Health Status: Older people with disabilities
In 2003, over half of Australians aged 65 years and over (56%) had a disability.
People aged 65 years and over are more likely to have disabilities than younger people, and the likelihood of acquiring a disability increases with age. Severity of disability also increases as people get older. Consequently, as people age they tend to need greater assistance with health-related and day to day activities, and greater access to health and community services. With increasing numbers of people living to older ages, and the prospect of the baby boomer cohorts reaching older ages, questions of how best to meet the needs of greater numbers of older people with disabilities are becoming more acute.
In recent years, older people have increasingly been supported to remain living in the wider community, and wherever possible in their own homes, through the provision of appropriate services (endnote 1). Therefore, the focus is not only on the supply of cared accommodation, but on the supply of suitable community based facilities and services, and of informal carers (see Australian Social Trends 2005, 'Carers').
TRENDS IN DISABILITY
The prevalence of disability among older people did not change significantly between 1998 and 2003. A little more than half of older people had a disability in both years (54% and 56% respectively). However, largely due to an increase in the total number of older people in Australia over the period, (from 2.3 million to 2.5 million), as well as ageing in this group, older people with disabilities increased in number by 28%, from 1.2 million to 1.4 million.
Persons aged 65 years and over with disabilities
The greatest increases in the number of older people with disabilities (and of older people as a whole) were recorded for the those in the range over 74 years. The rate of disability was similar for men and women in both 1998 (54% in each case) and 2003 (55% and 56% respectively). However, as more women than men live to older ages, the number of older women with disabilities was 28% higher than that of older men with disabilities, in both 1998 and 2003.
| Older people with disabilities The ABS collects data on the characteristics of older people and people with disability in surveys of disability, ageing and carers. Information from the most recent survey (2003) is published in Disability, Ageing and Carers: Summary of Findings, 2003 (ABS cat. no. 4430.0). Older people in this article are those aged 65 years and over. Disability as defined in the ABS 2003 Survey of Disability Ageing and Carers refers to a limitation, restriction or impairment, which has lasted, or is likely to last, for at least six months. This definition is consistent with the International Classification of Functioning, Disability and Health, which defines disability as an umbrella term for impairments, activity limitations and participation restrictions. Core-activity limitation refers to a limitation in the core-activities of self care, communication or mobility. Levels of severity of these limitations are: profound, severe, moderate, mild. People with a profound core-activity limitation always need help or supervision with self care, communication or mobility, or are unable to perform these tasks themselves. People with severe core-activity limitations sometimes need help with self care, communication or mobility, have difficulty understanding or being understood by friends or family, or can communicate more easily using sign language or other non-spoken forms of communication. |
...profound or severe limitation
Older people with a disability varied in the type and severity of the limitations or impairments they had. In 2003, 22% of all older people had a profound or severe core activity limitation. That is, they were limited in everyday activities (e.g. walking or dressing), or sometimes needed help to do these things, or had difficulty communicating. Of people aged 65-69 years, 10% had a profound or severe core activity limitation, increasing to 20% of those aged 75-79 years and 58% of those aged 85 years and over.
The proportion of older people with profound or severe core activity limitation remained about the same in 1998 and 2003 (21% and 22% respectively). Mostly resulting from the total increase in the number of older people, older people with a profound or severe core activity limitation increased in number between 1998 and 2003 from 481,000 to 562,000.
In contrast to the similar overall rates of disability reported for older men and older women, older women were more likely than older men to have a profound or severe core-activity limitation. In 1998 and 2003, this was observed for all five year age groups of older people, with the greatest differences between the rates observed for the oldest age groups. In 1998, 16% of older men and 25% of older women had a profound or severe core activity limitation, increasing to 17% and 27% respectively in 2003.
Older people with disabilities and older people with profound/severe core-activity limitations - 2003
Source: ABS 2003 Survey of Disability, Ageing and Carers.
Source: ABS 2003 Survey of Disability, Ageing and Carers.
LIVING ARRANGEMENTS
In both 1998 and 2003, most older people with disability live in private dwellings, either with other people or alone. As people age, their living arrangements may change to suit their circumstances. This is often as a result of illness or disability, or of a transition in their life, such as the death of a spouse. People with disabilities aged 85 years and over are less likely than people aged 65-74 years to be living with a partner or other family member, and more likely to be living alone or in cared accommodation.
Because men have a shorter life expectancy than women, and are on average somewhat older than the women they marry, older men are more likely than older women to live in family situations, particularly with partners. In 2003, this pattern was observed for older people with disabilities and for older people as a whole.
In 2003, most of the 1.4 million older people with disabilities (83%) lived in a private dwelling such as a house, a flat or a home unit. About one in ten older people with disabilities lived in cared accommodation such as nursing homes and aged cared hostels (12%). The remaining 6% lived in non-private dwellings other than cared accommodation, such as retirement villages staff quarters, religious institutions, or boarding houses.
There were differences in living arrangements of older people with disabilities by age. The proportion living in cared accommodation, or living alone in a private dwelling, was higher at older ages. In 2003, 3% of people with disabilities aged 65-74 years lived in cared accommodation, compared with 10% of people aged 75-84 years and 37% of people aged 85 years and over.
Between 1998 and 2003 there was an increase in the proportion of older people with disabilities living in non-private dwellings other than cared accommodation, from 2% to 6%. This may relate to increases in the availability of community care or older people choosing age-specific housing such as units in retirement villages which provide some care on-site. The increase was accompanied by decreases both in the proportion living in private dwellings (from 85% to 83%) and in cared accommodation (from 13% to 11% respectively).
LIVING ARRANGEMENTS OF OLDER PEOPLE WITH DISABILITIES - 1998 and 2003
 | 1998 | 2003 | ||
| Arrangement | With profound/ severe core activity limitation | Total (all with reported disability) | With profound/ severe core activity limitation | Total (all with reported disability) |
| % | % | % | % |
| Households | 67.8 | 86.8 | 72.6 | 88.5 |
| Private dwelling | 65.8 | 84.6 | 68.0 | 82.8 |
| With other people | 45.5 | 57.3 | 48.8 | 57.3 |
| Alone | 20.3 | 27.4 | 19.2 | 25.6 |
| Other non-private dwelling(a) | 2.0 | 2.1 | 4.6 | 5.7 |
| Cared accommodation | 32.2 | 13.2 | 27.4 | 11.5 |
| Total | 100.0 | 100.0 | 100.0 | 100.0 |
| '000 | '000 | '000 | '000 |
| Total (no.) | 481.2 | 1 225.2 | 561.7 | 1 391.5 |
| (a) Includes: hotels for the homeless, hotels, motels, educational and religious institutions, construction camps, boarding houses, staff quarters, guest houses, short stay caravan parks, youth camps and camping grounds, and self-care units in a retirement village which may have cared accommodation on-site. Source: ABS 1998 and 2003 Surveys of Disability, Ageing and Carers. | ||||
Older people with disabilities(a) living with a partner - 2003(a)
...cared accommodation
Changes in the use of cared accommodation are of particular interest. The decrease in the proportion of older people with disabilities living in cared accommodation occurred across all age groups of older people. The decrease among those aged 85 years and over was from 42% in 1998 to 37% in 2003. These decreases in the proportion of older people with disabilities living in cared accommodation were essentially offset by the increase in the older population over the period. Nevertheless there was a small decrease in the absolute number of older people with disabilities living in cared accommodation, from 162,000 to 159,000.
In both 1998 and 2003, almost all older people with a disability who were in cared accommodation had a profound or severe core activity limitation (96% and 97% respectively). This is consistent with the fact that entry to cared accommodation involves a disability assessment. However, the majority of older people with profound or severe core activity limitations lived in households (73% in 2003), rather than in cared accommodation. The proportion who did live in cared accommodation decreased from 32% to 27% between 1998 and 2003.
Older people with disabilities living in cared accommodation - 1998 and 2003(a)
ASSISTANCE FOR THOSE LIVING AT HOME
Older people with disabilities living at home often need help with tasks such as property maintenance or housework and with managing their health conditions. They may also need help or supervision in carrying out core everyday activities, such as making meals, or moving about in the home. In 2003, 69% of older people with disabilities who were living in households reported needing assistance in at least one such area.
The activities they most commonly reported needing assistance with were property maintenance (47%), health care (39%), transport (36%), housework (36%) and mobility (28%). Need for assistance with self care (17%), meal preparation (14%) and paperwork (14%) was somewhat less common. About 12% of all older people with disabilities needed assistance with emotion or cognition (for example, with maintaining relationships or interacting with others, coping with feelings or thinking through problems). Relatively few older people with disabilities needed assistance with communication (3%).
The need for assistance increased with age. For example, in 2003, 29% of people with disabilities aged 65-74 years needed assistance with health care, increasing to 58% of those aged 85 years and over. Similarly, 25% of people with disabilities aged 65-74 years needed assistance with transport, increasing to 67% of those aged 85 years and over.
Between 1998 and 2003, the proportion of older people with disabilities who needed assistance with tasks or activities increased for self care (from 15% to 17%), health care (from 36% to 39%) and for mobility (from 26% to 28%). For other activities, the need for assistance remained about the same. (No comparison was possible for the need for assistance with emotion or cognition which was covered for the first time in 2003.)
Almost all people with profound or severe core activity limitations needed assistance in at least one of the core activity areas (99.6%). A large majority needed assistance with mobility (84%), over half needed assistance with self care (51%) and 9% with communication. They were also very likely to need assistance with other tasks of daily life, most commonly with transport (73%), property maintenance (72%), health care (70%) and housework (69%), but also with meal preparation (36%) and paperwork (32%). More than one quarter (26%) needed assistance with emotion or cognition.
Between 1998 and 2003 the largest increases in the need for assistance of older people with a profound or severe core activity limitation were observed for self care (from 48% to 51%), health care (from 67% to 70%) and transport (from 71% to 73%). The largest decrease observed was in their need for assistance with property maintenance (from 77% to 72%). Need for assistance with other activities remained stable.
ASSISTANCE NEEDED BY OLDER PEOPLE WITH DISABILITIES LIVING IN HOUSEHOLDS(a) - 2003
| | All with reported disability | |||
| With profound/ severe core activity limitation | 65-74 years | 75-84 years | 85 years and over | Total |
| % | % | % | % | % |
| Self care | 51.0 | 13.7 | 17.4 | 27.4 | 16.9 |
| Mobility | 83.5 | 18.7 | 31.0 | 50.7 | 27.6 |
| Communication | 9.3 | 2.5 | 2.6 | *6.7 | 3.1 |
| Health care | 70.4 | 29.1 | 43.5 | 57.9 | 38.5 |
| Transport | 73.4 | 24.7 | 40.4 | 66.9 | 36.2 |
| Paperwork | 31.8 | 7.6 | 15.9 | 28.7 | 13.6 |
| Housework | 69.2 | 25.8 | 40.3 | 56.9 | 35.5 |
| Property maintenance | 71.5 | 38.3 | 51.0 | 65.7 | 46.8 |
| Meal preparation | 36.0 | 7.2 | 15.2 | 32.1 | 13.5 |
| Cognition and emotion | 26.3 | 10.0 | 11.8 | 17.8 | 11.7 |
| |||||
| At least one of the above activities | 99.6 | 60.4 | 73.3 | 86.4 | 68.8 |
| '000 | '000 | '000 | '000 | '000 |
| Total(a) | 407.7 | 576.6 | 507.4 | 148.2 | 1,232.2 |
| (a) All older people with disabilities except those living in cared accommodation. Source: ABS 2003 Survey of Disability, Ageing and Carers. | |||||
WHETHER NEEDS MET(a) - 2003
| | All with reported disability | |||
| With profound/ severe core activity limitation | 65-74 years | 75-84 years | 85 years and over | Total |
| % | % | % | % | % |
| Needed assistance | 99.6 | 60.4 | 73.2 | 86.4 | 68.8 |
| Fully met | 56.1 | 38.9 | 44.7 | 53.4 | 43.0 |
| Partly met | 42.3 | 18.0 | 25.9 | 32.2 | 23.0 |
| Not met at all | 1.2 | 3.5 | 2.6 | 0.8 | 2.8 |
| |||||
| Assistance not needed | 0.5 | 39.7 | 26.7 | 13.6 | 31.2 |
| Total | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 |
| '000 | '000 | '000 | '000 | '000 |
| Total(a) | 407.7 | 576.6 | 507.4 | 148.2 | 1,232.2 |
| (a) Need for assistance of older people living in households i.e. excludes those living in cared accommodation. Source: ABS 2003 Survey of Disability, Ageing and Carers. | |||||
...were needs met?
In 2003, the 69% of older people with disabilities who reported needing assistance comprised 43% whose needs were fully met, 23% whose needs were partly met and 3% whose needs were not met at all.
People with profound and severe core activity limitations tended to need and receive more assistance than other older people with disabilities. Almost all of this group reported needing assistance (99.6%), comprising 56% whose needs were fully met, 43% whose needs were partly met and 1% whose needs were not met at all.
As the need for assistance increased with age, so did the proportion of all older people with disabilities who received assistance. Around 57% of people aged 65-74 years both needed and received assistance (i.e. reported that their needs were either fully or partly met) increasing to 71% of people aged 75-84 years and 86% of those aged 85 years and over.
A lower proportion of people aged 85 years and over and needing assistance reported that their needs were not met at all (0.8%) than was the case for the two younger age groups (4% for 65-74 year olds and 3% for 75-84 year olds). Similarly, just over 1% of people with profound or severe core activity limitation who needed assistance reported that their needs were not met at all, compared with 3% of all people with reported disability who needed assistance.
Between 1998 and 2003 the proportion of people aged 65 years and over with a disability who needed assistance and whose needs were either fully or partly met remained stable. The proportion of older people with disabilities who needed assistance and whose needs were fully met was slightly higher in 2003 than in 1998 (by about two percentage points), with a decrease in the proportion whose needs were partly met. Similar small changes were observed in respect of older people with profound or severe core-activity limitations whose needs were fully or partly met.
ENDNOTES
1 Australian Institute of Health and Welfare 2001 Australia's Welfare 2001 Canberra: AIHW.
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