The overwhelming majority of older adults in the U.S. (81.7%) are not disabled.   However, for some older adults, increasing age is accompanied by a decline in physical and mental abilities which may result in the ability to live independently and the need for some type of long-term care, either in the home or in a skilled nursing, personal care, or assisted living facility.  Although many older adults with severe physical and mental impairments frequently live in institutions, a substantial number live in the community and receive help from a variety of formal and informal sources.  The demand for services for the impaired older adult population is expected to increase dramatically in the next few years as baby boomers age.  In addition, the increasing number of adults who are overweight and obese is expected to result in higher levels of chronic disability in older adults due to the increase in weight-related conditions such as arthritis, diabetes, high blood pressure, and heart disease.  As a result, by the year 2040 when the baby boomers reach their 80s and 90s, the number of older Americans with long-term disabilities is estimated to number between 14.8 and 22.6 million.   Many of these older adults will live in the community and will be female, due to the fact that women live longer than men and are more likely to develop a chronic disability at all ages.

The following article uses information from the 2004 Southeastern Pennsylvania Household Health Survey to describe the functional limitations and access to formal and informal care of non-institutionalized women aged 65 and over in Southeastern Pennsylvania (SEPA).  Kunkel and Applebaum's disability categories  were used to differentiate between individuals with little or no, moderate, and severe disability.
 
Number and characteristics of non-institutionalized disabled women aged 65+ in SEPA

Of the approximately 314,000 non-institutionalized women aged 65 and over in SEPA, nearly one-quarter (23.2%, representing 73,000 women) are either moderately or severely disabled (Figure 1).  Within SEPA, the majority of moderately and severely disabled older women (51.5%; representing 37,600 women) live in Philadelphia.   Smaller, but substantial, numbers of older disabled women live in the suburbs:  11,200 (Montgomery), 10,000 (Delaware), 7,600 (Bucks), and 6,900 (Chester).

The risk of disability increases with age and for racial and ethnic minorities.  This pattern is seen in SEPA, where older moderately and severely disabled women living in the community are more likely to be age 85 or over (53.3%) and African American (34.4%) or Latino (36.5%) than women aged 65-74 (14.9%), 75-84 (25.9%) or white women (20.8%) (Figures 2 and 3).  However, the percentage of severely disabled older women living in the community does not increase greatly with age, rising from 3.7% at age 65-74 to 6.7% at age 75-84 and 85 and over.  This may be due to the fact that many severely disabled older women enter skilled nursing facilities.

Although a substantial number of moderately and severely disabled older women live in the community, a relatively large percentage do not receive any type of formal or informal help with their ADLs or IADLs.  Only one-third of moderately disabled older women (32.5%) receive any type of formal or informal help, and the majority of severely disabled older women (52.9%) receive no help (Figure 4).  Severely disabled older women are more likely to receive informal help with IADLs (51.3%), and formal home care services (28.3%), than moderately disabled older women (44.7% and 19.6%, respectively).  However, moderately disabled older women are more likely to receive informal help with ADLs (32.9%) than severely disabled older women (20.4%).  This is probably due to the greater use of formal home care services by severely disabled older women compared to the moderately disabled (28.3% versus 19.6%).  The unmet need for informal and formal help can only be expected to grow with the projected increase over the next twenty years in the number of disabled older adults.

Help obtaining housing, formal home care services, and supportive services for caregivers is available through each County's Area Agency on Aging.  Unfortunately, only one-quarter of moderately and severely disabled older women in SEPA (26.0% and 25.3%, respectively) have heard of the senior Helpline or referral line.  For more information on services available to disabled older adults and their caregivers, please contact:

Bucks County Area Agency on Aging  215-348-0510   
Chester County Area Agency on Aging  610-344-6350
Delaware County Area Agency on Aging  215-713-2100
Montgomery County Aging and Adult Services 610-278-3601
Philadelphia Corporation for Aging   215-765-9040

For more information regarding impaired older adults, please contact Lisa R. Kleiner at 215.985.2576 or lisa@phmc.org.