Differential Trends in Disability Among Rich and Poor Adults in the United States and England From 2002 to 2016

Abstract

Objective Disability in the US has not improved in recent decades. Comparing temporal trends in disability prevalence across different income groups, both within and between the US and England, would inform public policy aimed at reducing disparities in disability. Methods Using the Health and Retirement Study (HRS) and the English Longitudinal Study of Ageing (ELSA), we estimated annual percent change from 2002 to 2016 in disability among community dwelling adults (197,021 person-years of observations). Disability was defined based on self-report of limitations with five instrumental activities of daily living (IADLs) and six activities of daily living (ADLs). We examined the trends by age and income quintile and adjusted for individual-level sociodemographic status and survey design. Results The adjusted annual percent change (AAPC) in disability prevalence declined significantly in both countries for ages 75 and older during 2002--2016. For ages 55-64 and 65-74, disability prevalence was unchanged in the US but declined in England. Both countries experienced a widening gap in disability between low- and high-income adults among the younger age groups. For example, for those ages 55-64 in each country, there was no significant improvement in disability for the low-income group but a significant improvement for the high-income group (AAPC=-3.60 95% CI [-6.57,-0.63] for the US; AAPC=-6.06 95% CI [-8.77,-3.35] for England). Discussion Improvements in disability were more widespread in England than in the US between 2002 and 2016. In both countries, the disparity in disability between low- and high-income adults widened for middle-aged adults. Policies targeted at preventing disability among low-income adults should be a priority in both countries.

Absence of Care Among Community-Living Older Persons with Dementia and Functional Limitations: A Cross-National Analysis of Population Survey from 22 Countries

“…The persistent gap in caregiving for PLWD experiencing functional limitations across countries may be attributed to global population aging, the increasing burden of chronic diseases, and a decreased availability of children to provide care for aging parents with dementia. 13,41,42 Furthermore, stigma related to functional limitations and dementia may discourage those affected from seeking care, which can further widen the gap in caregiving. 43 As a result, caregiving for PLWD with functional limitations becomes increasingly complex and challenging over time, highlighting the need for continuous and targeted efforts to improve care provision for this population in both developing and developed countries.…”

“…ADLs included six items: dressing, walking across a room, bathing, eating, getting in and out of bed, toileting; and IADLs included five items: preparing hot meals, shopping for groceries, making phone calls, taking medications, and managing money. 11,13 Each ADL/IADL item was similarly assessed in the HRS-family surveys. The participants were asked if they have any difficulty with each ADL/IADL because of a health or memory problem or not.…”

“…11,12 To the best of our knowledge, no studies have evaluated the patterns of care received by PLWD with functional limitations on a global or regional scale across multiple nations. 13 This lack of information is concerning, as assistance with functional limitations in daily living is crucial for those with dementia. The proportion of PLWD who have functional limitations but do not receive corresponding care is not well understood, and the absence of care may lead to avoidable hospitalization, early institutionalization, heightened mortality risk, increased societal healthcare costs, lowered quality of life.…”

Experiences of poverty amongst low‐income older adults living in a high‐income country: A qualitative study

“…However, living in poverty is more than having a lower-than-average household income, and it causes more deaths than hypertension, obesity and alcohol abuse (Stringhini et al, 2017). In older adults, poverty is linked to disability (Choi et al, 2022) and it can cause depression and anxiety (Ridley et al, 2020). Living in poverty negatively impacts cognitive and socioemotional processes commonly associated with healthy aging and it is considered a determining factor for social exclusion (Niedzwiedz et al, 2016) as it leads to inequalities and barriers to accessing public services (Price et al, 2018).…”

The Growing Gap of Unmet Need: Assessing the Demand for, and Supply of, Home-Based Support for Older Adults with Disabilities in 31 Countries

“…Low levels of physical functioning and elevated levels of disability are closely linked with various sociodemographic characteristics, health behaviors, and chronic diseases. Key factors associated with disability include older age (Lestari et al 2019), being female (Bloomberg et al 2021), lower levels of education (Gil-Salcedo et al 2022), lower socioeconomic status (Choi et al 2022), being widowed or single (Gil-Salcedo et al 2022), narrower social networks or lack of access to social capital (Portela et al 2020), sedentary lifestyles (Gil-Salcedo et al 2022), obesity (Ygnatios et al 2021), fatigue (Zaninotto et al 2020), smoking (Al Snih et al 2010), and having multiple chronic health conditions (Nobrega et al 2021). Despite these findings, there is a lack of multi-country comparative studies examining longitudinal trends in ADLs and IADLs.…”