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Disease and Comorbid Conditions as Pathway to Disability

Disease and comorbid conditions define one pathway to disability in older age. The prevalence and risk factors for chronic conditions leading to disability are especiallyvulnerable to disparities, for example by poverty, gender, and ethnicity (Albert,2004). In one example, Ettinger et al. (1994) examined the Cardiovascular HealthStudy to identify diseasesreported as causing difficulty with particular activities. Theassociation between disease and activity differed among men and women. Arthritiswas reported more frequently by women and was reported as the cause of limitationin walking  mile, doing heavy housework, and bathing; whereas, there was morevariability in the cause of reported activity limitation among men.Verbrugge and Patrick (1995) examined seven chronic conditions among olderpeople (arthritis, visual impairment, hearing impairment, ischemic heart diseasechronic obstructive pulmonary disease, diabetes, and cancer) and found that someconditions – vision impairment and cancer – had high impact in terms of limitations;and others – hearing impairment – did not. These same conditions predicteddifferingutilizationof physician visits and hospital stays, as one would imagine.

Cancer, for example predicated high physician and hospital use. Arthritis andhearingimpairment predicted little physician or hospital use.

The pathway to disability is generally not a single diagnosis or condition, butcombinations that limit function (Gijsen et al., 2001). Verbrugge, Lepkowski andImanaka (1990) in an early study illustrated the prevalence and effects of comorbidconditions among people over age 55. Fried, Bandeen-Roche, Kasper and Guralnik(1999) examined the Women’s Health and Aging Study to identify the ten leadingco-occurring chronic conditions among eleven conditions examined for womenaged 65 and older. Arthritis and vision impairment are frequently occurring comorbidconditions that are evident in nine of the ten combinations.

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