Forgotten: Elderly Persons with Disability - a Consequence of Policy

Abstract

Forgotten: Elderly Persons With Disability--A Consequence of Policy The prolongation in life expectancy has greatly increased the proportion of older individuals within the population. In 1900 there were only 3 million persons aged 65 and over in the United States. By 1981 24 million persons in the United States were 65 or over. The increase in numbers for this age group is projected to be 31 million by the year 2000 and 55 million by the year 2030. (U.S. Department of Health Services, 1979). Although many elderly persons remain active and are not affected by the disabling effects of chronic disease, the incidence of chronic disease and associated disability increase with age by about 3 1/2 times. (Black, 1984). Aging should not be thought of as synonymous with disease or disability; however, the frequency and rate of total disability, occupational disabilities and secondary work limitations is greater after age 55 than for any other age group (Social Security Administration, 1981). Even though the incidence of disability increases with age, contact with and services offered to olderly persons by rehabilitation agencies appears to decrease (Blake, 1981). After the age of 24, the number of persons receiving rehabilitation services is inversely proportional to the age of the individuals served (Blake, 1981). Rehabilitation goals for younger individuals with chronic health problems generally place a priority on increasing functional capabilities whether the outcome is work related or not (Hunt, 1984). However, rehabilitation goals for older persons with the same chronic health problems may be minimal or non-existent (Becker & Kaufman, 1988; Richardson, 1981). Lack of rehabilitation services for the older age group evokes several consequences. First, rather than receiving services which would assist them to remain in the workforce longer, older individuals may instead be encouraged or forced to retire from employment. Second, rather than receiving services which would assist them to remain independent within their own home older individuals may, instead, be institutionalized because of functional limitations related to activities of daily living. The social consequences of disinterest in the rehabilitation needs of elderly persons is far reaching both in terms of lost human potential and in financial ramifications. Providing the same rehabilitation services to elderly persons with disability as those which would be offered to younger persons with the same disability is a step to counteract loos of human as well as financial resources. Distribution of Rehabilitation Services Major chronic, disabling conditions such as diabetes, heart disease, visual impairments, hearing impairments, and mental conditions are often progressive, requiring long term treatment (Brody, 1983; Hunt, 1984). The occurrence of these conditions in elderly persons contribute to the incidence of severe disability with increasing age (Becker & Kaufman, 1988; Blake, 1984). Younger individuals with these conditions are eligible for rehabilitation services which enable them to increase functional capacities, maintain independence, and reduce development of complications. The same rehabilitation services for the same conditions, however are often not available to persons over 60 years of age. (Becker & Kaufman 1988). Examples of inequitable distribution of rehabilitation services based on age are numerous. Although 85% of all amputations in the United States during peacetime occur in elderly persons as the result of complications of arteriosclerosis or diabetes (Brody, 1983) until recently many elderly persons were rejected for prosthetic fitting and training (Lippmann & Englewood, 1974). Rationale for rejecting such services for older persons was the perception that older individuals would be unable to learn how to use the prosthesis properly, even though there was no evidence to substantiate this claim (Brody, 1983). …