What is disability?

Three-quarters of all deaths in developed countries are due to chronic diseases (heart problems, cancer, stroke) — this may be the price we pay for living long (into the old-old years); problematic when the severity of a chronic disease leads to disability

Disabilities are functional impairments affecting one’s activities of daily living:

• Instrumental Activities of Daily Living (IADLs) are those activities that have to do with maintaining a household: using the telephone, getting to places within walking distance, shopping for groceries, meal preparation, doing housework, making small household repairs, doing laundry, managing one’s own money — difficulties in these may be managed by a loved one or supplemented by neighborhood services such as Meals on Wheels, Ride On, etc.
• Basic Activities of Daily Living (ADLs) involve basic care: eating, dressing, bathing and personal care, using the bathroom, taking medication — may require more constant care

The disability pathway

Two main pathways:

• Catastrophic event (e.g., stroke, fall) --> impairments in IADLs and/or ADLs (more likely for young-old)
• Chronic disease (e.g., diabetes, hypertension) --> worsens with age --> impairments in IADLs --> impairments in ADLs (more likely for the old-old)

Gender and SES

Women are more likely to be among the elderly disabled

• men are more likely to die sooner and of heart attacks
• women visit doctors more often throughout their lives
• women live longer, even with disabling conditions

• have less social support, more stress, etc. (risk factors for chronic diseases)
• are uninsured
• visit doctors less often
• have less access to primary care (prevention) or secondary care (changing risk factors so they don’t develop into a disease)
• because income often overlaps with race and ethnicity, there may be significant barriers to getting adequate health care in ethnic communities (location, hours, language spoken, ethnicity of the staff, etc.)

People over 65 are the most frequent consumers of health care; "covered" by Medicare, but many out of pocket costs with Medicare — 21% of community-living older adults’ yearly family income goes to health care

Home care & Specialized Services - people who are paid or volunteer to come into the home to perform a few select services (e.g., Meals on Wheels, shopping, Caring Callers), home health care (e.g., bathing), or even 24-hour care

Day centers and programs — can offer social enrichment, respite care, and/or medical services

Continuing-care Retirement Communities and Assisted Living Facilities — can offer a range of services from retirement living to skilled nursing; in assisted living facilities, residents would need levels of care not quite extensive enough for being in a skilled nursing facility

Nursing Homes — long-term care facility; 5% of those 65+, but the lifetime risk of placement is about 1 in 2; for those over 85, the residency rate is about 1 in 5 (22%). Discharges because of death account for one-quarter to one-third of the total discharges in any year. An average resident, stays only a few months.

Paying for care

• Private Funds
• Private Insurance (including long-term care insurance)
• Medicare (federally funded for those 65+ or with disability)
• Medi-Cal/Medicaid (state-by-state programs for the poor)

Women provide about 75% of the care for the disabled, community-living elderly.

• Caregivers dedicate, on average, 20 hours per week to provide care for older persons and even more time when the older person has multiple disabilities.
• Caring for an older person with disabilities can be physically and psychologically demanding, particularly for older caregivers, who make up about half of all caregivers.
• One-third of all caregivers describe their own health as fair to poor. Spouses as caregivers have lower morale, but fare better than daughters as caregivers (who report higher levels of depression, anxiety, ambivalence, and more time off from work).

• Asian American, African American, and Hispanic American households tend to be more involved in caregiving than the general population.
• The proportion of minority family members involved in caregiving is higher than those in non-minority families, particularly among adult children.
• Spouses account for 28 percent of the caregivers of white elders, 20 percent among Hispanic Americans, and 15 percent among African American elders;
• More than 52 percent of Hispanic Americans receive care from adult children; African Americans are most likely to receive care from non-relatives.

Elder Abuse

A national incidence study conducted in 1996 found the following:

• 551,011 persons, aged 60 and over, experienced abuse, neglect, and/or self-neglect in a one-year period;
• Almost four times as many new incidents of abuse, neglect, and/or self-neglect were not reported as those that were reported to and substantiated by adult protective services agencies;
• Persons, aged 80 years and older, suffered abuse and neglect two to three times their proportion of the older population; and
• Among known perpetrators of abuse and neglect, the perpetrator was a family member in 90 percent of cases. Two-thirds of the perpetrators were adult children or spouses.

• Physical abuse is the willful infliction of physical pain or injury, e.g., slapping, bruising, sexually molesting, or restraining.
• Sexual abuse is the infliction of non-consensual sexual contact of any kind.
• Psychological abuse is the infliction of mental or emotional anguish, e.g., humiliating, intimidating, or threatening.
• Financial or material exploitation is the improper act or process of an individual, using the resources of an older person, without his/her consent, for someone else's benefit.
• Neglect is the failure of a caretaker to provide goods or services necessary to avoid physical harm, mental anguish or mental illness, e.g., abandonment, denial of food or health related services. (Elder Abuse info from http://www.aoa.gov/factsheets/abuse.html)