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Late Life Disability

Aging research has generally employed the concepts Activities of Daily Living(ADLs) and Instrumental Activities of Daily Living (IADLs) as methods to characterizefunction and disability. ADLs include bathing, dressing, eating, transferring,and toileting. IADLs include using the phone, driving, meal preparation,shopping, housework, managing medications, and managing finances. Employingthese concepts of ADLs and IADLs, studies from the 1980s and 1990s indicatedthat late-life disability appeared to decline by about 1–1.5% a year (Freedman,Martin, & Schoeni, 2002). Freedman (2006) examined the National HealthInterview Survey over a 20 year period to identify changes in ADLs and IADLsamong community dwelling people age 70 and over. She found a 6% pointdecline in IADLs from about 14% in 1982 to about 8% in 2004. Meanwhile,ADLs remained fairly stable at about 8%. Different methodologies and differingcase definitions of disability make it difficult to accurately predict changes andattribute cause.

Manton, Gu, and Lamb (2006) examined the National Long-Term Care Survey from 1982 to 2004/2005 and found that overall prevalence of disability declined from 26.5% in 1982 to 19.0% in 2004/2005. Table 1 complements Freedman’s findings andillustrates that substantial decreases have occurred in IADLs over the 22 year period.A 2009 study by Fukller-Thomson, Yu, Nuru-Jeterm, Guralnik, and Minkler(2009), by contrast, shows increasing rates of ADL limitations. These investigatorsused the American Community Survey, and they employed a different casedefinition of disability (see Chapter “Social and Behavioral Dimensions of Health”for descriptions of these and other surveillance resource data).

Several factors, including improvement in technology, improved health care thatlimits the effects of heath conditions, and improved educational levels have all beenhypothesized as explaining these declines. One might surmise that activities likeon-line banking might have benefits improving IADLs, and technologies likemicrowave ovens make meal preparation easier for everyone. Changes broughtabout by the American with Disabilities Act (ADA) have, over time, benefited anincreasingly large population by making environments more accessible. The sum ofthese changes may improve IADLs.

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