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4102.0 - Australian Social Trends, 2001  
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Contents >> Health >> Health Status: Disability among adults

Health Status: Disability among adults

In 1998, around one in five adults had a disability (21%). Of these, almost three quarters were restricted by a physical impairment and almost a third by a sensory impairment or speech loss.

Disability can occur at any stage of a person's life and, depending on when it occurs, may affect an individual’s participation in a range of everyday activities. Disability is strongly age-related and, as a result, the support requirements of older people with disabilities are a major focus of issues relating to people with disabilities. However, disability also occurs in younger people and the effects of this may impact on important issues such as employment opportunities and career choices.

The rate of disability among people aged 65 years and over is much higher than it is for younger age groups. In addition, as people grow older the severity of their disability is likely to increase, particularly for those aged 75 years and over. Consequently, people in this age group are more likely to need assistance with health-related and other activities of their personal life.


Impairment, disability and restriction
The ABS collects data on people with disabilities in surveys of disability, ageing and carers, the last conducted in 1998. Findings from this survey are published in a summary of findings: Disability, Ageing and Carers, Australia: Summary of Findings, 1998 (cat. no. 4430.0) and a thematic publication: Disability, Ageing and Carers, Australia: Disability and Long-Term Health Conditions, 1998 (cat. no. 4433.0).

In 1998, 95% of people with disabilities lived in households and the remaining 5% were in cared accommodation such as hospitals and nursing homes. This topic focuses on the adult population aged 15 years and over living in households.

Impairment is defined as any loss or abnormality of psychological, physiological or anatomical structure or function. Examples of impairment are loss of sight or a limb, weakness that causes difficulty gripping or holding things, or impairment of mood or emotion.

Disability is defined as any restriction or lack (resulting from an impairment) of ability to perform an activity in a manner or within the range considered normal for a human being.

Specific restrictions refers to the core activities of self care, mobility and communication; or schooling or employment restrictions. The levels of severity of these restrictions are: profound, severe, moderate and mild.

People with a profound core activity restriction always need help or supervision with self care, mobility or communication or are unable to perform these tasks.

People with a severe core activity restriction sometimes need help with self care, mobility or communication, have difficulty understanding or being understood by family or friends, or can communicate more easily using sign language or other non-spoken forms of communication.


Disability among adults
In 1998, around 3.1 million adults living in households had a disability. The probability of a person developing a disability and possibly requiring assistance with everyday activities increases with age. The rate of disability was lowest for 15-34 year olds (9%), increasing to 21% of those aged 35-64 years and to 52% of those aged 65 years and over.

Of particular concern are those disabilities which result in a specific restriction and affect core activities, such as mobility or self care, or which affect schooling or employment activities. As with disability, the proportion of people with a specific restriction also increased with age, rising from 7% for people aged 15-34 years to 43% for those aged 65 years and over.

On an age standardised basis, disability rates among the adult population have generally increased over the last 10 years, from 19% in 1988 to 21% in 1998. Removing the effect of population ageing, there are a number of reasons for these increases, such as changes in attitude to, and increased diagnoses of, disability.1 The rate of specific restriction also increased over the same period (from 16% to 17%).

DISABILITY STATUS OF ADULTS(a) (b)

1988
1998


All with specific restrictions(c)
All with a disability
All with specific restrictions(c)
All with a disability
Age group (years)
%
%
%
%

15-34
5.3
7.0
7.0
8.9
35-64
15.0
17.8
16.5
20.9
65 and over
42.5
50.1
43.0
52.3
Total
15.6
18.7
17.0
21.2

(a) The 1988 and 1998 surveys have been adjusted for comparability.
(b) Age standardised to the estimated resident population for March, 1998.
(c) A restriction in a core activity, schooling or employment.

Source: ABS 1988 Survey of Disability and Handicap; ABS 1998 Survey of Disability, Ageing and Carers.


Impairment groups
All people with disabilities have been identified as having an impairment which restricts them in some aspect of everyday life. These impairments relate to specific functions or areas of the body or mind. The type and number of impairments and the level of restriction a person has, determines the extent to which their everyday life is affected by their disabilities. For example, employment opportunities or participation in social activities may be reduced by having a higher level of restriction or more than one impairment.

In 1998, 26% of adults with a disability had a profound or severe restriction - that is, their condition either completely restricted them from undertaking everyday activities such as dressing or walking, or they sometimes or always required assistance from others to do these things, or they had difficulty communicating. Unlike disability rates which increase gradually with age, the likelihood of being profoundly or severely restricted remains relatively low until fairly late in life. Less than 10% of adults aged under 75 years had a profound or severe restriction, compared with almost half of those aged
85 years and over.

PROPORTION OF ADULTS WITH DISABILITIES AND PROFOUND OR SEVERE RESTRICTIONS, 1998

Source: Disability, Ageing and Carers, Australia, 1998 (cat. no. 4430.0).


Among people with disabilities, certain impairment types are more common than others. In 1998, 2.3 million or 74% of adults with a disability were restricted by a physical impairment and almost a million by a sensory impairment or speech loss. Lower numbers of people with disabilities were restricted by psychological impairments, intellectual impairments or by head injury, stroke or brain damage (less than 300,000 for each).

Some impairment types are more likely to have a greater severity of restriction than others and consequently are more likely to effect people's everyday lives. Around half of those with head injury, stroke or brain damage (53%) or a psychological impairment (50%) were profoundly or severely restricted. In contrast, less than one third of those with a sensory and speech impairment, or a physical impairment had this level of restriction (29% and 31% respectively).


Restricting impairment groups
Impairments are grouped by type as follows:

    Sensory: loss of sight (not corrected by glasses or contact lenses); loss of hearing where communication is restricted, or an aid used; and speech difficulties, including loss;

    Intellectual: difficulty learning or understanding things;

    Physical: shortness of breath or breathing difficulties that restrict everyday activities; blackouts, fits or loss of consciousness; chronic or recurrent pain that restricts everyday activities; incomplete use of arms or fingers; difficulty gripping or holding things; incomplete use of feet or legs; restriction in physical activities or in doing physical work; and disfigurement or deformity;

    Psychological: nervous or emotional condition that restricts everyday activities; and mental illness or condition requiring help or supervision; and

    Head injury, stroke or other brain damage: with long term effects that restrict everyday activities.

RESTRICTING IMPAIRMENT GROUPS OF ADULTS WITH A DISABILITY, 1998

With a disability
Proportion with a profound or severe restriction
Restricting impairment group
'000
%

Sensory and speech
953.0
29.4
Intellectual
250.3
45.3
Physical
2,330.3
31.4
Psychological
294.7
49.9
Head injury, stroke or brain damage
229.3
53.3
All with disability(a)
3,130.0
26.1

(a) People may have more than one impairment and therefore components do not add to total.

Source: ABS 1998 Survey of Disability, Ageing and Carers.


Persons aged 15-64 years
People aged 15-64 years often participate in education and/or employment and many have family responsibilities. If they also have a disability, this may increase the difficulty in managing all the responsibilities in their lives. Of all people aged 15-64 years, 17% had a disability and 24% of these had a profound or severe restriction.

Physical impairments are the most common of all impairment types and show a steady increase with age. Of people aged 15-64 years who were restricted by a physical impairment, 9% were aged 15-24 years, while 29% were aged 55-64 years. Traffic accidents, as well as work and sporting injuries, are frequent causes of this type of impairment in the 15-64 years age group. The proportions of people with disabilities who had a sensory or speech impairment also increased with age, from 8% for 15-24 year olds to 32% for 55-64 year olds.

In contrast, intellectual impairments are more common in younger people. Among 15-64 year olds, this impairment type is often caused by congenital disorders such as Down Syndrome. Of people with an intellectual impairment, 35% were aged 15-24 years whereas 10% were aged 55-64 years.

PERSONS AGED 15-64 YEARS WITH A DISABILITY: AGE AND WHETHER HAD A PROFOUND OR SEVERE RESTRICTION, 1998

Restricting impairment groups

Sensory and speech
Intellectual
Physical
Psychological
Head injury, stroke or brain damage
All with a disability(a)

Age group (years)
%
%
%
%
%
%
    15-24
7.9
34.5
9.1
13.2
10.5
11.1
    25-34
13.0
19.6
14.0
17.1
15.3
14.7
    35-44
20.4
18.7
20.1
26.0
27.2
20.9
    45-54
26.4
16.8
28.2
26.5
25.4
26.4
    55-64
32.3
10.4
28.7
17.2
21.6
26.9
    Total
100.0
100.0
100.0
100.0
100.0
100.0
Proportion with a profound or severe restriction
24.4
40.5
28.0
45.6
44.4
23.7

'000
'000
'000
'000
'000
'000
All with a disability
449.3
213.9
1,535.0
238.8
146.4
2,066.7

(a) People may have more than one impairment and therefore components do not add to total.

Source: ABS 1998 Survey of Disability, Ageing and Carers.


Labour force outcomes
People with disabilities are less likely to be in the labour force than those without a disability. In 1998, the labour force participation rate for people with disabilities was 53%, while for all people it was 76% (see Australian Social Trends, 1997, Employment of people with a handicap). Furthermore, of those in the labour force, the unemployment rate was higher for people aged 15-64 years with disabilities (12%) than it was for all people in this age group (8%).

Employment opportunities are most directly affected by the level of restriction. Greater severity of restriction is associated with lower levels of labour force participation and higher levels of unemployment, compared with all people who are of working age. For example, almost half of those with a psychological impairment (46%) had a profound or severe restriction. They also had the lowest level of labour force participation (29%) and highest level of unemployment (25%) of all impairment groups. In contrast, those restricted by a sensory or speech impairment were least likely to have a profound or severe restriction (24%) and were more likely to be employed than those with other impairment types. This group had the highest participation rate (56%) and the lowest unemployment rate (8%). Many of these people had developed industrial deafness or age-related hearing loss in the course of their working life.

There are a number of employment assistance programs which give support to people with disabilities for job search activities and provide ongoing support at work. In May 1999, approximately 41,000 people with disabilities were in a supported or open employment program. Most of these people (70%) were employed while 27% were looking for work.2

SELECTED LABOUR FORCE CHARACTERISTICS OF PERSONS AGED 15-64 YEARS, 1998

All persons
Labour force participation rate
Unemployment rate
Restricting impairment groups
‘000
%
%

Sensory and speech
449.3
55.7
8.4
Intellectual
213.9
38.2
21.6
Physical
1,535.0
49.1
12.2
Psychological
238.8
28.8
24.9
Head injury, stroke or brain damage
146.4
36.5
18.0
All with a disability
2,066.7
53.2
11.5

All persons
12,455.0
75.6
8.3

Source: Disability and Long-Term Health Conditions, Australia, 1998 (cat. no. 4433.0).


Older people
As people grow older, their responsibilities also change. People aged 65 years and over are less likely to be working. However, they are more likely to either have a disability or to be caring for a partner with disabilities. Among people aged 65 years and over, just over half had a disability and almost one third of these were profoundly or severely restricted. The disability rate increased considerably after the age of 85 years with over three quarters in this age group having a disability.

Not all disabilities have a major impact on people's lives and many people with disabilities continue to live independently in the community well into later life (see Australian Social Trends 1999, Home care, hostels and nursing homes). However, people with higher levels of restriction need assistance with certain tasks as they are limited in their ability to do them.

Older people are more likely to develop certain types of restricting impairments because of the degenerative nature of some health conditions. For example, physical restricting impairments are a common and sometimes debilitating factor among the older population, with arthritis and circulatory disorders being frequently reported health conditions.3 Of people with disabilities, 75% of those aged 65 years and over were restricted by a physical impairment.

In contrast, there were fewer older people with psychological (55,900) or intellectual (36,400) impairments. Among older people, intellectual impairments are more likely to be dementia and associated age-related cognitive disorders, rather than the congenital conditions found in young people.

Some older people with profound or severe impairments will eventually need the level of care that is provided in a nursing home or hostel. However, increasingly, Government-funded community care programs are being developed which target older people with high support needs with the aim of providing them with a sufficient level of assistance with their daily living activities so that they can remain at home.4

PERSONS AGED 65 YEARS AND OVER WITH A DISABILITY: RESTRICTING IMPAIRMENT GROUPS, 1998

Age group (years)

65-74
75-84
85 and over
Total

Restricting impairment groups
%
%
%
%
    Sensory and speech
38.8
53.8
67.0
47.4
    Intellectual
2.5
3.2
9.2
3.4
    Physical
73.8
74.2
81.9
74.8
    Psychological
5.0
4.2
10.2
5.3
    Head injury, stroke or brain damage
6.6
8.8
10.0
7.8
    Total(a)
100.0
100.0
100.0
100.0
Proportion with a profound or severe restriction
21.6
34.4
62.7
30.7

'000
'000
'000
'000
All with a disability
554.3
398.5
110.5
1,063.3

(a) People may have more than one impairment and therefore components do not add to total.

Source: ABS 1998 Survey of Disability, Ageing and Carers.


Need for and receipt of assistance
Of all people aged 65 years and over, 43% needed assistance with at least one activity and this was more likely if the person had a disability (69% of this group needed assistance). Almost half of all older people with disabilities needed assistance with light property maintenance, and 35% with housework. Because of general frailty, which often occurs among the very old, there were some older people without a disability who needed help. Proportions in this group who required assistance ranged from 3% for housework tasks to 11% for light property maintenance tasks.

The level of assistance needed varied by impairment type. For example, a high proportion of older people with a psychological impairment or a head injury, stroke or brain damage needed assistance in at least one activity (94% and 93% respectively). People with these impairment types were most likely to need assistance with property maintenance (69% and 68% respectively) and with transport (65% and 68%). Although people with a sensory or speech impairment were least likely to need assistance, almost two thirds of these (65%) needed help.

The majority of older people with disabilities who needed assistance received assistance. Sources of assistance can be informal (such as help provided by family or friends without cost) or formal (such as that provided by a government or private organisation). People with disabilities may receive assistance from more than one source, but this source was more likely to be informal (56%) than formal (41%).

PERSONS AGED 65 YEARS AND OVER: NEED FOR AND RECEIPT OF ASSISTANCE, 1998

Restricting impairment groups(a)

Sensory
and speech
Intellectual
Physical
Psychological
Head injury, stroke or brain damage
All with disability(c)
All persons aged 65 years and over

Needed assistance with
%
%
%
%
%
%
%
    Property maintenance
45.1
60.9
57.6
69.2
68.4
48.4
29.8
    Transport
40.3
68.1
41.5
65.2
67.5
35.8
21.6
    Housework
33.1
53.1
42.3
64.1
60.6
34.7
19.2
    Total needing assistance(b)
65.2
91.3
77.4
94.0
93.2
68.7
42.6
Received assistance
    Received informal assistance
54.4
82.9
64.6
83.9
86.3
56.1
33.8
    Received formal assistance
40.4
60.7
47.7
60.2
60.0
40.9
24.1
    Total receiving assistance(b)
62.3
88.0
75.0
87.8
90.7
65.8
40.5
All persons(b)
100.0
100.0
100.0
100.0
100.0
100.0
100.0

‘000
‘000
‘000
‘000
‘000
‘000
‘000
All persons
503.7
36.4
795.3
55.9
82.9
1,063.3
2,104.4

(a) Proportion in each restricting impairment group who need assistance with one or more activities.
(b) People may need assistance with more than one activity, and therefore components do not add to total.
(c) People may have more than one impairment and therefore components do not add to total.

Source: ABS 1998 Survey of Disability, Ageing and Carers.


Endnotes
1 Australian Bureau of Statistics 2001, Accounting for change in disability and severe restriction, 1981-1998, Working papers in Social and Labour statistics, No. 2001/1.

2 Department of Family and Community Services 2000, Annual Report 1999-2000, FACS, Canberra.

3 Australian Bureau of Statistics 1999, Health and Disability, Older People, Australia, A social report, cat. no. 4109.0, ABS, Canberra.

4 Department of Health and Aged Care 2000, Annual Report 1999-2000, DHAC, Canberra.


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