• Posted February 8, 2023

There's Been a Big Decline in the Rate of Americans Hit by Disability

A new study delivers some great news to older Americans, something many likely already realize in their daily lives.

The prevalence of disabilities among seniors is down sharply from what it was just a decade before, researchers say.

Fewer older adults have limitations in the activities that are an important part of daily life, from climbing stairs or walking without difficulty to dressing and bathing.

"Our findings suggest millions more Americans are remaining disability-free and therefore could feasibly stay in their homes well into their 80s and 90s,"said study author Esme Fuller-Thomson, director of the University of Toronto's Institute for Life Course and Aging.

This study updates earlier information that seniors have been getting healthier since about the 1980s, she said.

"Certainly between 1980 and 2010, there were quite a few studies showing improvements over time,"Fuller-Thomson said. "So, we are just trying to see if it continues. And the good news is, yes, it does."

In the study, researchers analyzed 10 consecutive cross-sectional waves of the American Community Survey from 2008 to 2017. The survey included adults living in the community and those living in institutions, such as assisted living facilities.

Each year included about a half-million adults ages 65 and up, with 5.4 million seniors as the final sample size.

The odds of having functional limitations in activities of daily living like dressing and bathing dropped 18% between 2008 and 2017. The odds of having limitations such as serious difficulty walking or climbing stairs were 13% lower.

While just over 12% of older Americans reported having limitations in 2008, that number was 9.6% by 2017.

If as many older Americans had functional limitations in 2017 as had in 2008, 1.3 million more older Americans would have these limitations.

The percentage of older adults with functional limitations also dropped from 27.3% in 2008 to 23.5% in 2017. That is equivalent to 1.9 million fewer older adults having these limitations.

Yet not all the news is great.

"The worrisome news is the progress isn't nearly as good in the baby boomer generation, who were the youngest cohort,"Fuller-Thomson noted.

"The 65- to 74-year-olds were the boomers in my study," she said. "And they're not showing nearly as substantial improvements as those who are older, like 75 and up in our study."

It's not certain why, but obesity is a likely culprit.

"It's something to seriously consider because obesity is associated with a lot of negative outcomes, including much higher incidence of developing functional limitations or having trouble with your daily activities such as feeding yourself,"Fuller-Thomson said.

"So this makes us concerned that this really positive trajectory may not continue into the 2020s and 2030s because as the boomers age, if they're not doing as well as the previous generations, there might not be the same level of improvements we currently see," she said.

The study also found that improvements in disabilities were greater for women, having decreased by about 20%, compared to 13% for men after adjusting for age and race.

Researchers suggested this may be due to women being more likely to adopt preventive care practices.

Reasons for why so many seniors are aging with fewer disabilities could include higher levels of education and decreases in smoking and air pollution.

The findings were published Feb. 2 in the International Journal of Environmental Research and Public Health.

Dr. Christine Kistler is an associate professor in the Division of Geriatric Medicine at the University of North Carolina School of Medicine. She said it's nice to see that some of the efforts of the past decades -- from getting people to be more physically active to smoking less and managing common health conditions like stroke and high blood pressure better -- are having an impact.

"That improvement in the quality of our air, our water, our food, vaccinations and the widespread use of all of it appears to have helped,"said Kistler, who was not involved in the study.

She said the hope of those in the health care system, and beyond, is to reduce the amount of disability by compressing it into a shorter time frame, letting people live healthier lives for longer.

Even with the improvements, there are still substantial numbers of older adults living with functional limitations, Kistler noted.

Yet, it's become more commonplace to have octogenarians, nonagenarians and centenarians as patients.

It's also more common to do joint surgeries on much older adults. And programs to keep seniors active have expanded as more people age without disability, Kistler said.

Advantages to living without disabilities are extensive, including maintaining independence and living at home.

"I think it makes a lot of sense that if you can compress these functional limitations and ADL [assisted daily living] limitations that you see a big gain in terms of quality of life and satisfaction,"Kistler said.

Kistler said she would like to see expanded information on other activities of daily living. She would also like to see if there are differences in the data for those in racial and ethnic minority groups.

Fuller-Thomson said she plans to continue to follow up on this research, though may delay the next look because the COVID-19 pandemic made it harder to gather comparable data.

More information

The U.S. National Institute on Aging has more on healthy aging.

SOURCES: Esme Fuller-Thomson, PhD, director, Institute for Life Course and Aging and professor, Factor-Inwentash Faculty of Social Work and Department of Family and Community Medicine, University of Toronto, Canada; Christine Kistler, MD, MASc, associate professor, Division of Geriatric Medicine and Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill; International Journal of Environmental Research and Public Health, Feb. 2, 2023