Number of disabled expected to rise; more research urged

Washington -- Although disabilities among older adults have declined in the past two decades, younger and middle-aged people are facing a future of increasing disability, predicted a panel of physicians and researchers who drafted a report released April 24 by the Institute of Medicine.

Conditions that contribute to disability -- notably, physical inactivity, diabetes and obesity -- are increasing, the panel said. The percentage of Americans ages 18 to 64 with reported activity limitations grew during the 1990s, which does not bode well for a healthy older age, they concluded.

Plus, there has been a worrisome increase in overweight or obesity among children, raising concerns that when these children reach middle age, they may experience more disability than the current cohort of people older than 65.

More than 40 million Americans-- about one in seven -- are now disabled, and that number is likely to increase significantly in the next 30 years as the population of baby boomers ages, since age itself is a major risk factor for disability, the panelists noted.

"If one considers people who now are disabled, those likely to develop a future disability and people who are or will be affected by the disabilities of family members or others close to them, it becomes clear that disability will eventually affect the lives of most Americans," said Alan M. Jette, MPH, PhD, director of Boston University's Health and Disability Research Institute and chair of the committee that wrote the report.

The document, "The Future of Disability in America," follows IOM papers on disability that were drafted in 1991 and 1997. The new report finds that progress has been made since the timing of these earlier efforts. An understanding since has emerged that disability does not rest with the individual but results from interactions between them and their social and physical environments, the panel said.

The Americans with Disabilities Act and other policies intended to reduce barriers have helped increase recognition of environmental obstacles, the report's authors noted. But the implementation and enforcement of those laws has been disappointing.

Difficulties to address

Ironically, even within health care facilities, people with disabilities encounter equipment and surroundings that aren't designed appropriately. For example, examination tables and weight scales are difficult for people in wheelchairs to use.

Ongoing advances in science and a broad array of assistive technologies -- combined with regulatory requirements for such features -- have been liberating for many people with disabilities, the panel said.

They recommended that a federal campaign be launched to increase doctors' and others' awareness of these technologies.

The panel also developed other recommendations for federal agencies and Congress. For instance, the Centers for Disease Control and Prevention, the U.S. Census Bureau and other agencies should create a monitoring system to gather an accurate population-wide count of people with disabilities.

In addition, Congress should adequately fund disability research, and health care facilities should be made accessible to adults and children with mobility, sensory or other impairments.

The panel also recommended that education programs be developed for physicians and other health care professionals to help them care for patients with disabilities. Physicians and others are not always well informed about the primary health care needs of this population, the prevention and management of secondary health conditions, the challenge of aging with disabilities and the transition of young people from pediatric to adult services.