What are the main risk factors for disability in old age and how can disability be prevented?

Summary

The issue

In the next twenty years, the European Union will gain 17 million people over age 65 – a 30% increase – and 5.5 million more people over age 80, a 39% increase. Disability in old age is frequent and not only lowers the quality of life of its victims, but strains society’s limited resources for assistance, care and rehabilitation. Prevention of disability in old age is therefore a matter of great humanitarian and economic concern.

Findings

Research on disability in old age has identified non-modifiable risk factors such as age, gender and genetics, and modifiable risk factors such as age-related diseases, impairments, functional limitations, poor coping strategies, sedentary lifestyles and other unhealthy behaviours, as well as social and environmental obstacles. Many of these stem from earlier phases of life and the prevalent socioeconomic conditions. This knowledge has allowed the development of successful techniques of preventing and reducing disability in old age. Disabling chronic illness, depressive mood, functional decline and sedentary lifestyles are among the most important prevention targets.

Much evidence shows that physical activity may ameliorate diseases, reduce depressive symptoms and prevent or delay functional limitations and disabilities in the elderly. Consistent results find that long-term physical activity leads to postponed disability and sustained independence, even for the chronically ill. Several studies conclude that telephone-based efforts to encourage participation in ongoing physical activity programmes, either alone or with groups, are effective in preventing disability. Other studies show the effectiveness of moderate centre-based exercise, group activities and targeting specific at-risk populations.

There are, however, gaps and conflicting findings on the relative importance of various risk factors and the best ways of intervening. The benefits of comprehensive geriatric assessments and in-home visits have been examined in numerous studies. The results are so far inconclusive, but recent controlled studies suggest that they are effective. Environmental risk factors have largely been neglected in earlier research, as have risk factors and prevention with respect to the oldest age groups. There is essentially no evidence on the costs and benefits for various old-age disability preventive strategies.

Policy considerations

Effective programmes for disability prevention and reduction, especially among the poor, are urgently needed. An important starting point for successful prevention is to use the available evidence to dispel the old myths that the risk of disease is a normal part of old age and not amenable to change, and that an old body cannot respond positively to lifestyle changes.

Diseases, particularly multiple chronic illnesses, are the main cause of old age disability. Interventions should therefore include their prevention and effective management, including self-management. The promotion of physically active lifestyles is among the most promising strategies.

Improved disability prevention will require a change in organizational priorities, restructuring of the symptom-driven health care system, and training for providers and clients to cooperate in collaborative care. Many interventions are most effective in concert with community resources and policies.

More specific policy recommendations are:

• to develop strategic preventive plans at national and community levels;
• to promote training in gerontology and geriatric medicine for relevant professional groups;
• to develop programmes to enable older people to cope with disability risk factors and manage chronic illnesses; and
• to create initiatives to stimulate research and development on old age disability.