That there is a correlation between aging and disability makes intuitive sense. We all know someone who has become less able in some way as they aged—less ambulatory, harder of hearing, less facile with memorization or other cognitive skills. For the first time in its history, the U.S. Census Bureau has provided concrete evidence for this correlation in a report by researchers Wan He and Luke J. Larsen, Older Americans with a Disability: 2008-2012. He and Larsen provide fascinating insights into a range of variables and how they correlate to disability among the aged, suggesting ways to channel resources to prevent or mitigate disabilities for many older Americans.
Published in December, The report is based on five years of interviews for the Bureau’s nationwide American Community Survey (ACS), “designed to provide communities with reliable and timely demographic, social, economic, and housing data.” Conducted annually in every county of every state, the ACS has a sample size of about 3.5 million people, including not only home owners and apartment dwellers, but also those who live in institutions like prisons and nursing homes.
Definitions of Disabilities
This report focuses on people aged 65 or older. Between 2008 and 2012, this sector was about 13.2 percent of the total population, which amounts to 40.7 million Americans. Nearly 40 percent in this age group—almost 16 million people—were found to have one or more disabilities. (When all age groups are taken into account, only about 20 percent have disabilities.)
The Bureau’s definition of disability, based on the Americans with Disabilities Act, is “an individual’s physical or mental impairment that substantially limits one or more major life activities.” The survey focused on six disability types:
- Hearing difficulty—deaf or having serious difficulty hearing.
- Vision difficulty—blind or having serious difficulty seeing, even when wearing glasses.
- Cognitive difficulty—because of a physical, mental, or emotional problem, having difficulty remembering, concentrating, or making decisions.
- Ambulatory difficulty—having serious difficulty walking or climbing stairs.
- Self-care difficulty—having difficulty bathing or dressing.
- Independent living difficulty—because of a physical, mental, or emotional problem, having difficulty doing errands alone, such as visiting a doctor’s office or shopping.
For purposes of comparison, the report breaks down the population under study into three age groups: 65-74, 75-84, and 85 and older (referred to in the report as “the oldest old”). Not surprisingly, the incidence of disability increases as the demographic age increases. Among the youngest cohort of older Americans in the study, the incidence of individuals with three or more disabilities is 7 percent; among the oldest old, the incidence with three or more disabilities rises to 41.5 percent.
The most common disability among all of the aged is ambulatory disability. “About 10 million people, or two-thirds (66.5 percent) of the total older population with a disability, reported having serious difficulty walking or climbing stairs,” the report says. The next most common disabilities, in descending order, are “difficulty with independent living” (“a distant second” at 47.8 percent, according to the report) and difficulty hearing (40.4 percent). The order of those is the same for people aged 75 and older; for those 65-74, the order of the second most frequent disabilities is reversed, with hearing loss reported more frequently than loss of independence.
These are interesting figures in themselves, but the survey becomes more illuminating when the numbers are broken down and compared across different demographics like sex, geographic region, education, and race or ethnicity. Some of the more interesting findings:
- Women and men report different frequencies of disabilities across the three oldest segments of the population. Women report higher incidence of ambulatory disabilities (73.3 percent vs. 57.1 percent), and men, higher incidences of hearing disabilities (52 percent vs. 32.3 percent). Additionally, “older women with a disability were nearly twice as likely to live alone as older men with a disability (36.6 percent compared with 20.2 percent).”
- Married older men are more likely than married older women to have a disability (33.0 percent, compared to 26.7 percent). On the other hand, older widowers had a slightly lower prevalence of disability (52.3 percent) than older widows (53.6 percent).
- Which region you live in as you age has an impact on your healthy life expectancy, according to the report. “Residents in the South, regardless of race or sex, had lower healthy life expectancy (HLE) at age 65 than residents in other regions…. Mississippi’s older population with a disability was equivalent to 48.0 percent of the state’s total older population, the highest disability prevalence rate in the nation.”
- New York, with 6.2 percent of the nation’s seniors with a disability (about 976,000), has a disability prevalence rate of 37 percent among the older population, just under the national average of 38.7 percent among all seniors. The state has a slightly higher percentage of those seniors with disabilities living alone (32.2 percent) compared to the national average (29.9 percent), and a higher incidence (12.2 percent) of those living in “group quarters” (i.e., nursing homes) than the national average of 9.2 percent.
- The higher one’s education level, the lower one’s likelihood of having a disability after reaching 65, regardless of race. “More than half (54.4 percent) of the older population who had not graduated from high school had a disability, twice the rate of those with a bachelor’s degree or higher (26.0 percent).”
- Older people of Asian descent, regardless of educational background, marital status or living arrangement, have the lowest prevalence of disability across the three age groups in the study, compared to whites, African Americans and Latinos—33.3 percent compared to an average of 38.7 for all American seniors.
- Older blacks with disabilities are almost twice as likely to live in poverty (23.7 percent) as the national average of 12.6 percent. Older women with disabilities are likelier to be living in poverty than their male counterparts (15.2 percent vs. 9.2 percent).
A Valuable Tool
Perhaps the most useful aspect of the report is the county-level detail hinted at in three national maps that more or less echo each other, one showing the comparative density of seniors with disabilities among all seniors in each county, another the prevalence of seniors with disabilities living alone, and the last the prevalence of seniors with disabilities living at 150 percent of the poverty threshold. A glance at each shows the highest densities in the South and in regions where the overall population is lowest—rural America.
He and Larsen’s report concludes that older Americans with disabilities are “likely to be women, aged 85 and over, with less than high school education, widowed, living alone, or living in or near poverty.” It also suggests that, with the retirement of the baby boomers (born between 1946 and 1964), “the United States may experience a rapid expansion of the number of older people with a disability in the next two decades.” It offers no solutions to the difficulties these older Americans face, but it does offer what seems to be a valuable tool for analyzing them in detail.