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1301.0 - Year Book Australia, 2002  
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Contents >> Health >> Disability and long-term health conditions

DISABILITY AND LONG-TERM HEALTH CONDITIONS

This article discusses disability and long-term health conditions over time and for specific populations. Disability occurs when a person has an impairment such as loss of sight or is restricted in their activities or participation because of health condition(s). Government policy is designed to provide services to people who are restricted in the basic activities of daily living, referred to as core activities. Severity of disability is measured in terms of a person's ability to manage in these areas. These concepts are summarised below.

Core activities are:
Self care - bathing or showering, dressing, eating, using the toilet and managing incontinence
Mobility - moving around at home and away from home, getting into or out of a bed or chair; and using public transport
Communication - understanding and being understood by others: strangers, family and friends
Severity of disability:
Profound - a person is unable to perform a core activity task, or always needs assistance
Severe - a person sometimes needs assistance to perform a core activity task
Moderate - a person does not need assistance, but has difficulty performing a core activity task
Mild - a person has no difficulty performing a core activity task, but uses aids or equipment because of a disability


Disability and restriction rates
According to the 1998 Survey of Disability, Ageing and Carers, there has been a steady rise in the underlying disability rate since the first disability survey in 1981. After adjusting for changes between surveys and in the age distribution of the population, the disability rate increased from 15% in 1981 to 19% in 1998 (table 9.6). During the same period the proportion with a core activity restriction increased from 9% to 14%. After removing the effect of population ageing, there are a number of possible explanations for these increases, such as changes in attitude to, and increased diagnoses of, disability.

9.6 DISABILITY RATES - ADJUSTED(a), All Persons(b) by Selected Years - 1981 to 1998

Age-standardised rates
1981
1988
1993
1998
Disability status
%
%
%
%

MALES

Core activity restriction(c)
Severe/profound
3.2
3.4
3.5
4.9
Moderate
2.6
4.1
2.5
3.1
Mild
2.8
5.0
6.2
6.5
Total
8.6
12.5
12.2
14.5
Disability
15.0
16.8
18.1
19.9

FEMALES

Core activity restriction(c)
Severe/profound
4.6
5.4
5.1
6.1
Moderate
2.0
3.6
2.3
2.7
Mild
2.7
4.5
5.2
5.4
Total
9.3
13.4
12.6
14.2
15.6
Disability
14.2
16.2
16.3
17.6

PERSONS

Core activity restriction(c)
Severe/profound
3.9
4.4
4.4
5.5
Moderate
2.3
3.9
2.4
2.9
Mild
2.7
4.8
5.6
5.9
Total
8.9
13.1
12.4
14.3
Disability
14.6
16.5
17.2
18.8

(a) Only criteria common to the four collections have been used and data age-standardised to the estimated resident population for March 1998.
(b) Living in households or cared accommodation.
(c) Core activities comprise self care, mobility and communication.

Source: ABS 1998 Survey of Disability, Ageing and Carers.


In 1998 some 3.6 million people in Australia, living in households or cared accommodation, had a disability (19%), and a further 3.1 million had a long-term health condition but no disability (17%). The overall proportions of males and females with a disability were similar, and as expected the likelihood of having a disability increased with age. From birth to early adolescence boys had higher rates of disability (5% to 12%) than girls (3% to 7%). This reflected the higher incidence of birth disorders in boys and their higher prevalence of childhood conditions, such as asthma and intellectual disorders. At the other end of the age spectrum, for persons 85 years of age or more, men and women had the same rate of disability (84%). As there were more women than men in this age group, the number of women with a disability was substantially higher (132,100) than the number of men (58,200).

Having a disability may not interfere with a person's participation in normal daily activities. That will depend on the level of restriction associated with their particular disability. In 1998, a small proportion of the total population (6%) had a profound or severe restriction from their disability. Unlike the disability rate, which increased gradually over the lifespan, the likelihood of being profoundly or severely restricted remained relatively low (less than 9%) until about age 70. After this age it increased rapidly - from 14% for those aged 70-74, to 31% for those aged 80-84. From 85 years onwards almost two-thirds (65%) in this age group had a profound or severe restriction.
    Men and women had similar rates of profound or severe restrictions to age 70 years. However, thereafter greater proportions of women than men had these levels of restriction (graph 9.7). This may be because men are more likely to develop potentially fatal disorders (e.g. resulting in heart attack or stroke), with only the most robust surviving to advanced old age with lower rates of restriction. In 1998 the median age of death for men was 74.5. There were 107,900 women aged 85 and over (69%) who had a profound or severe restriction, compared with 38,600 men in this age group (56%). Of people in this age group, more than two-thirds (69%) were women.



    Restricting impairment groups

    All people with disabilities have been identified as having an impairment which restricts them in some aspect of everyday life. These impairments relate to specific functions or areas of the body or mind. The type and number of impairments and the level of restriction a person has determines the extent to which their everyday life is affected by their disabilities. For example, employment opportunities or participation in social activities may be reduced by having a higher level of restriction or more than one impairment.

    In 1998 those restricted by a physical impairment were the largest group and comprised 14% of all people (2.6 million). Some 6% (1.2 million) were restricted by a sensory impairment or by speech loss. Men had similar rates of sensory (including speech) and intellectual impairments (7% and 3% respectively) to women (6% and 2% respectively) (graph 9.8), but were more at risk than women of developing sensory impairments such as industrial deafness, and to have higher rates of intellectual disorders from birth. Intellectual disorders can also occur at varying times throughout the lifecycle and arise from many different types of conditions, such as brain damage through accident or injury, or senile dementia.





    Area of restriction

    Being able to easily move about at home or in the community, to communicate with others without difficulty, or to perform basic self care functions such as dressing, washing and eating, are all important elements of independent living. In 1998 some 2.4 million Australians living in households had a mobility restriction, and just over one million had a restriction in the area of self care. As expected, the likelihood of being restricted in one of these areas, or in communication, was greater for older people. For people aged 65 and over who were restricted by a physical impairment, 89% had a mobility restriction and 45% a self care restriction (table 9.9). Many people are restricted in more than one area.

    Of the small number of older people with an intellectual impairment (36,400), 96% had a mobility restriction and 71% a self care restriction. Many of those with a mobility restriction would have a need for supervision, for example people with dementia, rather than for actual physical assistance in walking or moving about.

    9.9 PERSONS WITH A DISABILITY(a), Restricting Impairment by Area of Restriction - 1998

    Physical
    Sensory and speech
    Intellectual
    Psychological
    Head injury, stroke
    or brain damage
    All with disability(b)
    Area of restriction
    %
    %
    %
    %
    %
    %

    0-64 YEARS

    Self care
    33.7
    26.5
    36.9
    44.3
    47.0
    27.1
    Mobility
    75.0
    52.2
    67.5
    81.6
    84.2
    65.0
    Communication
    7.3
    38.7
    39.2
    25.1
    22.7
    12.6
    Employment restriction
    71.6
    51.0
    52.5
    78.5
    78.5
    62.1
    Schooling restriction
    4.6
    13.6
    41.2
    15.5
    7.7
    9.6
    '000
    '000
    '000
    '000
    '000
    '000
    Persons aged 0-64 years
    1,649.8
    565.1
    346.8
    275.5
    159.7
    2,363.0

    65 YEARS AND OVER

    Self care
    45.2
    34.5
    70.9
    67.4
    68.2
    36.2
    Mobility
    89.2
    69.0
    95.9
    94.6
    93.1
    77.7
    Communication
    22.0
    59.5
    58.5
    42.2
    39.6
    29.3
    '000
    '000
    '000
    '000
    '000
    '000
    Persons aged 65 years and over
    795.3
    503.7
    36.4
    55.9
    82.9
    1,063.3

    (a) Living in households, excluding those in cared accommodation.
    (b) Total may be less than the sum of the components as persons may have more than one restriction.

    Source: Disability, Ageing and Carers, Disability and Long-Term Health Conditions, Australia, 1998 (4433.0).


    Persons aged 65 years and over

    Older people are more likely than younger people to have a long-term health condition and to have developed degenerative conditions as a consequence of ageing. In 1998, there were 993,300 men and 1,277,900 women aged 65 and over. Of these, 827,900 men (83%) of and 1,090,300 women (85%) had a long-term health condition (table 9.10). While some conditions affect both men and women at approximately the same rate, some are more gender specific. For example, a high proportion of both men and women in this age group had circulatory disorders (excluding heart disease) (43% and 47% respectively) but women were more likely to have arthritis (47%) than men (36%).

    The level of restriction varied between men and women. Women with a long-term health condition were more likely than men to have a profound or severe restriction (25% and 16% respectively). This may reflect the fact that women live longer than men and this allows for the development of chronic conditions. For example, just over a third (34%) of women with arthritis had a profound or severe restriction compared with 20% of men with this condition.


    9.10 SELECTED LONG-TERM HEALTH CONDITIONS FOR PERSONS AGED 65 YEARS AND OVER(a), By Disability Status - 1998

    Profound/severe
    restriction(b)
    Disability
    Condition only,
    no disability(c)
    Total with
    a condition
    Long-term health condition
    '000
    '000
    '000
    '000

    MALES

    Arthritis
    58.8
    216.3
    80.0
    296.2
    Other musculo-skeletal disorders
    33.7
    125.5
    37.5
    162.9
    Heart disease
    44.7
    138.5
    41.0
    179.5
    Other circulatory disorders
    79.6
    223.9
    134.2
    358.1
    Diabetes
    24.4
    62.3
    37.9
    100.3
    Males aged 65 years and over with a condition
    162.3
    537.5
    290.4
    827.9

    FEMALES

    Arthritis
    170.5
    373.2
    133.7
    506.8
    Other musculo-skeletal disorders
    91.9
    198.3
    46.9
    245.1
    Heart disease
    94.8
    160.7
    52.3
    213.0
    Other circulatory disorders
    149.3
    312.2
    204.8
    517.0
    Diabetes
    39.9
    70.3
    29.3
    99.6
    Females aged 65 years and over with a condition
    318.9
    687.7
    402.6
    1,090.3


    (a) Living in households or cared accommodation.
    (b) Persons with a disability who are unable to do, or sometimes or always require help or supervision with, one or more of the core activities of self care, mobility and communication.
    (c) Persons with a long-term health condition who do not have a disability.

    Source: ABS data available on request, 1998 Survey of Disability, Ageing and Carers 1998.


    Children aged 0 to 14 years

    Greater ill health is commonly associated with the ageing process. However, children are also at risk of having a disability or long-term health condition, due to accidents, environmental factors, or because they were born with a particular disorder. A number of health conditions occur more frequently in this age group and are of particular interest. These include asthma, attention deficit disorder/attention deficit and hyperactivity disorder (ADD/ADHD), intellectual and developmental disorders and hearing or speech loss. Of the 3.9 million children aged 0 to 14 years in 1998, just under one in seven had a long-term health condition (594,600 or 15%), with boys more likely to be affected (18%) than girls (13%).

    Asthma was the most common long-term health condition for this age group, affecting 312,000 children (8%). However, unlike other conditions, there was a lower level of restriction associated with this condition. Almost three-quarters (74%) of those with asthma had no disability.

    While the overall prevalence of these selected conditions was greater for boys than for girls, the difference between the sexes was particularly pronounced in the case of ADD/ADHD. Of children with a long-term health condition, more boys (13%) had this condition than girls (3%) (table 9.11). While ADD/ADHD only represents a small number of children overall, it is a condition which has been diagnosed more frequently during the last decade. It often causes difficulties in learning, which may potentially lead to more restricted education and employment opportunities, as well as problems in the home environment due to the behavioural aspects of the condition. Nearly half (49%) of children who had this condition had a profound or severe restriction and needed some form of assistance.

    9.11 SELECTED LONG-TERM HEALTH CONDITIONS FOR CHILDREN AGED 0-14 YEARS(a), By Disability Status - 1998

    Profound/severe core activity restriction(b)
    Disability
    Condition only,
    no disability(c)
    All children
    with a condition
    Proportion
    Long-term health condition
    '000
    '000
    '000
    '000
    %

    MALES

    Asthma
    21.6
    50.8
    124.4
    175.2
    49.4
    Intellectual/developmental
    27.5
    55.8
    n.p.
    56.4
    15.9
    Hearing/speech loss
    24.6
    43.6
    *6.1
    49.7
    14.0
    ADD/ADHD(d)
    21.2
    36.2
    10.4
    46.6
    13.1
    Total with these conditions
    77.8
    154.4
    137.3
    291.7
    82.3
    Boys aged 0 to 14 with a condition
    97.0
    192.7
    161.7
    354.4
    100.0

    FEMALES

    Asthma
    12.2
    30.1
    106.7
    136.8
    57.0
    Intellectual/developmental
    14.5
    24.6
    . .
    24.6
    10.2
    Hearing/speech loss
    9.8
    21.4
    *5.8
    27.2
    11.3
    ADD/ADHD(d)
    *4.9
    *6.9
    n.p.
    *7.2
    3.0
    Total with these conditions
    32.2
    69.2
    112.0
    181.2
    75.5
    Girls aged 0 to 14 with a condition
    46.9
    103.6
    136.6
    240.2
    100.0

    (a) Living in households.
    (b) Persons with a disability who are unable to do, or sometimes or always require help or supervision with, one or more of the core activities of self care, mobility and communication.
    (c) Children with a long-term health condition who do not have a disability.
    (d) Attention deficit disorder and attention deficit/hyperactivity disorder.

    Source: ABS data available on request, Survey of Disability, Ageing and Carers 1998.


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