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Progressive and Catastrophic Onset of Disability

Not all disability is caused by progressive chronic conditions. While aging anddisabilityare both dimensional and dynamic experiences, the onset of disabilitymay be catastrophic – as in the case with falls – and consequent injury – and stroke.Ferrucci et al. (1996) examined the Established Populations for EpidemiologicStudies of the Elderly (EPESE) to distinguish between progressive and catastrophiconset of disability. This study revealed that the incidence rates of progressive andcatastrophic disability were virtually the same – 11.3 vs. 12.1 per 1,000 personyears. Table 4 illustrates that the rates of progressive and catastrophic disabilityincrease rapidly with age.

Falls often represent catastrophic events for older people. About 30% of olderpeople fall each year resulting in injury, death, and disability. Unintentional falls arethe leading cause of injury-related death and emergency room visits for people aged65 and over (Centers for Disease Control and Prevention [CDC], 2005). In 2003,1.8 million older people received emergency room treatments for falls; 13,700 diedas a result of falls. Falls represent the leading cause of hip fracture. Between 1993and 2003 fatal falls increased by 55.3% while hip fractures decreased by 15.5%(CDC, 2006). Falls and fear of falling are well documented concerns that limit activity and social participation (Kempen, van Haastegt, McKee, Delbaere, &Zijlstra, 2009). Thomas, Stevens, Sarmiento, and Wald (2008) found that traumaticbrain injury (TBI) was associated with half of falls-related deaths, and 8% of fallsrelatedhospitalizations were associated with TBI.

Late life disability associated chronic conditions, comorbid chronic conditionsor injury suggests the role of public health in terms of primary prevention andhealth promotion among people who acquire disability. For example, in the pairs ofchronic conditions Fried (1999) identified, preventing or ameliorating the effects ofarthritis or vision impairment would mitigate the effects created by both. If arthritisand/or vision loss cannot be prevented, then strategies need to be employed to controlthe potential compounding effects of comorbid conditions. Interventions tomanage arthritis – say walking – may be compromised by poor vision. Travel andvision loss can be addressed through orientation and mobility training provided byvision rehabilitation programs. Improved mobility for those with vision impairmentmay then result in improved travel skills as well as improved overall health.Innovative, often interdisciplinary, interventions are required to improve health,activity performance, and social participation. In addition, improvements in theenvironment – sidewalks, good lighting, and safety – may have similar outcomes ofimproved overall health.

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