Disability Among Elderly Not Always A One-Way Street: Nearly One Third Regain Independence In Activities Of Daily Living

NEW HAVEN, Conn., Jan. 21, 1998--A sizable minority of disabled older people living in the community recover their ability to perform essential activities of daily living (ADLs), such as bathing, dressing and walking, over a two-year period, according to a new study by Yale University School of Medicine researchers.

Their study, published in the Journal of General Internal Medicine, refutes the popular perception that ADL disability invariably leads to further decline and increasing dependence. "There is a misperception among the lay public as well as the medical community about the ability of older persons to recover from disability, that once an older person becomes disabled and dependent, it means a ticket to the nursing home," says Thomas M. Gill, M.D., assistant professor of medicine (geriatrics) at the Yale University School of Medicine. "But our study showed that a substantial minority do regain their function."

The Yale researchers studied 213 residents of New Haven, Conn. All were 72 years of age or older and disabled in one or more of the ADLs, requiring help from another person to perform functions such as bathing, dressing, walking, eating, toileting or grooming. Participants were followed for up to two years to determine whether they recovered the ability to perform their ADLs independently. Nearly 30 percent of the people in the study regained their ADL independence. However, all participants were not equally likely to recover. The Yale team found that the strongest predictor of recovery was age: Participants aged 85 or younger were more than eight times as likely to regain independent ADL function than those aged 86 and older.

These findings are consistent with previous research. But this is the first community-based study that tried to identify the factors--besides age--that predict recovery from ADL disability. The group found that other than age, intact cognitive function (including memory), high mobility and good nutrition were each independently associated with ADL recovery. According to Dr. Gill, these factors may serve as markers of resiliency in the older population.

This study has some important implications. "It's a good news/bad news situation," says Dr. Gill. It offers hope to the "young old," those up to age 85, (and their caregivers) that once disabled, they will have a high likelihood of recovering independence in ADL function. Unfortunately, people older than 85 who become disabled are unlikely to regain their ability to function independently.

"This finding raises a red flag that the 'old old' group needs more aggressive treatment or rehabilitation," adds Dr. Gill. "It may be even better to target special preventive efforts to forestall the onset of ADL disability." Such strategies might include treating chronic medical conditions, preventing falls and increasing daily activity. Other interventions--to strengthen muscles, improve balance and gait, provide better nutrition and pay closer attention to medications--may also be in order.

The National Institute on Aging (NIA) has estimated that $15 billion is spent annually for long-term care for those not able to remain in the community because of disabilities in their ADLs. Even a small reduction in the number of people who lose ADL independence would translate into large health-care savings,

Dr. Gill points out. And this is particularly important because the number of Americans older than 85 could reach 15.3 million by 2050, a figure five times higher than that population group today.

"Disability in ADLs is a major public health problem for the aged population," says Dr. Gill. "But it is not a one-way street. Older people are moving in and out of disability. Our role is to first try to prevent people from becoming disabled and then to help them recover if preventive efforts are unsuccessful."

NOTE: Dr. Gill, also a Beeson Physician Faculty Scholar in Aging Research and a Robert Wood Johnson Generalist Physician Faculty Scholar, conducts research directed toward identifying factors that contribute to functional decline and disability among older persons and developing preventive strategies that will keep older persons healthy and at a high functional level. This research was funded, in part, by the Claude D. Pepper Older Americans Independence Center, one of 10 designated by the NIA, a component of the National Institutes of Health. Results were published in the journal's December issue.