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Trends in Late-Life Disablement: Women Are Losing Ground

Alan M. Jette
DOI: 10.2522/ptj.2016.96.9.1314 Published 1 September 2016
Alan M. Jette
Catherine Worthingham Fellow of the American Physical Therapy AssociationEditor in Chief, PTJ
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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.

Footnotes

  • In the 47th McMillan Lecture, Carole Lewis, PT, DPT, urges physical therapists to consider the “unprecedented opportunities” of rehabilitation for the older population. Visit www.apta.org/NEXT/2016/McMillanLecture, or see PTJ's, October issue for the published version.

  • © 2016 American Physical Therapy Association

References

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    1. Colby S,
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    . The Baby Boom cohort in the United States: 2012–2060. Current Population Reports. Washington, DC: US Census Bureau; 2014;25:1141.
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    1. Fries J
    . Aging, natural death, and the compression of morbidity. NEJM. 1980;303:130–135.
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    1. Laditka S,
    2. Laditka J
    . Recent perspectives on active life expectancy for older women. J Women Aging. 2002;14(1/2):163–184.
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    1. Freedman V,
    2. Spillman B,
    3. Andreski P,
    4. et al
    . Trends in late-life activity limitations: an update from five national surveys. Demography. 2013;50:661–671.
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    1. Manton KG,
    2. Gu X,
    3. Lamb V
    . Long-term trends in life expectancy and active life expectancy in the United States. Popul Dev Rev. 2006;32:81–105.
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    1. Freedman VA,
    2. Wolf DA,
    3. Spillman BC
    . Disability-free life expectancy over 30 years: a growing female disadvantage in the US population. Am J Public Health. 2016;106:1079–1085.
    OpenUrlCrossRefPubMed
  7. ↵
    1. Leveille S,
    2. Resnick H,
    3. Balfour J
    . Gender differences in disability: evidence and underlying reasons. Aging Clin Exp Res. 2000;12:106–112.
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    1. Crimmins EM,
    2. Kim JK,
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    . Gender differences in health: results from SHARE, ELSA, and HRS. Eur J Public Health. 2011;21:81–91.
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    1. Freedman V,
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    . Disability and care needs among older Americans. Milbank Q. 2014;92:509–541.
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Vol 96 Issue 9 Table of Contents
Physical Therapy: 96 (9)

Issue highlights

  • Experiences of Physical Therapists Working in the Acute Hospital Setting: Systematic Review
  • Physician Impressions of Physical Therapist Practice in the Emergency Department: Descriptive, Comparative Analysis Over Time
  • Simulated Patients in Physical Therapy Education: Systematic Review and Meta-Analysis
  • Physical Therapists' Perceptions and Use of Exercise in the Management of Subacromial Shoulder Impingement Syndrome: Focus Group Study
  • Balance and Gait Represent Independent Domains of Mobility in Parkinson Disease
  • Client Perspectives on Reclaiming Participation After a Traumatic Spinal Cord Injury in South Africa
  • Inpatient Rehabilitation Outcomes in Patients With Stroke Aged 85 Years or Older
  • Physical Activity Levels and Their Associations With Postural Control in the First Year After Stroke
  • Patient Perspectives on Participation in Cognitive Functional Therapy for Chronic Low Back Pain
  • Effectiveness of Global Postural Re-education in Patients With Chronic Nonspecific Neck Pain: Randomized Controlled Trial
  • Development and Integration of Professional Core Values Among Practicing Clinicians
  • Translation, Validation, and Reliability of the Dutch Late-Life Function and Disability Instrument Computer Adaptive Test
  • Coactivation During Dynamometry Testing in Adolescents With Spastic Cerebral Palsy
  • Cohort Study Comparing the Berg Balance Scale and the Mini-BESTest in People Who Have Multiple Sclerosis and Are Ambulatory
  • Use of Six-Minute Walk Test to Measure Functional Capacity After Liver Transplantation
  • Feasibility of the Six-Minute Walk Test for Patients Who Have Cystic Fibrosis, Are Ambulatory, and Require Mechanical Ventilation Before Lung Transplantation
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Trends in Late-Life Disablement: Women Are Losing Ground
Alan M. Jette
Physical Therapy Sep 2016, 96 (9) 1314-1315; DOI: 10.2522/ptj.2016.96.9.1314

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Trends in Late-Life Disablement: Women Are Losing Ground
Alan M. Jette
Physical Therapy Sep 2016, 96 (9) 1314-1315; DOI: 10.2522/ptj.2016.96.9.1314
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