Growing older may be getting easier

Landrum Bolling, 94, the globe-trotting director at large for the relief agency Mercy Corps.
Landrum Bolling, 94, the globe-trotting director at large for the relief agency Mercy Corps. Chuck Kennedy / MCT

WASHINGTON — The remarkable thing about National Public Radio senior news analyst Daniel Schorr, 91, who only recently gave up tennis, and Landrum Bolling, 94, the globe-trotting director at large for the relief agency Mercy Corps, is the same: They aren't as remarkable as you'd think they are.

A surprising decline in disability rates among older Americans since the 1980s is enabling millions more to lead longer, richer, spryer lives. The oldest old, such as Schorr and Bolling, are the biggest beneficiaries, but the entire 65-plus population has the best odds ever of living disability-free.

"This is a very important positive outcome," said Dr. Richard Suzman, the director of the behavioral and social research program at the National Institute on Aging, the lead federal agency on the health and well-being of older Americans.

Suzman cautioned that the drop in disabilities, which has averaged about 1.5 percent a year since 1984, might not continue. But if it does, he said, "It's like the reverse of compound interest. You could end up with a flat number — not a flat percentage — of disabled elderly between 1990 and 2030, despite a huge increase in the size of the elderly population."

Already, the decline has put to rest fears that greater longevity would mean only more years in pain. A National Center for Health Statistics study published in August found the opposite: that older Americans typically are disability-free for the roughly 10 months of life expectancy that were added from 1992 to 2003.

The chief vexation of living to be 94, the Tennessee-bred Bolling said recently, is women who get up to give him seats on buses. "The idea of a woman giving a man a seat is unheard-of in my Southern culture," he said.

Not everyone wins equally or even wins from declines in disabilities, however.

According to Dr. Eileen Crimmins, a professor of gerontology and sociology at the University of Southern California, 25 percent of Hispanic and black Americans older than 65 need help with basic tasks. For whites, the rate is 17 percent. Differences in disability rates linked to income and education also persist, Crimmins and others have found, and while women live longer than men, they endure more disabilities.

There are also two clouds on the horizon, Suzman noted. One is higher obesity rates in populations who aren't yet 65. Obesity increases the likelihood of chronic back and joint pain, among other disabilities, and it's associated with increases in heart disease, diabetes and the disabilities that accompany them.

The second is smoking's effects. They're declining among men, who in general took up smoking years before most women did. These men suffered for their smoking, in terms of disability and longevity, and now are gaining from the scourge's passing and/or their quitting. But it hasn't passed yet, statistically speaking, for millions of women who started smoking in the `60s or more recently.

Nonetheless, today's gains from declining disability rates are huge for large numbers of people.

Suzman said he had no recent estimate of how many more older Americans were living disability-free. However, he once calculated that if 1982 rates of chronic disability among the elderly had persisted through 1999, there would have been 2.4 million more sufferers in 1999.

The decline shows up in Bureau of Labor Statistics reports that growing numbers of older Americans are continuing or returning to work. The good news: Their earnings reduce the pressures on Social Security, as well as on households. In addition, Dr. Kenneth Manton, a research professor for demographic studies at Duke University in Durham, N.C., projects Medicare savings from reduced chronic disabilty of $73 billion for 2009 alone.

Abler older people also exercise more, which is why the AARP offers its members discounts at Gold's Gym, Curves and a personal trainer group called the American Council on Exercise.

Older people travel more, too, according to Amy Kotkin, the director of Smithsonian Journeys, the national museums' travel affiliate.

Edna Grenlie, of San Francisco, is booked to take in the Kentucky Derby next spring. It's her 15th Smithsonian tour since 1998.

"I don't like to tell anybody my age because I don't want anyone to say, 'She's too old to do that,' " Grenlie said recently. She'll be 100 on Jan. 3.

While federally sponsored surveys agree that disabilities are declining, their estimates of the number of people who have disabilities and are older than 65 range from 4.2 million to 6.8 million. That reflects differing definitions of "disabled" and the difficulty of measuring disability.

A typical battery of disability-defining questions asks respondents to rate how well they can carry out basic functions called Activities of Daily Living. These usually include getting out of bed or chairs, walking, bathing, dressing, eating and using the toilet. It also asks about essential but less basic Instrumental Activities of Daily Living, such as using the telephone, doing light and heavy housework, preparing meals, shopping, and managing money and medications.

The earliest declines in disability were found in instrumental activities such as shopping and managing money, but disabilities involving more basic activities started declining, too, sometime in the late '90s. Analysts offer many explanations for the drops.

Dr. Vicki Freedman, a geriatric epidemiologist at the University of Medicine and Dentistry of New Jersey, attributes most of the decline — at least for chronic conditions — to improvements in treatment for heart and circulatory conditions, which are implicated in large numbers of disabilities.

Among the improvements, according to Freedman, are drugs such as beta blockers, ACE inhibitors, anti-cholesterol agents and anti-hypertensive treatments. Stents to open narrowed arteries and balloon angioplasty to reduce plaque are helping, too.

Another big factor in disability — impaired vision — dropped as cataract surgery rates rose in the late '90s, Freedman found. Growth in knee- and hip-replacement surgery probably is having the same effect on osteoarthritis.

The effect, according to Freedman, is that "more elderly people are living with chronic diseases, but their diseases are less disabling."

Linda Martin, a senior fellow at the RAND Corp.'s Washington office, said that technology changes — some of them inadvertant — were reducing disabilities, too.

For example, a Social Security Administration decision in 1987 to use direct deposit to banks as the default option for Social Security checks vastly simplified money management, according to Martin. The microwave oven made preparing meals easier, she added, just as computers with adjustable font sizes have helped ease vision problems.

Duke's Manton thinks that lifestyle changes helped, too. Among them: less smoking, more education, better nutrition, more emphasis on exercise, more moderate alcohol consumption and more widespread use of rehabilitative services.

USC's Crimmins also sees more conscientiousness about health. Older people now are more involved with medical decisions, more averse to institutional care and more eager to live independently.

One sign of the last: soaring sales of canes, walkers, walk-in showers with seats, and other devices that reduce the need for outside help.

"We're selling a lot of bathroom safety products, like shower benches and elevated toilet seats," said Doug Geier, the owner of Independent Living Technologies Inc. of Garner, N.C. "Hearing-loss devices are huge too, especially for baby boomers who say they need them to keep their jobs."

How baby boomers experience disability as they age in surging numbers will determine future trends.

According to Jack Guralnik, the chief of the National Institute on Aging's Laboratory of Epidemiology, Demography and Biometry, some gains are likely from future advances in treatment.

"Heart disease and stroke will continue to decline," he predicted. "There'll be better hypertension treatment and better treatment of diabetes. I'm hoping to see better treatment of osteoarthritis, especially of knees.

"But we won't see the effects of this right away, especially in the face of growing obesity problems."

To really make a difference, Freedman said, "The question is, how do we accelerate rates of decline in the future so that people of all ages and abilities can participate in the benefits?"


More on the decline in disabilities.

An optimistic view of disability trends.

Other influential studies. (Click on "TRENDS Working papers.")