More Older Women Now Living With 'Moderate' Disability, Study Shows

Trend a reversal from the 1980s, researchers say

Thursday, March 17, 2016

THURSDAY, March 17, 2016 (HealthDay News) -- Back in the 1980s, older U.S. women typically lived more years free of disabilities than their male peers did, but a new study shows that pattern appears to be changing.

For older men, the news is largely positive, researchers report: They're not only living longer, but with fewer disabilities.

For women, the picture is different: They've made smaller gains than men have and, in some respects, they've taken a step backward.

Specifically, older U.S. women were more likely to be living with moderate disabilities in 2011, compared with 2004 -- a reversal in the improvement seen since 1982.

The study defined moderate disabilities as problems with daily activities such as shopping, doing household chores or managing money. For men, the prevalence of those issues dropped between 1982 and 2004, then stayed largely unchanged.

Older women, on the other hand, saw their prevalence of moderate disability decline from almost 13 percent in 1982, to about 10 percent in 2004. But by 2011, that figure had risen to 14 percent, the investigators found.

The reasons for the trends are not clear, said study author Vicki Freedman, a researcher at the University of Michigan Institute for Social Research, in Ann Arbor.

On average, she said, women are at an economic disadvantage compared with men, and that could be one factor. "The next step is to better understand why this is happening," Freedman said.

Another expert had a different theory.

Women's higher rate of obesity in more recent decades could also be playing a role, said Barbara Resnick, chair of gerontology at the University of Maryland School of Medicine in Baltimore. She is also a former president of the American Geriatrics Society.

U.S. men are heavier than they used to be, too. But, Resnick said, they also typically have more muscle mass and strength than women do, so they may be able to preserve more of their physical function as they grow older.

The findings are based on information from national health surveys of Americans aged 65 and up, conducted in 1982, 2004 and 2011.

Over those years, men started to gain on women in terms of life expectancy, and disability-free life: In 1982, a 65-year-old man could expect to live, on average, another 14 years; by 2011, that had increased to 19 years -- with almost all of that extra time disability-free.

For the typical 65-year-old woman, life expectancy rose by only two years, from 18.5 to 20.5 years. And she could expect to live disability-free for one of those extra years, the researchers said.

The increase in older women's level of moderate disability seems to be the main driver, Freedman's team found. Rates of severe disability -- requiring a nursing home or help at home with bathing, dressing and other basic needs -- held steady for men and women between 2004 and 2011.

Women are at greater risk of debilitating conditions like arthritis, bone fractures and dementia. But it's not clear whether that accounts for the recent increase in moderate disability among older women, according to Freedman.

Dr. Amy Kelley is an associate professor of geriatrics and palliative medicine at Mount Sinai's Icahn School of Medicine, in New York City. She cautioned that the increase in women's moderate disability levels was seen over a short time period -- from 2004 to 2011.

There could have been similar ups-and-downs between 1982 and 2004, Kelley pointed out.

That said, she applauded the study's aim. "This is focusing on not just life expectancy, but the quality of people's lives," Kelley said.

And that, she added, needs more attention in everyday health care, too.

Americans who make it to age 65 typically have a lot of years left ahead, Kelley pointed out. "So how can we make that time high-quality?" she asked.

Resnick said it's important for older adults to stay physically active -- through a daily walk or light resistance exercise to keep muscles strong, for example.

Kelley agreed, saying older adults and their doctors need to think beyond controlling "numbers" -- such as blood pressure and cholesterol levels. "So you can ask your doctor, what should I be doing to keep up my capacity for daily activities?" she suggested.

But, Kelley added, it's not up to older adults and their doctors alone.

"Communities need to make sure there are sidewalks that are safe for an older person with a cane," she said. "They need to have community centers that offer opportunities for older [people] to be active."

And "active" does not only mean exercise, Kelley said. Everyone benefits when older adults have chances to volunteer and otherwise stay involved in their community, she pointed out.

"Older adult have so much to offer," Kelley said. "As a society, we should make sure the opportunities are available."

SOURCES: Vicki Freedman, Ph.D., research professor, University of Michigan Institute for Social Research, Ann Arbor; Amy Kelley, M.D., associate professor, geriatrics and palliative medicine, Icahn School of Medicine at Mount Sinai, New York City; Barbara Resnick, Ph.D., R.N., chair, gerontology, University of Maryland School of Nursing, Baltimore; March 17, 2016 American Journal of Public Health, online

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