Home     |     News     |     Buyer's Guide     |     Features     |     Products     |     Education     |     Archives

October 2001


Growing Old with a Disability

By Lucy C. Spruill, MSW
As we enter the 21st century, our entire culture is concerned with the aging of the American population and the health care, economic, and public policy issues related to maintaining a good quality of life for older Americans. Success in improving health care and rehabilitation services has dramatically improved health indicators and long-term survival rates of people with significant disabilities born during the Baby Boom years and later.1 This success now requires us to turn our attention to the needs and concerns of this aging population of people with disabilities.

In many ways, health and rehabilitation issues for those aging with a disability are the same as those for people aging without a disability. We all experience loss of physical vigor and sensory acuity, cognitive deterioration, and loss of significant relationships as we age. Many will also experience a decrease in economic and other resources. These changes are accompanied by increased utilization of and need to be able to manage health care and medications, increased dependence on formal community services, and the emotional need to accept losses and lifestyle changes.

Early Onset
For people with long-term disabilities, however, the "normal" accompaniments of the aging process set in at an earlier age, worsen more rapidly, and have multiplying effects.2 People with long-term mobility impairments, for example, will typically experience pain, fatigue, and degenerative joint disease by midlife as a result of long-term weight bearing on the upper extremities. They are also at increased risk of early onset of osteoporosis, skin deterioration and breakdown, and cardiovascular disease as a result of immobility.1

The greater susceptibility of people with long-term disabilities to infections, cardiovascular complications, falls, and other negative health outcomes will be significantly increased by the same susceptibilities that are a part of the aging process. Many people with major disabilities are able to maintain a good quality of life because they understand their conditions and health care needs well, and are skillful at planning and using their residual abilities and personal/social resources. Loss of cognitive ability related to aging will diminish the individual's ability to use these strategies to maintain a satisfying lifestyle without external supports. Thus, a younger person who experienced life as a productive, healthy, and active individual who compensated well for one major disability may age into a multiply disabled older person with fatigue, pain, and medical complications.

Many people with long-term disabilities have enjoyed active lifestyles and a good quality of life with the assistance of friends, coworkers, and family members. As these human assistants age themselves, move away, or become too busy and can no longer provide physical assistance as well as satisfying personal relationships, they will have to be replaced with formal personal assistance services and assistive technology. People with disabilities may be as resistive as those without previous disability to using these types of assistance.

Knowledge Is Key
Rehabilitation professionals may be surprised to find that aging people with disabilities know as little as their nondisabled peers about how to access supports and services available to older Americans and people with disabilities. Rehabilitation professionals need to understand that these changes will be as difficult for the person with a previous disability as those who are disabled only by the aging process. Significant others in the life of an aging person with a disability will need support to accept that they can no longer provide the assistance they once did for their loved one or friend.

It is important to understand cultural issues unique to the community of people with disabilities to adequately respond to their rehabilitation needs as they age. The result of aging coupled with disability is a need to adjust the pace of one's lifestyle, to substitute interdependence and appropriate use of help from others for independence, and to increase use of assistive technology, accessible public transportation, and homes modified for accessibility. Most people with long-term significant disabilities, whether sensory, cognitive, or physical in nature, have received rehabilitation services that strongly emphasized overcoming disability, self-reliance, productivity, achieving independence, and normalization. These rehabilitation successes may well find it even harder to accept adjustments that come with the aging process than their able-bodied peers. Rehabilitation professionals may want to consider discussion of the importance of interdependence as well as independence; the benefits of power mobility, assistive technology, and environmental modification to reduce fatigue and stress on the body; ways to live well with rather than overcome the body one has; and the availability of community supports well before their patients face the aging process. Successful introduction of these concepts in the rehabilitation process can reduce secondary conditions and delay the aging process to a more appropriate time.

Women, including women with disabilities, have unique health and wellness issues. Menopause, a normal part of the aging process for women, brings increased risk for depression, cardiovascular illness, and osteoporosis, as well as increased need for cancer screening and good primary health care. Screening and medication for these conditions will be particularly challenging for women with the health risks related to long-term immobility and other disabilities. Because women live longer than men and normally have provided the caregiving and supportive functions for other family members, they often face the aging process without adequate human support and tangible resources themselves. Decreased mobility, energy, and sensory and cognitive acuity and loss of human supports will act as significant barriers for women to get their needs met in traditional community settings. Programs based in nonprofit, health care, and faith-based organizations that provide volunteer "friendly visitors" can significantly reduce the risk of isolation, depression, and cognitive deterioration that often accompany and exacerbate the aging process especially for frail elderly women.

Coverage Concerns
From a management and public policy perspective, good access to primary health care, assistive technology, personal assistance services, and accessible housing is vital to maintain health and quality of life for people aging with a disability. Good sensory and physical accessibility that meets or exceeds Americans with Disabilities Act requirements are a must in health care settings that serve older patients with disabilities. Medicare and private insurances for people over 65 are typically much more restrictive than insurance for younger people with regard to providing home health and rehabilitation services, prescription coverage, and assistive technology. Although these restrictions pose a hardship for all, they are most burdensome on people aging with a disability who will typically have increased needs for coverage of these items. Many state personal assistance programs are very limited in scope and are available only to those with very low incomes. Long-term care insurance, which would cover the cost of increased in-home supports needed by people aging with a disability, is typically not available to people who already have disabilities, however independent they may be at the time they would like to enroll. Such restrictions frequently result in people aging with a disability having to receive assistance in facility-based settings rather than the home and community-based settings they would prefer and which are usually more cost-effective to provide. Furthermore, most assisted living facilities are not accustomed to facilitating the level of independence, risk-taking, and active community participation that have been an important part of the lifestyles of people with long-term disabilities. An example of this can be seen in the restriction on use of power wheelchairs in many assisted living facilities.

The Glass Is Half Full
Finally, maintaining a positive emotional outlook has been cited as perhaps the most critical factor in maintaining health, longevity, and quality of life throughout the aging process.3 Rehabilitation professionals can be valuable partners to people with disabilities in advocating for equal and friendly access to community resources for recreation, socialization, and wellness activities. A few examples of such resources include community swimming programs for seniors, Elderhostel activities, private and public senior citizen centers, AARP chapter meetings, and low-cost group trips for sightseeing and recreation. Cost as well as physical and sensory accessibility are important for people who are likely to have had lifelong lower-than-average incomes and now have multiple limitations in ability and functioning. Affordable access to computer technology, which provides easy communication with friends and family, opportunities to learn new things and make new friends, and access to helpful information about health and disability concerns and resources, has great potential for improving the quality of life for people aging with a disability. The Web sites for Health, Wellness, and Aging with Disability (www.jik.com/hwawd.html) and the Rehabilitation Research and Training Center on Aging with a Disability (www.agingwithdisability.org) will be particularly helpful to both professionals and consumers as valuable sources of education and resource materials on a wide range of issues.

References
1. Galas J, ed. SCI and Aging: A State of Body and Mind. Lawrence, Kan: Research & Training Center on Independent Living, University of Kansas; 1994.
2. Campbell MI, Sheets D, Strong PS. Secondary health conditions among middle-aged individuals with chronic physical disabilities: implications for unmet needs for services. Assist Technol. 1999;11(2):105-122.
3. Penninx BW, Guralnik JM, Bandeen-Roche K, et al. The protective effect of emotional vitality on adverse health outcomes in disabled older women. J Am Geriatr Soc. 2000;48:1359-1366.


Lucy C. Spruill, MSW, is Attendant Care Program Director at Community Living and Support Services in Pittsburgh and adjunct instructor in the Department of Rehabilitation Science and Technology and the School of Social Work at the University of Pittsburgh.

LOOKING FOR EXPERT ADVICE?

Experts here are available to answer all your questions!
Please contact us for more information about this feature, or to become an expert.

MEDIA CENTER

Interactive Media
Resources
Classifieds
Calendar
Consumer Resources
Media Kit
Advertiser Index
EAB
Reprints
Submit an Article
Home     |     News     |     Buyer's Guide     |     Features     |     Products     |     Education     |     Archives

ADDITIONAL ONLINE RESOURCES

Allied Healthcare
Medical Education
24X7mag
Chiropractic Products Magazine
Clinical Lab Products (CLP)
Orthodontic Products
The Hearing Industry Resource
HME Today
Rehab Management 		Physical Therapy Products
Plastic Surgery Products
Imaging Economics
Medical Imaging
RT Magazine
Sleep Review 		SynerMed Communications
IMED Communications
Practice Growth
Practice Builders
powered by:
Copyright © 2008 Ascend Media LLC | Rehab Management | All Rights Reserved.
Privacy Policy | Terms of Service