People grow old gradually and as people age, so do their disabilities. The number of disabled elderly is growing rapidly in many countries worldwide. Disability is usually defined as restrictions in the capacity to perform activities of daily living (ADL), or in the inability to function independently in terms of basic or instrumental ADL.
According to the World Health Organization (WHO), 10 per cent of the world’s population has some form of disability. Among them, 20 percent of those aged 70+ and 50 percent of those 85+ are disabled. In the United States, it is estimated that the number of Americans who will suffer functional disability will increase at least 300 percent by 2049.
Frequent diseases among the elderly
Several diseases can affect the elderly. The major chronic conditions are cardiovascular diseases, hypertension, stroke, diabetes, cancer, chronic obstructive pulmonary disease (COPD), muscular-skeletal conditions including arthritis and osteoporosis, mental health conditions such as dementia and depression, and blindness and visual impairment. To these conditions should be added injuries due to falls and to road traffic accidents.
The WHO argues that old age starts at age 75, although with increasing longevity this criteria is changing rapidly, reaching older years. The very old are the most rapidly growing sector of the population, and it is among them that severe disability is the highest.
Some chronic conditions that frequently lead to disability include stroke, diabetes, cognitive impairment, arthritis and visual impairment. Cognitive problems and depression are frequent among the elderly, and require special attention. While visual loss is associated with increased risk of falling, hearing and visual impairment increase the risk of social isolation and depression.
It was found that for adults with arthritis the odds of disability rise with age, diminish with education and is higher for those who are not married. Osteoporosis is frequent among the elderly, particularly women, and their falls are more likely to result in fractures.
Almost 75 percent of the elderly have at least one chronic illness, and about 50 percent have two. Chronic conditions such as hip fractures and stroke can provoke some severe and immediate disabilities. They can also lead to progressive disabilities that affect older people’s ability to care for themselves.
The costs for caring and treating the elderly with chronic conditions are high and continue to grow. Home care expenses contribute to these high costs. Because of their higher health care needs, the elderly are more likely than younger people to incur high expenses for home health care.
Overall, women experience disability more often than men. However, women generally survive longer and with greater disability than men. The reasons for this difference are not yet well understood.
There is a strong relationship between poverty and disability. Poverty can lead to malnutrition, inadequate health services and sanitation. Unsafe living and working conditions that can lead to disability trap people in a life of poverty. Differences in education also contribute to the prevalence of disability. In general, older adults with less education are also more prone to suffer disability than the more educated ones.
One cannot disregard the effect of the environment in its effects on increasing or preventing disabilities. Poor living conditions are conducive to isolation and, therefore, to an increase in disability. On the other hand, while a polluted environment that affects healthy living also increases disability, a healthy environment that fosters independent living can make a significant difference in the lives of those suffering from disabilities.
Aspects of management
Several studies have shown that keeping physically and mentally active when getting older or after retirement is critical to prevent or alleviate disabilities. According to Dr. Claude Bouchard, director of the human genomics laboratory at Pennington Biomedical Research Center in Louisiana, no pill comes close to what exercise can do. Any exercise program should include stretching activities, strength training and aerobics. Low-impact exercises such as walking and table tennis are very beneficial for older adults, since it can lead to improved physical and visual coordination.
Stimulation of mental activities through games and language learning can alleviate –and to some extent prevent- the negative effects of some mental conditions, such as poor memory. Also important is carrying out actions that provide a feeling of being useful, particularly through participation in community activities and helping in the education and care of younger people. When activities are carried out among people of like-minded interests the beneficial effects are even greater.
Because cognitive impairment and depression are frequent among the elderly, the company of a pet can significantly improve their situation. Pets can not only reduce depression and lessen loneliness, but also reduce stress, lower blood pressure and help improve social interaction.
Appropriate nutrition is critical to keeping in good health. One aim is to provide minimum nutrition requirements including adequate dietary fiber and vitamin D that tends to be low in older people. In addition, folic acid and vitamin B12 benefit cognitive function among the elderly.
Physical exercise provides a wide range of beneficial effects. Appropriate exercise increases strength and mobility, improves balance and cardiovascular function, decreases fatigue, helps prevent weight gain and improves mood. In regard to that last aspect, laughing has proven to be a good medicine. As George Bernard Shaw said, “You don’t stop laughing when you grow old. You grow old when you stop laughing.”
Dr. César Chelala is an international public health consultant.