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DISABILITY AND LONG-TERM HEALTH CONDITIONS
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
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.
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
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.
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