I. Prevalence and Characteristics of Persons with Disabilities
Table 1. Number and Percent of Persons by Degree of Activity Limitation Due to
Chronic Conditions and Age, Race and Sex: United States, 1989
** Highlights
Chronic activity limitation, or long-term disability, affects 14.1 percent of
the U.S. population. This includes 4.1 percent who are unable to carry out
their major activity, such as working, keeping house, or attending school,
and another 5.4 percent who are limited in the amount or kind of major
activity they can perform. An additional 4.5 percent, while not limited in
their major activity, respond positively when asked if they are limited in
other ways (total affected by rounding).
While most persons 65 and over have no activity limitation, the prevalence
and severity of activity limitation increases with age. For those under the
age of 18, only 5.3 percent have a limitation and 0.6 percent are unable to
carry on their major activity. In the 18-44 age group 9.0 percent have an
activity limitation and 2.6 percent cannot conduct their major activity. The
percentage rises to 22.2 percent with a limitation and 8.8 percent unable to
conduct their major activity in the 45-64 age group, and for those 65 and
older 38.3 percent have an activity limitation while 10.1 percent are unable
to carry on their major activity at all.
Stated another way, by re-computing the figures, those under age 18 make up
26.3 percent of the total population (and 29.0 percent of those without a
limitation) but only 10.0 percent of those who are limited in their activity.
Conversely, those 70 years of age and over constitute only 7.9 percent of the
total population (and only 5.6 percent of those without an activity
limitation) but 21.9 percent of those limited in their activity.
Nonetheless, over two- thirds of those with an activity limitation are under
age 65.
The prevalence of limitation is fairly consistent between genders within the
specific age groupings. However, the severity of limitation (unable to
perform one's major activity) is greater for men than women in the 65-69 age
group where men are more likely to report a limitation in work than women in
keeping house (see introduction). Also, because there are more women than
men in the oldest age group, the increased prevalence of limitation for
females is a function of age.
Differences in populations with limitations along racial lines do not become
apparent until the population reaches age 45, at which point blacks have a
consistently higher prevalence and severity rates.
** Explanatory Notes
Data for this table come from the 1989 National Health Interview Survey
(NHIS) conducted by the National Center for Health Statistics (NCHS). The
interview sample was composed of 45,711 households containing 116,929 people.
The survey data were collected by the U.S. Bureau of the Census in
interviews with civilian, non-institutionalized, family members. Proxy
responses were accepted for members who were unavailable, incapable of
responding, or children 17 years or younger.
The disability measures used in this table identify long-term reduction in
activity (activity limitation) due to chronic disease or impairments.
Limitation in major activity is based on what is usual for one's particular
age group: ordinary play or going to school (under 18 years), working or
keeping house (18 to 69 years) or living independently (70 years and over).
Two measures of severity apply: 1) unable to carry on one's major activity or
2) limited in the amount or kind of major activity, the former defined as
severe. Limitations in non-major activity refers to reduction in one's
ability to participate in other endeavors such as civic, religious, or
recreational activities, but for the retired or those keeping house it can
include the more challenging task of work. (See the introduction for a
discussion of definition effects.)
Chronic disease and impairments are those conditions first noticed by the
respondent more than three months prior to the interview or belong to a group
of conditions, such as heart disease or diabetes, that are considered chronic
regardless of when they began. (For a listing of these conditions, see Table
13.)
Table 1. Number and Percent Distribution of Persons by Degree of Activity
Limitation Due to Chronic Conditions and Age, Race and Sex:
United States, 1989
***** Degree of Activity Limitation *****
(1) Limited
All Total Unable in Amount Limited,
Characteristic Persons with to Carry or Kind But Not
(In Thousands) Activity on Major of Major in Major
Limitation Activity Activity Activity
******* Percent Distribution *******
All Persons 243,532 14.1 4.1 5.4 4.5
Age
Under 18 Years 64,003 5.3 0.6 3.2 1.5
18-44 Years 104,196 9.0 2.6 3.7 2.7
45-64 Years 46,114 22.2 8.8 7.7 5.6
65 Years and Over 29,219 38.3 10.1 12.7 15.5
65-69 Years 9,903 36.9 15.7 13.4 7.7
70 Years and Over 19,316 39.0 7.2 12.3 19.4
Sex and Age
Male All Ages 118,009 13.7 4.6 5.0 4.0
Under 18 Years 32,752 6.3 0.6 4.0 1.7
18-44 Years 51,044 9.1 2.9 3.8 2.4
45-64 Years 22,070 21.4 10.4 6.5 4.5
65-69 Years 4,553 38.3 20.8 12.6 4.9
70 Years and Over 7,590 38.7 7.2 9.0 22.5
Female All Ages 125,523 14.4 3.6 5.8 4.9
Under 18 Years 31,251 4.3 0.5 2.5 1.3
18-44 Years 53,152 9.0 2.3 3.7 3.0
45-64 Years 24,044 22.8 7.3 8.9 6.7
65-69 Years 5,350 35.7 11.4 14.1 10.1
70 Years and Over 11,726 39.1 7.2 14.5 17.4
Race And Age
White All Ages 205,312 14.2 3.9 5.5 4.7
Under 18 Years 51,549 5.4 0.5 3.3 1.6
18-44 Years 87,429 9.0 2.4 3.8 2.8
45-64 Years 40,022 21.5 8.0 7.8 5.7
65-69 Years 8,814 35.6 14.7 13.2 7.7
70 Years and Over 17,498 38.2 6.9 11.7 19.6
Black All Ages 29,891 14.9 5.9 5.3 3.6
Under 18 Years 9,959 5.6 0.8 3.2 1.6
18-44 Years 12,766 10.2 4.2 3.7 2.3
45-64 Years 4,712 29.5 15.8 7.9 5.8
65-69 Years 905 48.8 25.6 14.6 8.6
70 Years and Over 1,548 48.2 11.2 18.6 18.3
1 This total of the three adjacent percentages may not add exactly
due to rounding.
Source: National Center for Health Statistics, National Health Interview
Survey, "Current Estimates from the National Health Interview Survey,
1989," Vital and Health Statistics, Series 10, No. 176, Tables 67
and 68.
Table 2. Number and Percent of Persons by Degree of Activity Limitation
Due to Chronic Conditions and Age, Income, and Location: United States, 1989
** Highlights
The prevalence and severity of activity limitation increase as family income
falls. For those with family incomes of less than $10,000, 26.8 percent have
an activity limitation including 9.7 percent who were unable to carry out
their major activity at all. As income rises these percentages drop. Among
the $10,000-$19,999 group, the corresponding figures are 19.4 and 6.1
percent, for the $20,000-$39,999 group they are 11.9 and 3.0 percent. For
those with family incomes of $35,000 and over the figures fall to 8.2 percent
with an activity limitation, including 1.7 percent unable to carry out their
major activity.
In combination, age and income correlate with much higher rates of activity
limitation than do these factors individually. For example, Table 1 shows
that 22.2 percent of all persons in the 45 to 64 age group have an activity
limitation, compared to 55.6 percent for the same age group with family
incomes below $10,000.
Persons residing in the South (15.2 percent with an activity limitation) and
outside metropolitan areas (16.6 percent) are somewhat more likely to have a
disability than those in other locations.
** Explanatory Notes
Data for this table come from the 1989 National Health Interview Survey
(NHIS) conducted by the National Center for Health Statistics. For a
description of this data source, see Table 1.
Family income is the total from all sources including wages, rents, pensions,
government payments, and help from relatives in the preceding twelve months,
for all family members, whether by blood, marriage, or adoption, including
earnings of family members with no disability.
Metropolitan Statistical Areas (MSAs) are generally defined as a central city
or twin cities with a population of over 50,000 and adjacent metropolitan
counties linked socially and economically to the central city. MSAs may
include a number of counties and are not restricted by state boundaries; an
individual MSA may be located in more than one state. The MSAs used in this
table were those defined in the 1980 census.
Table 2. Number and Percent Distribution of Persons by Degree of
Activity Limitation Due to Chronic Conditions and Age, Income and Location:
United States, 1989
********* Degree of Limitation *********
(1) Limited
All Total Unable in Amount Limited,
Characteristic Persons with to Carry or Kind But Not
(In Thousands) Activity on Major of Major in Major
Limitation Activity Activity Activity
Under $10,000 ********* Percent Distribution *********
All Ages 26,185 26.8 9.7 9.6 7.4
Under 18 Years 7,447 8.5 0.9 5.6 2.0
18-44 Years 9,763 17.6 7.3 6.0 4.2
45-64 Years 3,363 55.6 31.6 14.7 9.4
65-69 Years 1,427 57.0 26.1 18.2 12.6
70 Years and Over 4,185 47.3 8.0 18.3 21.1
$10,000-$19,999
All Ages 41,040 19.4 6.1 7.3 6.0
Under 18 Years 10,640 6.8 0.6 4.5 1.6
18-44 Years 15,915 12.4 4.0 5.0 3.4
45-64 Years 6,483 32.7 15.2 10.8 6.7
65-69 Years 2,586 39.6 17.6 15.2 6.8
70 Years and Over 5,416 39.5 6.6 11.7 21.1
$20,000-$34,999
All Ages 56,718 11.9 3.0 4.9 3.9
Under 18 Years 15,776 4.8 0.5 2.8 1.5
18-44 Years 25,856 8.3 1.8 3.9 2.6
45-64 Years 9,843 21.3 7.2 8.6 5.6
65-69 Years 2,096 31.9 12.0 13.2 6.8
70 Years and Over 3,146 33.4 5.5 7.6 20.3
$35,000 or More
All Ages 80,203 8.2 1.7 3.4 3.0
Under 18 Years 21,488 4.0 0.4 2.2 1.5
18-44 Years 37,310 6.2 1.1 2.7 2.4
56-64 Years 17,921 13.0 3.2 5.2 4.6
65-69 Years 1,652 27.5 9.7 11.1 6.7
70 Years and Over 1,831 32.2 7.4 8.0 16.8
Geographic Region
Northeast 48,930 13.1 3.7 4.9 4.5
Midwest 59,540 13.7 3.8 5.6 4.4
South 83,148 15.2 4.7 5.9 4.7
West 51,913 13.5 4.0 5.2 4.3
Place of Residence
MSA 189,860 13.3 3.9 5.2 4.3
Central City 74,410 14.6 4.7 5.4 4.5
Not Central City 115,450 12.5 3.4 5.0 4.1
Not MSA 53,672 16.6 5.0 6.4 5.2
1 This total of the three adjacent percentages may not add exactly
due to rounding.
Source: National Center for Health Statistics, 1989 National Health
Interview Survey, "Current Estimates from the National Health
Interview Survey, 1989," Vital and Health Statistics, Series 10,
No. 176, Tables 67 and 68.
Table 3. Functional Limitation Status, by Selected Characteristics:
United States, 1984
** Highlights
Persons who had difficulty with one or more functional activities (see list,
below) comprised 20.6 percent of the civilian non-institutionalized
population, or 37.3 million persons 15 years and older. This included 7.5
percent who had a severe limitation, defined as either unable to perform one
or more activities or needed the assistance of another person to do so. This
leaves 13.1 percent with a non-severe limitation.
Functional limitation increased at an accelerated rate with age. For
example, persons 65 years of age and older were more than four times as
likely to have a functional limitation and over seven times as likely to have
a severe limitation than their younger counterparts. At the same time,
vulnerability, such as living alone, has a high, direct correlation with
disability. Those living completely alone are more likely to have a
functional limitation (37.9 percent) than married persons with their spouse
present (20.0 percent). Re-computing and presenting theses figures another
way, persons with a functional limitation are over twice as likely to live
completely alone as those without such a limitation (21.4% versus 9.1%).
Those with low incomes (less than $600 per month) were nearly four times as
likely to have a functional limitation, at 39.9 percent, and over six times
as likely to have a severe limitation, at 18.1 percent, than persons with
monthly incomes of $3,000 and over, with functional limitation rate of 10.7
percent and a severe rate of 2.7 percent. Related to income, dependence on
public benefit programs had a direct relationship with functional limitation.
For example, over 45 percent of all Medicaid recipients and nearly 37 percent
of all Food Stamp recipients have a functional limitation, compared to the
20.6 percent figure for the total population 15 years of age and over.
Disability and labor force participation are also inversely related. Only
10.1 percent of persons in the labor force have a functional limitation,
compared to 25.7 percent of those outside the labor force. This disparity
increases for those with a severe functional limitation at 1.5 and 10.7
percent, respectively.
The rate of functional limitation is almost twice as high among persons age
15 to 64 not covered by private health insurance (22.3 percent) as among
those with such coverage (11.9 percent).
Educational attainment and disability are highly, inversely related. Persons
without a high school diploma were over twice as likely to have a functional
limitation and over three times as likely to have a severe limitation as
those who are high school graduates.
** Explanatory Notes
Data in this table come from the U.S. Census Bureau's 1984 Survey of Income
and Program Participation (SIPP). The Bureau asked a sample of
non-institutionalized persons 15 years of age and older about their ability
to perform 9 sensory and physical activities: 1) Seeing words and letters in
ordinary newspaper print even when wearing glasses or contact lenses (7.1
percent with a limitation); 2) Hearing what is said in a normal conversation
(4.3 percent); 3) Having speech understood (1.4 percent); 4) Lifting and
carrying a full bag of groceries (10 lbs.) (10.1 percent); 5) Walking three
city blocks (1/4 mile) (10.6 percent); 6) Walking up a flight of stairs
without resting (10.0 percent); 7) Getting around outside the house by
yourself (3.3 percent); 8) Getting around inside the house by yourself (1.4
percent); and 9) Getting into and out of bed by yourself (1.1 percent).
Except for having speech understood, respondents also reported on the
severity of their difficulty by indicating 1) if they had difficulty and 2)
if they were unable to do the activity at all or without the assistance of
another person, the latter defined as severe.
SIPP presents another perspective to the figures from the National Health
Interview Survey by using different questions and a single set of activities
and criteria for disability regardless of the age or major activity of the
respondent.
Table 3. Functional Limitation Status, by Selected Characteristics,
United States, 1984
(Persons 15 years and over. Numbers in Thousands)
*** With a Functional Limitation ***
Total Severe
Characteristic Total Number Percent Number Percent
Total 180,987 37,304 20.6 13,537 7.5
Age
15 to 24 years 39,297 2,054 5.2 346 0.9
25 to 34 years 40,464 3,049 7.5 596 1.5
35 to 44 years 30,480 4,074 13.4 890 2.9
45 to 54 years 22,264 5,110 23.0 1,431 6.4
55 to 64 years 22,060 7,552 34.2 2,734 12.4
65 years and over 26,422 15,465 58.5 7,539 28.5
65 to 69 years 8,928 4,052 45.4 1,682 18.8
70 to 74 years 7,378 4,078 55.3 1,691 22.9
75 years and over 10,116 7,335 72.5 4,166 41.2
Family Status
Married, spouse present 102,836 20,614 20.0 6,612 6.4
Other family member 49,403 7,545 15.3 2,988 6.0
Not a family member 28,749 9,145 31.8 3,937 13.7
Lives alone 21,113 8,000 37.9 3,520 16.7
Program Participation
Received -
Cash assistance other than 10,037 4,594 45.8 2,342 23.3
SSI
SSI 3,473 2,683 77.3 1,674 48.2
Food Stamps 10,867 3,994 36.8 1,776 16.3
Medicaid Coverage 10,610 4,788 45.1 2,527 23.8
Public or subsidized housing 5,932 2,243 37.8 1,019 17.2
VA Payments 3,460 1,979 57.2 974 28.2
Social Security 32,832 18,543 56.5 9,051 27.6
Medicare Coverage 27,948 16,932 60.6 8,549 30.6
Monthly Household Income
Under $600 20,690 8,262 39.9 3,746 18.1
$600 to $1,199 27,866 8,944 32.1 3,731 13.4
$1,200 to $1,999 38,648 8,211 21.2 2,826 7.3
$2,000 to $2,999 40,999 6,249 15.2 1,804 4.4
$3,000 and over 52,784 5,639 10.7 1,430 2.7
Labor Force Status
Persons 15 to 64 years
In the labor force 114,745 11,624 10.1 1,750 1.5
Not in the labor force 39,820 10,215 25.7 4,247 10.7
Private Health Insurance Coverage
Persons 15 to 64 years
Covered 121,337 14,430 11.9 3,435 2.8
Not Covered 33,228 7,409 22.3 2,563 7.7
Persons 65 years and over
Covered 19,221 10,401 54.1 4,607 24.0
Not Covered 7,202 5,064 70.3 2,932 40.7
Educational Attainment
Persons 15 to 64 years
Not a high school graduate 41,614 9,764 23.5 3,332 8.0
High school graduate 112,951 12,075 10.7 2,666 2.4
Persons 65 years and over
Not a high school graduate 14,389 9,871 68.6 5,271 36.6
High school graduate 12,034 5,594 46.5 2,268 18.8
Source: U.S. Bureau of the Census, 1984 Survey of Income and Program
Participation, Current Populations Reports, Series P-70, No. 8,
Table C.
Table 4. Percent of Persons 15 Years Old and Over Who Needed Assistance from
Others with Everyday Activities, by Age and Selected Characteristics: 1986
** Highlights
A total of 4.4 percent of the U.S. population 15 years of age and older
needed assistance from other persons to perform one or more of these everyday
activities.
The greatest numbers needing assistance required help in doing housework (3.2
percent) or 72.7 percent of all persons requiring assistance from others.
The fewest number needed assistance in keeping track of bills and/or money
(1.6 percent).
Personal assistance requirements increased with age. Only 2.4 percent of the
population under the age of 65 required assistance in one or more of the
everyday activities. This increased to 16 percent for those in the 65 and
above age cohort. For those of advanced age these rates rose substantially.
Almost one quarter of persons 80-84 years old needed assistance while 45.4
percent of those 85 and over depended on others for assistance with these
everyday activities.
Females required more assistance than males, with 5.8 percent of the total
female population dependent on others for personal assistance, compared to
2.9 percent of males. This gender relationship held for all age categories
except for those 75 years and over where rates for women increased relative
to men. This reflects the higher average age of women than men in the 75 and
over cohort group.
While the need for assistance among all persons surveyed does not vary
greatly along racial lines, marked racial differences appear among those 65
years and over, where 22.7 percent of blacks and 19.2 percent of Hispanics
needed personal assistance, compared to 15.4 percent for whites.
Of particular significance is the correlation between living alone and the
need for assistance from others. This is especially true among those 65
years and over where over more than 20 percent of those living completely
alone required assistance from others.
** Explanatory Notes
Data presented in this table were collected as part of the 1986 Survey of
Income and Program Participation (SIPP) conducted by the U.S. Census Bureau.
The 1986 SIPP covered those non-institutionalized individuals 15 years of age
and over who, because of a health condition lasting more than three months,
required assistance from other persons in their everyday activities.
Activities determined to be essential to everyday living consist of: personal
care including dressing, eating, and hygiene; getting around outside the
household; doing light housework; preparing meals; and keeping track of bills
and/or money.
These figures differ from other surveys by limiting the respondents to those
requiring help from others with a specified set of activities necessary to
live independently in the community (personal assistance).
The disability measures in the 1986 SIPP are similar to two other frequently
used indicators of need for assistance - Activities of Daily Living (ADL) and
Instrumental Activities of Daily Living (IADL). ADL includes the basic tasks
of eating, toileting, continence, transferring (in and out of bed or chair),
dressing, and bathing; IADL goes beyond ADL in level of complexity and
includes handling personal finances, meal preparation, shopping, traveling,
doing housework, using the telephone, and taking medications.
Table 4. Percent of Persons 15 Years Old and Over Who Needed Assistance from
Others with Everyday Activities, by Age and Selected Characteristics: 1986
(numbers in thousands)
************ Needed Assistance With ************
Keeping
Track of
One or Getting Bills
More Personal Around Preparing Doing and/or
Total Activities Care Outside Meals Housework Money
Characteristic
Total 186,022 4.4 1.7 2.8 2.6 3.2 1.6
Age (years)
Under 65 158,359 2.4 0.9 1.3 1.5 1.8 0.7
65 and over 27,663 16.0 6.6 11.3 9.1 11.2 7.2
65 to 69 9,615 9.3 3.0 5.7 5.0 6.6 2.8
70 to 74 7,391 10.9 4.5 7.1 6.4 7.7 4.0
75 to 79 5,434 18.9 7.5 12.5 10.2 13.1 7.5
80 to 84 3,126 23.6 10.0 19.0 11.7 15.1 10.7
85 and over 2,097 45.4 23.2 37.7 30.5 34.4 32.1
Sex Male 88,958 2.9 1.4 1.8 1.6 1.6 1.3
Under 65 77,547 1.7 0.8 1.0 1.0 1.0 0.7
65 and over 11,411 11.0 5.4 7.5 5.9 5.8 5.0
65 to 69 4,316 7.0 3.3 4.7 3.8 3.7 2.8
70 to 74 3,208 8.8 3.6 5.2 4.9 4.1 3.6
75 and over 3,886 17.2 9.2 12.4 9.0 9.5 8.4
Female 97,064 5.8 2.0 3.7 3.5 4.6 2.0
Under 65 80,812 3.1 0.9 1.6 2.0 2.6 0.6
65 and over 16,252 19.4 7.5 14.0 11.3 15.1 8.7
65 to 69 5,298 11.1 2.7 6.4 6.0 9.0 2.9
70 to 74 4,183 12.6 5.3 8.6 7.5 10.4 4.4
75 and over 6,771 30.2 12.5 23.4 17.8 22.7 16.1
Ethnic
Group (1)
White 160,194 4.3 1.6 2.8 2.4 3.1 1.5
Under 65 135,172 2.2 0.8 1.3 1.3 1.7 0.6
65 and over 25,022 15.4 6.2 11.0 8.4 10.5 6.7
Black 20,845 5.7 2.7 3.3 4.1 4.4 2.6
Under 65 18,572 3.6 1.5 1.8 2.6 2.6 1.4
65 and over 2,273 22.7 12.0 15.6 16.6 19.5 13.1
Hispanic 12,823 3.4 1.4 1.9 2.4 2.3 1.1
origin (1)
Under 65 12,020 2.4 1.1 1.3 1.7 1.7 0.7
65 and over 803 19.2 6.5 11.6 11.7 11.8 6.5
Family Status
15 and over:
Family member 154,866 3.6 1.6 2.3 2.3 2.6 1.3
Lives with 104,636 3.2 1.3 2.0 2.0 2.4 0.9
spouse
Not a family 31,156 8.4 2.5 5.3 3.9 6.1 3.3
member
Lives alone 21,907 10.4 2.9 6.5 4.6 7.4 3.8
15 to 64 :
Family member 136,340 2.2 0.8 1.2 1.4 1.7 0.6
Lives with 89,505 2.1 0.7 1.1 1.4 1.7 0.4
spouse
Not a family 22,019 3.4 1.1 1.9 1.7 2.6 1.1
member
Lives alone 13,267 3.9 1.0 1.9 1.8 2.9 1.1
65 and over:
Family member 18,526 13.8 6.9 10.2 9.0 9.6 6.6
Lives with 15,132 10.1 4.9 7.0 6.0 6.5 3.9
spouse
Not a family 9,137 20.3 6.0 13.7 9.3 14.5 8.4
member
Lives alone 8,639 20.3 5.7 13.5 8.9 14.4 8.0
1 Persons of Hispanic origin may be of any race.
Source: U.S. Bureau of the Census, 1986 Survey of Income and Program
Participation, Current Population Reports, Series P-70,
Number 19, Tables A and B.
Table 5. Functional Status of the Non-Institutionalized Population Aged 55-64
and 65 Years and Over: Estimates of Persons with Activity of Daily Living
(ADL), Mobility and Instrumental Activity of Daily Living (IADL)
Difficulties: United States, 1987
** Highlights
A total of 3.6 million persons, or 12.9 percent of all persons in the
community 65 years and over, had difficulty with at least one Activity of
Daily Living (ADL) or mobility (walking). Nearly all of these persons (11.7
percent of all non-institutionalized elderly) had one or more of these
problems for longer than three months, and most (8.2 percent) needed the help
of other persons, either alone (3.5 percent) or in conjunction with assistive
devices (4.7 percent). ADL and mobility difficulties affecting the greatest
number of elderly were bathing (8.9 percent) and walking (7.7 percent).
These were followed by transferring between bed and chair (5.9 percent),
dressing (5.1 percent), toileting (excluding incontinence) (3.5 percent) and
feeding oneself (1.1 percent).
While each listed ADL difficulty required assistance from others in the
majority of cases, most persons with walking difficulty did not need personal
assistance, relying instead on assistive devices (3.6 percent) or functioning
entirely on their own (0.6 percent). However, nearly one-fifth of those with
walking difficulties (1.4 percent of all elderly in the community) could not
walk at all. As shown in Table 5C, ADL difficulties varied directly with
age. A total of 3.8 percent of all non-institutionalized persons in the
55-54 age group had difficulty with one or more ADL, a rate over three and
one-third times less than for the 65 and over age cohort.
Nearly 4.9 million persons aged 65 and over, or 17.5 percent of all elderly
persons in the community, had difficulty performing at least one Instrumental
Activity of Daily Living (IADL). Almost all of these persons (16.4 percent
of all non-institutionalized elderly) had difficulties which were long term,
having lasted for more than three months. Over half (9.4 percent) were
unable to perform the IADL at all, even with the assistance of other persons
or devices, and the overwhelming majority of the rest (6.8 percent) required
the assistance of other persons.
The most frequently occurring IADL difficulties for persons 65 years and over
were getting about the community (13.5 percent of all elderly), shopping
(11.0 percent) and doing light housework (10.1 percent). Use of the telephone
presented the least difficulty (4.4 percent). IADL difficulties and age are
strongly related, as shown in Table 5D. Among persons aged 55 to 64 years,
4.7 percent experienced difficulty with one or more IADL, a rate over three
and one-half times less than their counterparts 65 years and over.
As Table 5E shows, 19.5 percent of the elderly cohort had at least one ADL or
IADL, and 11.4 percent had at least one ADL (excluding mobility). Table 5B
shows that 17.5 percent had at least one IADL. Therefore, by computing the
differences, 8.1 percent had only an IADL limitation (19.5-11.4), and 2.1
percent only an ADL (19.5-17.5) (figure affected by rounding). Rates
increased for the very old, females, minorities and those living alone, in
the south and rural areas, and for Medicaid recipients and non-veterans.
** Explanatory Notes
These Tables come from Round 1, 1987 National Medical Expenditure Survey and
present estimates of the number of non-institutionalized persons 65 years and
over and 55-64 with difficulty performing Activities of Daily Living (ADL)
and Instrumental Activities of Daily Living (IADL). These estimates show the
particular ADL/IADL involved and whether the difficulty required assistance,
either from another person, a device or both. Activities of daily living are
those essential for self care and consist of bathing, dressing, feeding
oneself, toileting (excluding incontinence), and transferring between bed and
chair. Instrumental activities of daily living consist of household and
social tasks such as meals preparation, house cleaning, the handling of
money, shopping and getting around the community. Mobility is shown
separately because, unlike other ADLs, many persons are able to overcome
walking difficulties by using assistive devices (see introduction for ADL
issues).
Table 5A. Functional Status of the Non-Institutionalized Population
Aged 65 and Older: Estimates of Persons with ADL and Mobility Difficulties
as a Percent of the Total Population Aged 65 and Older, United States, 1987
(a)
Total Walking
Population or Bed/
Population Aged 65 at least Bath Chair Dress Toilet Feed Walk
Characteristic or Older one ADL -ing Xsfer -ing -ing -ing -ing
** Population with ADL and Walking Difficulties **
Number 27,909 3,601 2,492 1,635 1,437 975 316 2,152
(in thousands)
Percent 12.9 8.9 5.9 5.1 3.5 1.1 7.7
Percent of Total Population by Level of Difficulty and Dependence
Functioning 1.8 0.9 1.4 0.6 0.2 0.1* 0.6
without help (b)
Functioning
with help (b)
Equipment only 2.9 1.1 1.1 0.1* 0.9 0.0* 3.6
Personal assistance only 3.5 4.5 1.7 4.1 0.9 0.6 0.6
Both 4.7 2.4 1.2 0.3 1.0 0.1* 1.5
Unable to perform activity
with or without help (b) N/A N/A 0.5 N/A 0.5 0.3 1.4
Percent of Total Population by Duration of Problem
More than 3 months 11.7 0.8 5.1 4.5 3.0 0.9 6.8
More than 3 months and 1.6 0.8 1.3 0.5 0.2 0.1* 0.5
functioning without help
Table 5B. Functional Status of the Non-Institutionalized Population
Aged 65 and Older: Estimates of Persons with IADL Difficulties
as a Percent of the Total Population Aged 65 or Older, United States, 1987
Get-
(a) ting
Total At About Doing
Population least Use of Handl the Prepar Light
Population Aged 65 one Tele- -ing Shop- Com- -ing House-
Characteristic or Older IADL phone Money ping munity Meals work
Population with IADL and Walking Difficulties
Number 27,909 4,884 1,237 1,758 3,072 3,774 2,090 2,823
(in thousands)
Percent 17.5 4.4 6.3 11.0 13.5 7.5 10.1
Percent of Total Population by Level of Difficulty and Dependence
Difficulty but functioning 1.3 1.1 0.3 0.3 0.6 0.5 0.8
without help (b)
Functioning with help (b) 6.8 1.7 2.8 3.9 8.9 1.9 3.3
Unable to perform activity 9.4 1.6 3.2 6.8 4.0 5.1 6.0
with or without help (b)
Percent of Total Population by Duration of Problem
More than 3 months 16.4 4.1 5.9 10.2 12.5 6.7 9.0
(a) Persons with more than one difficulty are assigned to the category
representing the highest level of dependence.
(b) The levels indicate increasing dependence and are mutually exclusive.
* Relative standard effort is equal to or greater than 30 percent;
sample size is too small for a reliable estimate.
Source: Agency for Health Care Policy and Research, 1987 National Medical
Expenditure Survey, Research Findings 4.
Table 5C. Functional Status of the Non-Institutionalized Population
Aged 55-64: Estimates of Persons with ADL and Mobility Difficulties as a
Percent of the Total Population Aged 55-64, United States, 1987
(a)
Total Walking
Population or Bed/
Population Aged at least Bath Chair Dress Toilet Feed Walk
Characteristic 55-64 one ADL -ing Xsfer -ing -ing -ing -ing
** Population with ADL and Walking Difficulties **
Number 22,045 848 488 467 354 159 52 520
(in thousands)
Percent 3.8 2.2 2.1 1.6 0.7 0.2* 2.4
Percent of Total Population by Level of Difficulty and Dependence
Functioning 0.5 0.3 0.5 0.3* 0.0* 0.0* 0.3*
without help (b)
Functioning with help (b)
Equipment only 0.8 0.4* 0.4 0.0* 0.3* 0.0* 1.0
Personal assistance only 1.3 1.1 0.8 1.2 0.2* 0.2* 0.2*
Both 1.2 0.4 0.3* 0.1* 0.2* 0.0* 0.6
Unable to perform activity
with or without help (b) N/A N/A 0.1* N/A 0.1* 0.0* 0.3*
Percent of Total Population by Duration of Problem
More than 3 months 3.5 2.0 2.1 1.5 0.7 0.2* 2.3
More than 3 months and 0.3 0.3* 0.4 0.3* 0.0* 0.0* 0.3*
functioning without help
Table 5D. Functional Status of the Non-Institutionalized Population
Aged 55-64 and Older: Estimates of Persons with IADL Difficulties
as a Percent of the Total Population Aged 55-64, United States, 1987
Get-
(a) ting
Total At About Doing
Population least Use of Handl the Prepar Light
Population Aged one Tele- -ing Shop- Com- -ing House-
Characteristic 55-64 IADL phone Money ping munity Meals work
Population with IADL and Walking Difficulties
Number 22,045 1,033 155 210 511 644 333 664
(in thousands)
Percent 4.7 0.7 1.0 2.3 2.9 1.5 3.0
Percent of Total Population by Level of Difficulty and Dependence
Difficulty but functioning 0.6 0.2* 0.1* 0.0* 0.2* 0.2* 0.4
without help (b)
Functioning with help (b) 1.9 0.3 0.6 1.1 2.0 0.4 1.1
Unable to perform activity 2.2 0.2* 0.3* 1.2 0.7 0.9 1.5
with or without help (b)
Percent of Total Population by Duration of Problem
More than 3 months 4.4 0.7 1.0 2.2 2.8 1.4 2.8
(a) Persons with more than one difficulty are assigned to the category
representing the highest level of dependence.
(b) The levels indicate increasing dependence and are mutually exclusive.
* Relative standard effort is equal to or greater than 30 percent;
sample size is too small for a reliable estimate.
Source: Agency for Health Care Policy and Research, 1987 National
Medical Expenditure Survey, Research Findings 4.
Table 5E. Estimates of ADL/IADL Difficulties of the Non-Institutionalized
Population Aged 65 or Older by Selected Demographic Characteristics,
United States, 1987
Number of ADL Difficulties
(1)
Population At least one At least
Demographic aged 65 or older ADL or IADL one ADL
Characteristic (in thousands) Difficulty Difficulty 1 2 or 3 4 or more
**** Percent **** Percent Distribution
Total (a) 27,909 19.5 11.4 5.2 3.8 2.4
Age and Sex
Both Sexes
65-69 9,361 9.9 5.9 2.4 2.1 1.3
70-74 7,525 13.2 7.9 3.4 3.0 1.5
75-79 5,389 19.9 11.5 6.2 3.3 2.0
80-84 3,361 34.1 18.6 8.0 7.5 3.2
85 and older 2,274 56.8 34.5 15.6 9.7 9.2
Male
65-69 4,097 8.0 5.0 1.7 1.8 1.4
70-74 3,359 9.2 6.3 2.3 2.3 1.7
75-79 2,167 15.5 8.7 4.2 2.7* 1.8
80-84 1,175 29.5 17.4 7.4 6.6 3.4*
85 and older 743 51.5 26.3 13.0 9.2 4.1*
Female
65-69 5,264 11.3 6.5 2.9 2.4 1.3
70-74 4,165 16.5 9.2 4.3 3.5 1.3
75-79 3,222 22.9 13.3 7.6 3.7 2.0
80-84 2,186 36.6 19.3 8.3 7.9 3.1
85 and older 1,531 59.3 38.4 16.9 9.9 11.7
Ethnic/Racial Background
White 24,135 19.1 11.1 5.1 3.6 2.4
Black 2,327 26.3 15.5 6.0 6.4 3.2
Hispanic 863 14.1 7.8 3.7* 4.1* 0.0*
Living Arrangements
Alone 8,985 25.5 13.3 6.5 5.2 1.5
With spouse 12,744 13.1 7.9 3.5 2.4 1.9
only
With other 5,631 23.1 15.6 6.7 4.8 4.1
relatives
Insurance Status
Medicare only 4,721 22.9 12.5 5.9 4.1 2.4
Medicaid (b) 2,444 43.4 27.0 9.5 11.9 5.6
Private (b) 20,504 15.9 9.3 4.5 2.8 2.0
Veteran Status (Male)
Veteran 5,476 11.9 7.3 3.2 2.5 1.6
Other 6,064 17.5 10.0 4.1 3.6 2.3
Place of Residence
Largest SMSAs 7,452 16.5 9.4 3.9 3.3 2.2
Other SMSAs 13,106 19.1 11.1 5.2 3.6 2.3
Other 7,352 23.1 13.9 6.3 4.9 2.7
U.S. Census Region
Northeast 6,248 17.1 9.7 4.7 3.0 2.0
Midwest 6,958 18.5 10.5 4.7 3.7 2.1
South 9,577 21.9 13.0 5.5 4.7 2.9
West 5,126 19.1 11.5 5.7 3.6 2.2
(1) This column is the total of the three adjacent percentages;
unlike Table 5A-D, ADL measures in this table do not include mobility
(walking).
(a) Includes persons with other ethnic/racial background, unknown veteran
and insurance status, other living arrangements, and without insurance.
(b) Coverage in addition to Medicare and including CHAMPUS/CHAMPVA.
* Relative standard error is greater than or equal to 30 percent;
sample size is too small for a reliable estimate.
Source: Agency for Health Care Policy and Research, 1987 National Medical
Expenditures Survey, Research Findings 4.
Table 6.Activity of Daily Living (ADL) Disabilities among
Non-Institutionalized Persons Aged 65 and Over, by Survey and Type of
Activity: United States, Various Years
** Highlights
As an overall measure of difficulty, between 5.0 and 8.1 percent of the
elderly 65 years of age and over in the community received help with one or
more ADL from a list of five common activities.
Between 4.6 and 6.9 percent of the elderly required personal assistance
bathing, and between 2.9 and 4.4 percent of the elderly needed similar help
dressing.
Between 2.6 and 4.2 percent needed help transferring (in and out of bed or
chair), and between 2.4 and 3.4 percent needed help with toileting.
Between 0.7 and 2.5 percent needed help eating, which was the ADL limitation
with the lowest prevalence.
** Explanatory Notes
This table compares five different surveys according to five selected
Activity of Daily Living (ADL) measures for persons 65 years of age and over
living in the community. Activities of Daily Living consist of everyday
tasks performed for self care and independent living. ADL measures vary
considerably among surveys in terms of the particular list of activities
involved, the degree and duration of ADL difficulties, whether persons
require active human assistance or need the help of mechanical devices, how
long ago the survey was conducted, the sampling methodology, the method of
interviewing, and other factors influencing the survey results.
A major cause of disparity among ADL studies is that the more activities
there are on a particular survey's list, the larger will be the number of
persons responding positively to an ADL disability. For this reason the
table uses a selected list which is consistent across most of the studies and
represents a consensus among many in the disability statistics community on
appropriate criteria for assessing needs and determining benefits for long
term care.
To control for some of these differences, the table uses weighted estimates
for the five common activities of daily living. These ADLs cover those
needing help from other persons with bathing, dressing, transferring (in and
out of bed or chair), toileting (which does not include continence), and
eating. The table cannot control for many differences, however, including
the wording of particular survey questions and related items. For additional
information, consult the source article from which this table draws its data
and narrative explanation.
Table 6. Activity of Daily Living Disabilities Among the
Noninstitutionalized Elderly Aged 65 and Over by Survey and Type of Activity:
United States, Various Years
(In thousands)
1984 1987
1982 1984 Survey National
National National 1984 on Income Medical
Long-Term Long-Term Supplement and Program Expenditure
Care Survey Care Survey on Aging Participation Survey
Noninstitutionalized
Elderly Population/%
Aged 65 and Over
Total 25,440 26,481 26,268 26,422 27,909
Percent 100.0 100.0 100.0 100.0 100.0
Receives Help of
Another Person
One or More ADLs 1,992 2,062 1,318 1,538 2,250
7.8 7.8 5.0 5.8 (a) 8.1
Bathing 1,609 1,660 1,211 1,459 1,926
6.3 6.3 4.6 5.5 (b) 6.9
Dressing 1,072 1,063 771 b 1,228
4.2 4.0 2.9 4.4
Transferring* 1,072 1,072 675 699 977
4.2 4.0 2.6 2.6 3.5
Toileting 857 880 619 n.a. 670
3.4 3.3 2.4 2.4
Eating 624 618 183 b c
2.5 2.3 0.7
a Excludes toileting.
b Combines bathing, dressing, eating and personal hygiene in one question.
c Cell size too small for reliable estimate.
* In and out of bed or chair
Source: Wiener, Joshua M. and Hanley, Raymond J., "Measuring the
Activities of Daily Living among the Elderly: A Guide to National
Surveys," The Interagency Forum on Aging-Related Statistics,
October 1989, Table 1; This table also appears in Wiener, J. M.
et al., "Measuring the Activities of Daily Living: Comparisons
across National Surveys," Journal of Gerontology: SOCIAL SCIENCES,
Vol. 45, No. 6 (1990).
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