Trends in Late-Life Disablement: Women Are Losing Ground

With the aging of the Baby Boomer generation, concerns have intensified about meeting the US population's late-life disability and long-term care needs, which are expected to peak by 2030—when 1 in 5 people in the United States will be aged 65 years or older.¹

I recall attending an International Gerontology Conference in 1981 in Hamburg, Germany, where rheumatologist Dr James Fries first presented his theory of the “compression of morbidity” to the gerontology community. Fries's theory predicted that health promotion and disease prevention would increase the average age of onset of late-life disablement, compressing the period of morbidity and disability before death.² Despite being met with initial skepticism and competing theories, Fries's theory eventually prevailed: several large-scale population studies highlighted a welcome pattern of “compression of morbidity” through the 1980s and 1990s.^3–5

More recently, however, some disturbing evidence has raised important questions about whether this pattern of morbidity and disability compression is being sustained—evidence that has illuminated some important gender differences in our population.⁶

Recent longitudinal data have indicated that men and women may be experiencing different patterns of late-life life expectancy and subsequent disablement. First, it has long been recognized that women outlive men in the United States (and in most countries). Yet, of late, men have made substantial gains in life expectancy relative to women, primarily because of the decline in cardiovascular disease–related deaths among men and the shifts in smoking patterns among women that currently are more closely following those of men. Second, causes of death in the United States also have shifted, with women now just as likely as men to die from chronic respiratory disease.⁶ What are the impacts of these changes on late-life disablement?

Although we have long understood that women in later life are more likely than men to report activity restrictions, there are few data on gender differences in long-term disablement trends.⁷ Analyses by Freedman et al,⁶ who used data from the National Long Term Care Survey (NLTCS) and the National Health and Aging Trends Study (NHATS), showed that mortality and disability have changed in different ways for men and women in the United States over the past 3 decades. For men, longevity over the past 3 decades increased, disability prevalence fell, and, as Fries² predicted, disablement was compressed into the older ages with an increase in the percentage of remaining years spent disability free.

For women, however, the trends are distinctly different. Among women in the United States, longevity increases over the past 3 decades were small and were accompanied by even smaller postponements in disablement and an overall stagnation in both life expectancy and disability-free life expectancy. In other words, over the past 3 decades, women lost ground relative to men in both life expectancy and disability-free life expectancy. They still live longer lives than men, but older women no longer live a greater number of disability-free years than men.^3,6–9

These findings have important implications for physical therapists in specific and rehabilitation professionals in general. As society seeks “compression of disability” and an enhanced disability-free life expectancy, we have an important role to play in designing and directing evidence-based interventions to address the known preventable risk factors commonly found among older women in our society. We know, for example, that disabling conditions such as arthritis, depressive symptoms, lower muscle strength, and reduced bone density—as well as the dementias—are seen more commonly in women than in men. We also know that older women and older men are at risk of obesity and sedentary lifestyles, and both have considerable risk of falling in later life.^3,7 Secondary prevention efforts, if implemented at a population level, could be an especially effective way of reducing late-life disability trends for both women and men entering their later years.

Ultimately, the creative efforts of rehabilitation professionals can go a long way toward offsetting the impending long-term care pressures for our growing older population and enhance the quality of life in late life. The time to act is now; 2030 is closer than we think.

• © 2016 American Physical Therapy Association