Disability and Disease

Older people tend to have more disease and disability than younger adults. Most of the diseases are chronic, and older people often have many diseases at the same time. Disease and disability can greatly limit independence and increase the need for support. How well a person functions is determined by the ability to perform essential self-care activities (usually called activities of daily living), such as eating, dressing, bathing, transferring between bed and chair, and using the toilet. How well a person functions is also determined by the ability to perform additional important activities (usually called instrumental activities of daily living), such as preparing meals, performing housework, taking drugs as instructed, going on errands, managing finances, and using a telephone.

One of the goals of care is to help keep older people independent and functioning well for as long as possible. In a perfect world, most people would remain fully functional and independent until just before their death, when they would get sick and die without a prolonged period during which they have a poor level of function.

Fortunately, progress is being made toward this goal. Only 5 to 8% of people 65 or over who live in their own home need assistance with one or more self-care activities, and this percentage has decreased slightly over the past decade. Even among people 85 or over, one half of women and two thirds of men are able to live at home without needing assistance with self-care activities.

Chronic conditions that cause disability include those that also commonly cause death (for example, heart disease, stroke, chronic obstructive pulmonary disease, diabetes). Other chronic conditions are unlikely to cause death but affect how well people are able to function (for example, arthritis, osteoporosis, vision and hearing loss). Women tend to have more nonfatal chronic conditions than men. However, the chronic conditions of men are more likely to be fatal.

See the table Most Commonly Reported Chronic Conditions in People 65 and Over in 1996.