A recent report reveals that chronic disability rates among the nation's elderly are falling at an accelerating pace. The report, published in the May 22 issue of the Proceedings of the National Academy of Sciences, details trends in chronic disability rates from 1982 to 1999 for patients age 65 and older. The report is based on data from the 1999 National Long-Term Care Survey. It cites a drop in the prevalence of chronic disability from 26.2 percent to 19.7 percent.
"I can tell you with 100 percent certainty that I have fewer disabled patients than I had 10 years ago," says Cheryl Lambing, M.D., assistant clinical professor of family medicine at the University of California-Los Angeles and a faculty member at the Ventura County Medical Center Family Practice Residency.
Lambing, an expert in musculoskeletal rheumatology, attributes disability declines to two major factors -- overall improved health and the increasing use of home health care or assisted-living facilities in lieu of traditional nursing homes.
Improved health care, immunizations, medications and sanitation have given people longer lives, she says. "Now that they're aged, how do we prevent them from being disabled? We make their environment safe. We treat all their comorbid conditions. You don't want an 80-year-old who's frail and disabled; you want an 80-year-old who's still getting around independently."
Medicine has made great strides in warding off disabilities, says Lambing. "In my waiting room 10 years ago, I had many patients who were disabled," she says. "They were disabled, for instance, with class 4 rheumatoid arthritis. They were wholly unable to take care of themselves. Many of them are in long-term facilities. Why is that? We didn't know how to treat them, and we weren't treating them effectively.
"We have new medicines now. We have a better understanding of the inflammatory process. It's the same thing in orthopedics: Instead of waiting until the last possible moment, we think about lavage, debridement, earlier joint replacement. If people are mobile, they probably report less disability."
The NAS report cites a growth in assisted-care living facilities, and Lambing says such facilities have proliferated in California. Many of her success stories involve patients living in an assisted-care residence or remaining at home with help from aides, who do everything from grocery shopping and meal preparation to in-home physical therapy. "The mind is a powerful thing," she says. "For many patients, going to the long-term care facility is essentially the kiss of death. Whereas, if you have the same patient who could be rehabbed at home and that patient is able to stay in the home environment and enjoy all their social interactions, that patient tends to do well."
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Lambing has seen that firsthand. "In my home, I have four generations," she says. "I have my grandmother, my parents, my husband and me, and my kids. My grandmother has osteoporosis; she's had fractures; she requires oxygen 24 hours a day; and she has macular degeneration, a very common cause of disability in older folks. So I can see it right under my own roof. She would do horribly in a nursing home. But at home, she has time with her great-grandchildren; she has a lot of help."
Lambing says the report is significant for primary care physicians because it spells out the benefits to society of preventing disability in the elderly. "By 2030, the largest segment of the population is going to be patients over the age of 65," Lambing says. "That's a huge group of patients, and we're the ones who are primarily going to be managing them. If we can keep them healthy for longer, we won't strap our medical resources."
Visit http://www.pnas.org/cgi/content/abstract/98/11/6354 to view a copy of the report.
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