** Limitation in Activities of Daily Living (ADL) and Instrumental Activities
of Daily Living (IADL)
Using data from the Census Bureau's 1986 SIPP, the following tables show
prevalence figures on the need for assistance from others with everyday
activities. While 4.4 percent of the total population 15 years of age and
older needed assistance with one or more of the five everyday activities,
this rate varied considerably depending on persons' demographic
characteristics.
Age: As Table J shows, persons 65 years and older were nearly seven times
more likely to need personal assistance than their younger counterparts (16.0
versus 2.4 percent). The additional age detail in Table 4 shows this
disparity increased for those of advanced age, with over 45 percent of
persons 85 and over needing personal assistance. The particular type of
personal assistance also varied with age. Persons needing assistance who
were 65 years and over were more likely to require help with getting around
outside and keeping track of money and bills than their younger counterparts
with a need for assistance. While the need for personal assistance increased
with age, nearly half (46.4 percent) of those requiring help in this regard
were under the age of 65.
Table J: Number of Persons 15 Years Old and Over by Need for
Assistance and Age, 1986
(Numbers in thousands)
--------------- Needed assistance with ----------------
Characteristic Total Keeping
track of
One or Getting Doing bills
more Personal around Preparing house- and/or
activities care outside meals work money
Person 15
Years and Over
Total Number 186,022 8,206 3,211 5,213 4,830 5,927 3,039
Total Percent 100 4.4 1.7 2.8 2.6 3.2 1.6
Persons 15
to 64 Years
Total Number 158,359 3,794 1,383 2,077 2,315 2,821 1,050
Total Percent 100 2.4 0.9 1.3 1.5 1.8 0.7
Persons 65
Years and Over
Total Number 27,663 4,412 1,827 3,136 2,515 3,106 1,990
Total Percent 100 16.0 6.6 11.3 9.1 11.2 7.2
Source: U.S. Bureau of the Census, 1986 Survey of Income and Program
Participation, Current Population Reports, Series P-70, No. 19,
Tables A and B.
Income: As Table K shows, persons with low household incomes (under $600 per
month) were more likely to need personal assistance than those with monthly
incomes of $3,000 and over (11.8 versus 1.9 percent). In combination, low
income and advanced age correlate with the highest rate of need for personal
assistance. Of persons 65 years of age and over with monthly incomes under
$600, 27.2 percent had a need for assistance with one or more of the
activities.
Table K: Number of Persons 15 Years Old and Over
by Need for Assistance and Income, 1986
(Numbers in thousands)
Need Assistance
Monthly Income Total with One or
by Age Group More Activities
Persons 15 Years and Over 186,022 4.4%
Under $600 16,227 11.8
$600 to 1,199 25,066 8.2
$1,200 to 1,999 37,483 4.6
$2,000 to 2,999 39,737 3.0
#3,000 and Over 67,509 1.9
Persons 15 to 64 Years 158,359 2.4%
Under $600 11,708 5.9
$600 to 1,199 17,240 4.5
$1,200 to 1,999 30,164 2.4
$2,000 to 2,999 35,911 2.2
#3,000 and Over 63.337 1.3
Pesons 65 Years and Over 27,663 16.0%
Under $600 4,519 27.2
$600 to 1,199 7,827 16.5
$1,200 to 1,999 7,320 13.6
$2,000 to 2,999 3,826 11.2
#3,000 and Over 4,172 11.2
Source: U.S. Bureau of the Census, 1986 Survey of Income and Program
Participation, Current Population Reports, Series P-70, No. 19,
Tables 1 and 2.
Ethnicity: As Table 4 shows, blacks, at 5.7 percent, were more likely than
whites at 4.3 percent, or Hispanics at 3.4 percent to require personal
assistance. The black - white disparity in need for assistance increased
substantially for those of advanced age (22.7 versus 15.4 percent,
respectively) for persons 65 and older. In this age group, white and
Hispanic differences were not statistically different.
Gender: Table 4 also shows that a larger percentage of females than males
required personal assistance with one or more of the listed activities - 5.8
percent versus 2.9 percent. The gender disparity remained for all age groups,
but varied depending on the particular activity involved. Suggesting the
influence of traditional roles, males 65 to 74 years old reported they were
less likely to need assistance with meal preparation (4.3 percent) and
housekeeping (3.9 percent) than females (6.7 and 9.6 percent, respectively).
This was in spite of the fact that the overall need for assistance (with one
or more activities) for both males and females was about the same for this
age group.
Living Arrangements: From the same table, the data show that persons living
alone or with non- relatives had a greater likelihood of needing assistance
with one or more of the everyday activities (8.4 percent) than those living
with a family member (3.6 percent). Computed another way, nearly one-third
(32.0 percent) of the 8.2 million persons needing personal assistance did not
live with a family member, almost all of whom lived completely alone.
Personal Assistance Caregivers: The 1984 SIPP also collected data on persons
who provided personal assistance. Unpaid ADL and IADL assistance provided by
family and friends constitutes the primary source of support, and the SIPP
shows the extent to which this occurs, the specific everyday activities
involved, and the characteristics of those providing the help. Nearly 5.8
million persons provided assistance with one or more activities to a
household member, while another 15.1 million persons provided personal
assistance to one or more individuals outside the caregiver's household. For
both groups of caregivers, the most frequently provided care, although not in
the same order, was preparing meals, doing housework and helping someone get
around outside the house. Over 94 percent of those providing care to a
member of their own household were related to the recipient, including a
spouse (44%), daughters (18.4%) and sons (11.9%). For those assisting
persons outside the caregiver's household, 22.2 percent were daughters, 12.0
percent were sons, 32.6 percent were another relatives, and 33.2 percent were
non-relatives.
** Disability Status of Special Population Groups
Children: Disability status among children varies considerably depending on
the particular study and the types of conditions involved. For example, the
1988 NHIS, in addition to data on activity limitation, measured child health
in terms of: 1) delays in growth or development (4.0 percent of children age
17 years and under), 2) learning disabilities (6.5 percent of children 3 to
17 years of age), and 3) emotional or behavioral problems lasting three
months or more or requiring psychological treatment. (13.4 percent of
children 3 to 17 years of age) (see Table 7). Across all these measures, NCHS
estimates that over 10.7 million children, or 19.5 percent of those 3 to 17
years of age, had one or more of these conditions. Because of the long-term
effect which developmental, learning and emotional problems can have, these
figures include children who have ever had the condition at anytime in their
lives (lifetime prevalence). The NHIS Child Health Supplement shows that
despite the elimination or amelioration of childhood infectious diseases,
there is a high rate of chronic health problems, with psychological disorders
increasing and now ranking among the most prevalent.
As Table 7 shows, boys have substantially higher prevalence rates of learning
disabilities (8.6 percent) and emotional or behavioral problems (15.4
percent) than girls (4.4 and 11.3 percent, respectively). Gender differences
in growth or development delays were not statistically significant. Family
structure is an important correlate with learning disabilities and emotional
or behavioral problems (but not developmental delays), with the lowest rates
occurring in families where both the biological mother and father are
present.
Another perspective on child health comes from the core NHIS questionnaire on
prevalence of activity limitation. As previously shown in Table A, 5.3
percent of children under 18 years of age had a limitation in major or
outside activity in 1989. NCHS estimates that within this group, 2.3 percent
of children under 5 years old and 6.4 percent of those in the 5-14 age group
had such a limitation. For children 5 to 17 years of age, NCHS defines major
activity as attending school and, for children under 5, ordinary play.
As Table L shows, the 1984 SIPP measured disability among children under 18
years of age in terms of 1) a long-lasting physical condition that limited
his or her ability to walk, run or play (2.0 percent), or 2) a long-lasting
mental or emotional that limited his or her ability to learn or do regular
schoolwork (0.9 percent). Between the two groups, the Census Bureau
estimates that 1.9 million children under 18 years of age, or 3.1 percent of
this population, had either one of the conditions (2.9 percent) or both of
them (0.2 percent). The 1984 SIPP questions on disability status of children
included fewer conditions than the 1988 NHIS Child Health Supplement and
pertained to children who currently had the condition(s) as opposed to any
time in their lives.
With additional detail, Table 8 shows that children who live in very low
income households with less than $600 per month were more likely to have one
or both types of disability than their counterparts with $3,000 and over (4.5
versus 2.6 percent). Mirroring the income-related rates, children in female
headed households with no husband present were more likely than those living
in a married couple family to have one or both conditions (also 4.5 versus
2.6 percent).
Table L: Disability Status of Children Under 18 Years of Age, 1984
(Numbers in thousands)
******************** With a Disability ************************
Total Both Physical
Mental or and Mental
Number Percent Physical Only Emotional Only or Emotional
Number Percent Number Percent Number Percent
62,445 1,916 3.1 1,241 2.0 536 0.9 139 0.2
Source: U.S. Bureau of the Census, 1984 Survey of Income and Program
Participation, Current Population Reports, Series P-70, No. 8,
Table 6.
Elderly: The 1984 NHIS Supplement on Aging (SOA), among other surveys, used
ADL and IADL measures for studying the needs of non-institutionalized persons
65 years of age and over, including the elderly residents of board and care
homes. This survey shows that 4.8 million elderly persons outside of
institutions, or 18.2 percent of those 65 years of age and over, had at least
one ADL limitation - in this case the ADL definition includes mobility
(walking and getting outside) and continence as separate activities - and 4.7
million, or 17.8 percent of the elderly, had at least one IADL dependency. A
total of 6.7 million, or 25.4 percent of the elderly, had either an ADL or an
IADL dependency, and 2.7 million, or 10.4 percent, had both.
As Figure 8 shows, dependence in these activities, increased across the three
age groupings: 65-74 years, 75-84 years, and 85 years and over, with the
greatest rise occurring in the latter group. For persons 65-74 years, the
proportion who were dependent ranged from 18 to 48 per 1,000 (2 percent to 5
percent) across the eight activities listed, while those in the 75-84 age
group ranged in dependency from 37 to 97 per 1,000 persons (4 percent to 10
percent). The population 85 years and over ranged in dependency from 90 to
286 per 1,000 persons (9 percent to 29 percent), as much as six times higher
than for the 65-74 age cohort. Apart from the SOA, the core NHIS routinely
collects ADL and IADL information on the elderly through two components of
the survey. The first is the question on limitation in major activity, which
for persons 70 years of age and older, is the ability to live independently
(e.g., one combined ADL/IADL measure). As Table A shows, 7.2 percent of
those 70 years and over cannot perform such major activity and 12.3 percent
are limited in the amount or kind they can do. The NHIS also asks two other
global questions, one ADL and one IADL, of persons 60 to 69 years of age and
any other person 5 to 59 years old reporting an activity limitation (as well
as the elderly 70 years and older). In addition, a recent analysis of the
1979-1980 NHIS Home Care Supplement provides a detailed analysis of ADL and
IADL limitations across the life span.
|-----------------------------------------------------------------------------|
| Proportion of Persons 65 Years and Over |
| Dependent in Selected Activities |
| by Age Group: United States, 1984* |
| |
| Activity |
| |
| XXXXXXX |
| Shopping \\\\\\\\\\\\\\\\\ |
| /////////////////////////////////////////////////// |
| |
| XXXX |
| Light Housework \\\\\\\\\\\ |
| /////////////////////////////// |
| |
| XXX |
| Preparing Meals \\\\\\\\\\ |
| /////////////////////////////// |
| |
| XXXXXXX |
| Bathing \\\\\\\\\\\\\\ |
| /////////////////////////////////////// |
| |
| XXXXXX |
| Dressing \\\\\\\\\\ |
| /////////////////////// |
| |
| XXX |
| Transferring** \\\\\\\ |
| /////////////// |
| |
| XXXX |
| Getting Out/Walking \\\\\\\\ |
| /////////////////////// |
| |
| XXXXXXXX |
| Incontinent Daily \\\\\\\\\\\\\\ |
| //////////////////////// |
| 0 50 100 150 200 250 300 |
| Number per 1,000 Population |
| XXX 65-74 Years \\\ 75-84 Years /// 85 Years & Older|
| |
| Figure 8 |
| * ADL and IADL definitions and measures vary among studies (see Table 6). |
| ** Getting into and out of bed or chair |
| Source: NCHS, 1984 NHIS, SIA, Vital and Health Statistics, 10(167). |
| |
|-----------------------------------------------------------------------------|
Mental Health: For prevalence estimates in the adult, non-institutionalized
population, the National Institute of Mental Health uses the Epidemiological
Catchment Area Survey (ECA) which covers a range of mental and emotional
conditions, as presented in Figure 9 and Table 9. When the number of persons
and time period include all persons who have ever had any type of mental
disorder at any time in their lives (lifetime prevalence), NIMH estimates the
figure to be 32.2 percent of the non-institutionalized population 18 years of
age and over. While nearly one-third reported at least one disorder during
their lifetime, 19 percent reported one during the past six months, and 15
percent in any one month period, the latter measuring current prevalence
rates. Substance use disorders had the highest lifetime prevalence, followed
by anxiety disorders and affective disorders.
|-----------------------------------------------------------------------------|
| Prevalance of Mental Disorders |
| |
| Type of Disorder |
| |
| XXXXXXXXXXXXXXXXXX 15.4% |
| Any Disorder \\\\\\\\\\\\\\\\\\\\\\\ 19.1% |
| /////////////////////////////////////// 32.2% |
| |
| XXXX 3.8% |
| Substance Use \\\\\\\ 6% |
| /////////////////// 16.4% |
| |
| X 0.7% |
| Schizophrenia \ 0.9% |
| // 1.5% |
| |
| XXXXXX 5.1% |
| Affective \\\\\\\ 5.8% |
| ////////// 8.3% |
| |
| XXXXXXXXX 7.3% |
| Anxiety \\\\\\\\\\\ 8.9% |
| //////////////// 14.6% |
| |
| 0.1% |
| Somatization 0.1% |
| 0.1% |
| |
| X 0.5% |
| Personality \ 0.8% |
| /// 2.5% |
| |
| X 1.3% |
|Cognitive Impairment \ 1.3% |
| / 1.3% |
| |
| 0% 5% 10% 15% 20% 25% 30% 35% 40% |
| XXX One Month \\\ Six Month /// Lifetime |
| |
| Figure 9 |
| Source: Regier, D.A. et al.,"One-Month Prevalence of Mental Disorders in |
| the United States Based on Five Epidemiological Catchment Area |
| Sites," Archives of General Psychiatry (1988),961. |
| |
|-----------------------------------------------------------------------------|
As opposed to the ECA which measured prevalence of mental disorders,
regardless of severity, the 1989 NHIS Mental Health Supplement collected data
on the prevalence of severe and persistent mental illness. Based on a
preliminary analysis of these data, the National Institute of Mental Health
(NIMH), which sponsored the supplement, estimates that 3.3 million
non-institutionalized persons 18 years of age and over, currently have a
severe mental illness. Of these, between 2.2 and 2.8 million are currently
disabled as a result.
Mental Retardation and Developmental Disabilities: Developmental disabilities
include mental retardation, cerebral palsy, autism, epilepsy, and other
neurologically-based conditions such as dyslexia. At any given point in
time, approximately one percent of the population is mentally retarded, with
or without related developmental disabilities; of these, 15 percent are in
institutions and the remaining 85 percent live with their families or
otherwise independently. The Association of Retarded Citizens (ARC)
estimates that three percent of the population, or 6.6 million persons, will
develop mental retardation at some point in their lives. In terms of
severity, ARC estimates that of this number, 89.0 percent will have a mild
level of retardation, 6.0 percent moderate, 3.5 percent severe and 1.5
percent profound.
Self-Perception among Persons with Disabilities: The International Center for
the Disabled (ICD), in cooperation with the National Council on the
Handicapped, sponsored a Louis Harris poll on self-perception among persons
with and without a disability. Respondents reported if they were 1) very
satisfied, 2) somewhat satisfied, 3) neither satisfied nor dissatisfied, 4)
somewhat dissatisfied, 5) very dissatisfied, or 6) very dissatisfied with
life. The population with a disability was more than three times as likely
to be "somewhat dissatisfied" than their counterparts without a disability
(16 percent versus 5 percent), and eight times more likely to be "very
dissatisfied" (8 percent versus 1 percent) (see Tables 11 and 12).
|
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