantaged groups of older Americans. "Disparities across educational and income categories have generally widened in the last 20 years," says Robert Schoeni, lead author of the article and a research professor at the Institute for Social Research.
"Disparities by race and ethnicity have largely persisted," Schoeni says, adding that the size of racial and ethnic disparities would have been reduced if not for the fact that gaps in education and income have widened during the past two decades, and minorities are concentrated in disadvantaged groups.
For the study, Schoeni and co-authors Linda Martin, Patricia Andreski and Vicki Freedman analyzed data on 172,227 men and women age 70 and older from the National Health Interview Survey, a cross-sectional survey of the U.S. population conducted annually by the National Center for Health Statistics.
The researchers assessed the presence of disability through two questions. "Because of any impairment or health problem, do you need the help of other persons with personal care needs, such as eating, bathing, dressing or getting around this home?"
Those who answered "no" then were asked, "Because of any impairment or health problem, do you need the help of other persons in handling routine needs, such as everyday household chores, doing necessary business, shopping, or getting around for other purposes?" The first question measures more severe types of disabilities.
Adjusting for age, they found that older people in the lowest quartile of income and with the least education showed modest improvements in the least severe forms of disability and no improvements in the prevalence of severe disabilities in the 20-year period studied. At the same time, those in the highest quartile of income and with the most education showed considerable improvement in both types of disability.
As a result, the socioeconomic gap in disability prevalence, already in favor of more advantaged Americans in 1982, became larger between 1982-2002, the researchers found.
Both non-Hispanic whites and all other racial and ethnic groups experienced a decline in the prevalence of disability, and there was no statistically significant change in the disability gap favoring non-Hispanic whites.
Looking at the trends in severe disabilities, the researchers found a significant increase in prevalence among those with the least educationa disturbing finding, according to Schoeni.
"At the moment, we can only speculate about the causes of these widening disparities," he says. "But disability is a function of both underlying physical capacity and the environment in which a person lives and works. So closing the gaps in late-life functioning may require a combination of medical, behavioral and environmental interventions over the lifetime."