Health Status: Older people with disabilities
In 1993, 56% of people aged 65 and over had a disability. 89% of them lived in households rather than institutions.
In the twenty years to 1994 the median age of the Australian population increased by 5.6 years, to 33.4 years (see Population - National summary tables). The number of people aged 65 and over grew at a faster rate than the Australian population as a whole. In 1994 there were more than twice as many people aged 85 and over as there had been in 1974.
The presence of disability and handicap is strongly related to age. Disability rates and handicap rates for people aged 65 and over are significantly higher than for younger people. Apparent changes in the overall level of disability in the population may therefore be principally a result of the growing numbers of people in older age groups. However, because of these increasing numbers, the patterns of disability have consequences for provision of services and development of program policies.
| Disability and handicap In the context of health experience the World Health Organisation International Classification groups together impairments, disabilities and handicaps. An impairment is defined as any loss or abnormality of psychological or physical functioning. An impairment may lead to a disability, defined as any restriction or lack (resulting from an impairment) of ability to perform an activity in the manner or within the range considered normal for a human being. In the ABS surveys of disability and handicap, a series of screening questions on limitations, restrictions and impairments were asked about each individual, to identify those persons with disabilities. In 1993, three additional screening questions were included because of concern that earlier surveys missed specific groups of people with disabilities. A handicap is identified as a limitation in performing certain tasks associated with daily living. The limitation must be due to a disability and be in relation to one or more of the following areas:
Severity of handicap (profound, severe, moderate or mild) is determined by the ability to perform relevant tasks and by the amount and type of help required. People with a disability do not necessarily have a handicap; people with a handicap always have a disability. |
Changes in disability and handicap rates
In 1981, 13% of the population had a disability and of these 31% (594,100 people) were aged 65 and over. In 1988, 16% of the population had a disability and 36% of these were aged 65 and over.
Comparing the two populations, it was estimated that about half the difference between 1981 and 1988 was attributable to changes in the size and composition of the total population. Changing community attitudes, perhaps influenced by the International Year of Disabled People in 1981, may also have resulted in greater willingness to admit to disabling conditions, and therefore an increase in the numbers identified through the screening questions as having a disability.
In 1993, 18% of the population (3.2 million people) were identified as having a disability. 36% were aged 65 and over. The overall population proportion showed an apparent increase of two percentage points between 1988 and 1993. However, when the data are standardised to allow for the change in the age structure of the population and for the change in the definition of disability between the two surveys, it is estimated that there was an increase of 0.6% in the overall proportion of people with a disability. Comparisons of the standardised data for people with a handicap indicate that overall there was a decrease of 0.4% in the proportion with a handicap.
In the 65-74 years age group the proportion of people with a disability increased from 36% in 1981 to 49% in 1993. The proportion of people who had a handicap also increased, from 24% in 1981 to 39% in 1993. This represented an increase from 68% to 80% in the proportion of people with a disability who also had a handicap.
Among people aged 75 and over, the proportions were much higher but the patterns of increase were similar. In 1981, 53% of this age group had a disability and 45% had a handicap. In 1993, 67% had a disability and 61% had a handicap. This represented an increase from 86% to 91% in the proportion of people with a disability who also had a handicap.
In comparison, in 1993, 7% of young adults (aged 15-24) had a disability and 5% also had a handicap.
In 1993, men in nearly all age groups were more likely to have a disability than women. However, because of the larger numbers of women surviving to older ages, the number of women aged 70 and over who had a disability was 36% larger than the number of men (491,600 compared to 361,200 ).
PROPORTION OF THE POPULATION WITH DISABILITIES AND HANDICAPS
 | 1981 | 1988 | 1993 |
| Age group (years) | % | % | % |
| With a disability | | | |
| 35.5 | 44.2 | 48.8 |
| 53.1 | 63.5 | 66.7 |
| 13.2 | 15.6 | 18.0 |
| With a handicap | | | |
| 24.1 | 35.0 | 39.3 |
| 45.4 | 58.1 | 61.0 |
| 8.6 | 13.0 | 14.2 |
PROPORTION OF PEOPLE WITH A DISABILITY, 1993
Source: Survey of Disability, Ageing and Carers
Area of handicap
In both 1988 and 1993 about three-quarters of all people with a handicap reported limitations to their mobility. These limitations varied from difficulty in using public transport, in going to places away from their home, or in moving to and from their bed or chair, according to the severity of their handicap. Difficulties with mobility were more likely to be experienced by the older age groups. In 1993, 87% of people aged 75 and over with a handicap experienced difficulty in mobility compared to 81% of those aged 65-74.
In 1988 and 1993 about 40% of all people with a handicap experienced limitations to self care, that is, difficulty with activities such as eating, showering, dressing or toileting. Again limitations were more likely to be reported by the older age groups. In 1993, 59% of people aged 75 and over experienced such difficulties.
PERSONS WITH A HANDICAP BY SELECTED AREAS OF HANDICAP
| | | 1988 | | | 1993 |
| ||||||
| 65-74 years | 75 years and over | All persons | 65-74 years | 75 years and over | All persons |
| Area of handicap(a) | % | % | % | % | % | % |
| Self care | 45.5 | 64.1 | 42.8 | 41.1 | 58.7 | 39.6 |
| Mobility | 89.4 | 93.1 | 77.0 | 80.7 | 87.0 | 73.1 |
| Communication | 24.6 | 37.9 | 18.9 | 20.2 | 38.4 | 19.2 |
| ||||||
| '000 | '000 | '000 | '000 | '000 | '000 |
| Total with handicap | 383.3 | 398.7 | 2 120.6 | 484.6 | 496.6 | 2,500.2 |
Source: Survey of Disabled and Aged Persons (1988); Survey of Disability, Ageing and Carers (1993)
Living arrangements
Responding to changes in government and community attitudes, recent programs have been designed to avoid premature or inappropriate admission to long-term residential care for older people or people with disabilities. Instead, basic support services have been developed to help people be independent at home and in the community.
In 1993, 138,900 people aged 65 and over, 7% of the age group, lived in a health establishment of some kind. 95% of these institution residents had a disability and 87% also had a handicap, most of which were classified as profound.
Of the 1.9 million people aged 65 and over living in households, 53% had a disability and 45% also had a handicap. People with a handicap living in households were less likely than those in institutions to have a profound or severe handicap; 28% were so classified. A further 22% were classified as having a moderate handicap.
Overall, 96% of people aged 65-74 who had a disability lived in households, as did 80% of people aged 75 or more with a disability. Even those with a profound handicap were more likely not to live in institutions, although the proportion was reduced in the oldest age group.
In 1993 about one-third of non-institutionalised people aged 65 and over with a disability lived alone, a slightly higher proportion than of those without a disability.
Help with activities
People with a disability living in households may nevertheless need help with one or more everyday living activities other than the primary areas of limitation. They may need help or supervision to carry out certain tasks, or might find it difficult to do the task alone. People without a disability may also have such difficulties and the need for help was increasingly reported as age increased. In 1993, 21% of people aged 65-69 without a disability needed some help with one or more activity, compared to 49% of those aged 75 and over. For people with a disability, the pattern of help needed was very similar but at a higher rate, 49% of those aged 65-69 and 78% of those aged 75 and over.
People with a disability were most likely to need help with home maintenance, as were those without a disability aged 70 and over. Assistance with transport was important for both groups.
HELP NEEDED BY PEOPLE LIVING IN HOUSEHOLDS, 1993
| 65-69 years | 70-74 years | 75 years and over |
| Type of help needed | % | % | % |
| Persons with a disability | | | |
| 20.9 | 28.0 | 46.7 |
| 38.0 | 47.0 | 65.7 |
| 5.4 | 5.3 | 14.9 |
| 6.9 | 7.9 | 19.4 |
| 27.2 | 31.8 | 54.0 |
| |||
| 49.3 | 57.8 | 77.8 |
| |||
| Persons without a disability | | | |
| 2.9 | 5.4 | 11.4 |
| 10.1 | 17.2 | 33.5 |
| * * | * * | * * |
| 2.1 | 2.1* | 4.6 |
| 12.9 | 15.4 | 28.6 |
| |||
| 21.4 | 29.3 | 49.2 |
Source: Survey of Disability, Ageing and Carers
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