PRB

(March 2013) Baby boomers in the United States are more likely than the previous generation to have a disability as they near late-life, suggest a growing number of researchers.

One new study found that baby boomers (ages 49 to 67 in 2013) are living longer than people roughly 20 years older, but are not healthier.¹ While they are less likely to smoke, have emphysema, or a heart attack, they are more likely to be obese, have diabetes, or high blood pressure than the previous generation at similar ages.

Another recent study documented rising disability levels among middle-age Americans (ages 40 to 64, a group that included most baby boomers) in recent years.² The analysis identified a link between trends in obesity and disability, according to Linda Martin, a RAND Corporation demographer and lead author of the study.

And a study in a recent issue of the journal Demography–synthesizing the results of five national surveys—found increasing disability among those ages 55 to 64 between 2000 and 2008 (a group that included the oldest baby boomers).³ By contrast, disability levels continued to decline among the oldest Americans (ages 85 and older) and held steady among the elderly ages 65 to 84 during the same period, reported Vicki Freedman, a University of Michigan demographer and lead author.

“Troubling,” is what Martin, who has long tracked disability patterns, called the trends. “These are the members of our future older population.”

Researchers like Martin and Freedman had expected baby boomers to be doing better, given advances in public health and education during the lives of the baby boomers.

Decline in Disability Reversed

Disability levels among older Americans declined steadily during the 1980s and 1990s. This decline was hailed as one of the most significant advances in the health and well-being of Americans in the last quarter of the 20th century. Contributing to the decline were both a drop in the incidence of disability and a rise in the chance of recovery from a disabling condition.

But that trend has leveled off since 2000, as the study by Freedman’s team showed. “A new pattern has emerged by age,” Freedman explained, with rising disability levels among those nearing retirement age (ages 55 to 64) and flat trends for those ages 65 to 84.

The study looked closely at two types of disability known to be key to managing independently: the inability to carry out daily tasks such as shopping, cooking meals, managing money, and making phone calls (called instrumental activities of daily living); and the need for help with personal care activities such as bathing, dressing, and getting in or out of bed (called activities of daily living).

She was quick to point out that the disability rate of the preretirement age group is “still quite low compared to older Americans,” although it was a full percentage point higher—5 percent instead of 4 percent—compared to people of that same age 10 years earlier.

While not a dramatic increase in percentage terms, she described the trend as meaningful in terms of numbers of people. The 1 percent increase represents about 365,000 more people who are having difficulty or who are unable to carry out basic personal care activities and daily tasks central to living independently, she calculated.

This “uptick in disability is something important to keep an eye on,” because of the impact it may have on America’s families (who provide most of the care for individuals with disabilities) and on public health care programs, Freedman said.

Top 10 Health Conditions Reported By People Ages 40 to 64, 2004-2010

*Instrumental activities of daily living or activities of daily living.
Source: National Health Interview Survey, 2004-2010.

Exploring the Causes

Martin’s team also found growth in disability levels when they examined a wider age group— middle-age adults (ages 40 to 64). The share who reported needing help with personal care and daily tasks rose between 1997 and 2010. But like Freedman, she emphasized that while the increase was “a cause for concern,” the overall rates for middle-age people “were quite low, affecting fewer than 4 percent.”

Perhaps more worrisome was the level of mobility problems they found. In 2010, a greater proportion than in 1997 told interviewers that they had difficulty with at least one of nine physical functions examined. Specifically, about 40 percent of the respondents said that a health problem made it difficult for them to kneel or stoop; stand for two hours; walk one-quarter mile; climb 10 steps without resting; sit for two hours; lift and carry 10 pounds; reach over the head; push or pull a large object; or grasp small objects.

Such physical-function problems could be precursors to more serious disabilities later in life, Martin noted.

The study by Martin and her colleagues, prepared for a 2012 conference organized by the U.S. Department of Health and Human Services, was based on data from the 1997 to 2010 National Health Interview Survey. This survey collected health information from a nationally representative sample of older Americans who do not live in nursing homes or other institutions, including measuring the weight and height of a subset of the respondents.

The rise in obesity among 40-to-64-year-olds accounts for much of the rise in both disability and physical-function limitations, according to Martin’s analysis. But while they were able to show a statistical link between the two trends, she explained that “not all obese people had limitations and not all people with limitations were obese.”

Slightly more than one-half (52 percent) of those needing help with personal care and daily tasks were not obese. And, less than 4 percent of even the most severely obese group (body mass index of 40 or greater) reported needing help with personal care.

Respondents were more likely to report that weight problems caused difficulty with physical functioning than with personal care or daily activities (see table). This made sense to Martin: “When you think about obesity, you can imagine someone having trouble climbing a flight of stairs or walking a quarter mile, but not needing help shopping or dressing,” she said. But she also noted that some of the conditions respondents named as the reason they needed assistance (such as diabetes and back problems) could be related to obesity.

Certain health conditions became more prevalent from 1997 to 2010. Increasing proportions of people ages 40 to 64 attributed their need for help with daily activities or personal care to back or neck problems; other musculoskeletal conditions (problems with muscles or tendons, osteoporosis); diabetes; and depression, anxiety, or emotional problems. The share reporting nervous system conditions (including paralysis, Parkinson’s, and multiple sclerosis) also grew. People who reported these conditions said that the ailments started in their 30s to 40s.

Improved medical care also could be contributing to rising disability, Martin suggested. People whose disabilities began early in life are now living longer. “It could be seen as good news: improved survival for people with Down syndrome or spinal cord injuries who might have not reached middle age in the past,” she said.

Another dynamic may be at work, said Martin. Not only could the reported increases in disability reflect actual deteriorating health, but it could also reflect greater awareness of health conditions in the wake of more widespread diagnosis and treatment.

Martin’s team did find an encouraging trend: Disabilities related to hearing loss declined among people who are middle-aged. While the rock-and-roll music that baby boomers enjoyed might have taken a toll on hearing, improvements in industrial work settings, particularly noise abatement, likely offset it.

Improved Diagnosis and Treatment

In Martin’s view, these disability trends are “sobering and bear watching,” but she also offered a few reasons for optimism. She pointed to evidence of improved diagnosis and treatment of diabetes and other chronic conditions related to obesity. “The negative consequences might decline because of therapy.” And the level of obesity among adults appears to have stopped climbing in recent years.

But if obesity levels have reached a plateau, she noted, it is at twice the level seen in the early 1970s. “We don’t know much about the consequences of life-long obesity.”

A new federally funded national study has been designed to answer this sort of question, according to Freedman. The National Health and Aging Trends Study led by Johns Hopkins University researchers, is following more than 8,000 older Americans annually, to explore how their daily lives change as they age. Rather than relying exclusively on reports from participants, researchers are also giving short performance tests to measure physical and cognitive function.

“With this new study, we will be able to discern whether a shift in disability is due to a change in physical or cognitive capacity or to changes in the accommodations people make,” explained Freedman. The accommodations measured include behavior changes (such as bathing less often), asking someone for help, and using assistive devices and home modifications (a bath seat, for example). Among the goals, she said, is to identify the ways people adapt to disabilities that allow them to remain independent as long as possible.

Paola Scommegna is a senior writer/editor at the Population Reference Bureau.

References

1. Dana E. King, et al., “The Status of Baby Boomers’ Health in the United States: The Healthiest Generation?” JAMA Internal Medicine, published online Feb. 4, 2013, accessed Feb. 5, 2013.
2. Linda G. Martin and Robert F. Schoeni, “Trends in Disability and Related Chronic Conditions Among the Forty-and-Over Population: 1997-2010,” presented at an interagency conference, sponsored by the Administration for Community Living, U.S. Department of Health and Human Services, National Institute on Aging at the National Institutes of Health, National Institute on Disability and Rehabilitation Research, U.S. Department of Education, and the Interagency Committee on Disability Research, and organized by the Center for Aging and Policy Studies at Syracuse University and the Michigan Center on the Demography of Aging at the University of Michigan, May 17-18, 2012.
3. Vicki A. Freedman et al., “Trends in Late-Life Activity Limitations in the United States: An Update From Five National Surveys,” Demography 49, no. 4 (2012), accessed Feb. 6, 2013.