Functional Disability - Age 65+ in Tennessee

Tennessee

Compared with all other age groups, older adults are the most likely to have a disability. Older adults who do not have a disability are more likely to engage in physical activity than those with disabilities. Those with disabilities have a higher prevalence of smoking, heart disease and diabetes and are more likely to be victims of abuse, violence or harm compared with older adults who do not have a disability. In addition, older adults with cognitive disabilities such as Alzheimer’s or other forms of dementia are hospitalized twice as often as older adults without cognitive impairment.

People with disabilities can face many barriers to participating in everyday life, including:

• Physical barriers, such as obstacles in the environment.
• Transportation barriers, such as limited or no accessible transportation.
• Policy barriers, such as being denied certain benefits or federal services granted to people with disabilities. 
• Absence of accommodations that would overcome some of the other barriers listed and allow people with disabilities to participate in activities and access services — for example, ramps and curb cuts, closed captioning for the deaf/hard of hearing and audio descriptions for the visually impaired.

According to the U.S. Census Bureau, the most common disabilities among adults age 65 and older are: 

• Ambulatory difficulty, which covers a range of mobility issues that make it hard to do things like walking or climbing stairs.
• Hearing difficulty, which includes people who are deaf and those who have serious difficulty hearing.
• Independent living difficulty, which is characterized by serious difficulty with or inability to do things like grocery shopping or visiting the doctor on one’s own.

The Centers for Disease Control and Prevention lists several strategies for improving the inclusion of people with disabilities in everyday activities. Policies and legislation like the Americans with Disabilities Act (ADA) aim to protect the civil rights of people with disabilities. The ADA also mandates that businesses, public buildings and health care centers meet specific accessibility requirements. 

However, more can be done to improve disability legislation and remove discriminatory policies. Planning and building is another critical area for integration and inclusivity efforts. The universal design approach considers that people with disabilities will use the space or object in question and prioritizes accessibility, comfort and ease of use through adaptive structures. 

Physical activity has been shown to help older adults reduce their risk of significant mobility disabilities, including arthritis, the leading cause of disability in the U.S. Cognitive training, including exercises aimed at enhancing problem-solving and memory, can improve cognitive functioning and prevent or delay cognitive decline. Additionally, the National Council on Aging recommends several chronic disease self-management programs to help prevent or delay disability in older adults.

Healthy People 2030 has several goals related to disability, including: 

• Increasing the proportion of homes that have an entrance without steps.
• Increasing the proportion of older adults with physical or cognitive health problems who engage in physical activity.

Healthy People is also researching a new objective to increase the proportion of state and District of Columbia health departments with programs aimed at improving health in people with disabilities.

Downey, Autumn, Clare Stroud, Story Landis, and Alan I. Leshner, eds. Preventing Cognitive Decline and Dementia: A Way Forward. Washington, D.C.: National Academies Press, 2017. https://www.ncbi.nlm.nih.gov/books/NBK453387/.

Hootman, Jennifer M., Charles G. Helmick, and Teresa J. Brady. “A Public Health Approach to Addressing Arthritis in Older Adults: The Most Common Cause of Disability.” American Journal of Public Health 102, no. 3 (January 19, 2012): 426–33. https://doi.org/10.2105/AJPH.2011.300423.

Pahor, Marco, Jack M. Guralnik, Walter T. Ambrosius, Steven Blair, Denise E. Bonds, Timothy S. Church, Mark A. Espeland, et al. “Effect of Structured Physical Activity on Prevention of Major Mobility Disability in Older Adults: The LIFE Study Randomized Clinical Trial.” JAMA 311, no. 23 (June 18, 2014): 2387–96. https://doi.org/10.1001/jama.2014.5616.

Rosenberg, Dori E., Charles H. Bombardier, Jeanne M. Hoffman, and Basia Belza. “Physical Activity Among Persons Aging with Mobility Disabilities: Shaping a Research Agenda.” Journal of Aging Research 2011 (June 26, 2011). https://doi.org/10.4061/2011/708510.