CDC Aims to Minimize Disability

Article excerpt

More than 54 million Americans-- over half of them age 65 or older-have at least one disability. According to a report from the Institute of Medicine, disabilities cost the United States $300 billion a year. John E. Crews, a health scientist for the Centers for Disease Control and Prevention (CDC) in Atlanta, emphasized that the number of older people facing disabling conditions is likely to rise with the aging of the U.S. population-even though recent research has shown that the rate of disability among those over 65 may be declining.

When the U.S. Department of Health and Human Services released Healthy People 2010, it was the first of these once-a-decade strategic planning documents for public health to contain a chapter on disability. The chapter states that the national goal for 2010 is to "promote the health of people with disabilities, prevent secondary conditions and eliminate disparities in the U.S. population." In particular, Crews noted, "data from Healthy People 2010 point to the complexity of aging and disability."

Crews, who conducts research on disability among older people at CDC's National Center on Birth Defects and Developmental Disabilities, explained that CDC is examining the many facets of disability among elders, guided by the objectives of Healthy People 2010. "A comprehensive response must go beyond showing the need for more rehabilitation services for those with disabilities but must expand into the public-health sphere," he said. To understand disability and secondary conditions among older people, he continued, CDC is examining wide-ranging issues on several fronts. Key among these are ways to increase the health-enhancing social participation of elders; improve the accessibility of health and wellness programs for them; and reduce depression, which compounds the effects of disabling conditions.

Also important, Crews noted, is eliminating environmental barriers that can, for example, impede mobility, limit healthy activity and even cause falls and injuries. Furthermore, CDC is working with state governments to develop statebased surveillance and health-promotion programs that can track rates of disability and begin taking action to minimize disability-related problems.

One important focus of CDC is sensory loss (see "Vision, Hearing Loss Get Overdue Attention" on page eight). CDC epidemiologists are especially concerned about elders with multiple disabling conditions, such as the 1.8 million older adults with both vision and hearing loss. CDC scientists also are trying to understand the causal relationship between obesity and disability in older people. A 2002 CDC study shows that 24% of Americans with disabilities who are 65 or older are obese, compared with 14% of those without disabling conditions.

In addition, CDC is concentrating on health protections for disabled older women. For example, a 1994-1995 CDC study of 11,400 women found that only 43% of older women with three or more functional limitations had received a mammogram over a two-year period, compared with 59% of disability-free older women. The findings were similar for Pap smears.

EXERCISE

CDC is particularly concerned with exercise. According to Crews, a growing body of research in the past decade has shown that exercise is one of the best medicines for older people who have or hope to forestall disabilities, even for people 85 and older. "There is no age limit on the benefits of exercise," said James Rimmer, director of the CDC-- funded National Center on Physical Activity and Disability (NCPAD) at the University of Illinois, Chicago. "Older adults with disabilities can greatly reduce their risk for secondary conditions by remaining-or becoming-physically active," he said.

Rimmer observed that less than onethird of older Americans, and an even smaller fraction of those with disabilities, exercise regularly. …