Islamset - Disability and the quality of life

As the world's population ages, we are faced with important questions about how to ensure the highest quality of life possible for our increasing numbers of elderly. As Dr Darnton-Hil1 so correctly states, this involves economic, social, and disease-free well-being, or, regarding disease, at least the subjective perception of relative well-being.

The concept of pushing morbidity towards the years of "older" old age is becoming increasingly popular and producing good results with prevention programmes, regular check-ups, and the promotion of healthy lifestyles for the elderly. The success of such efforts, mainly in Western countries, can be seen in decreasing incidence and mortality rates for cardiovascular and cerebrovascular disease, for example. Unfortunately, the same cannot be said for all countries, especially those of Eastern Europe (including Russia and other formerly Soviet countries), where there have been increases of up to 63% in stroke mortality rates in the last 15 years. The reason for this dramatic rise is not yet known: it may be that changing lifestyle in this pan of the world is beginning to show its effect, but it could also be that health reporting is more efficient in these countries now than it was in the past.

At the beginning of this century, death was most often caused by infectious diseases, but by mid-century these were being replaced in the West by chronic diseases. At present, among persons 65 years and older, eight of the ten principal causes of death are related to chronic diseases: cardiovascular disease, malignant neoplasms, cerebrovascular disease, diabetes, arteriosclerosis, emphysema, cirrhosis and nephritis. The remaining principal causes of death are pneumonia and accidents (1).

As Dr Darnton-Hi11 mentions in his article, elderly individuals very often suffer from more than one disease at the same time. In a study done in the United States it was found that 49% of individuals 60 years of age and older who lived at home had two or more of the nine diseases stUdied; 23% had three or more, and 24% had four or more. Co-morbidity increased with age (2).

As the number of chronic diseases accumulates in individuals, they lose functional ability and this effects not only their own quality of 1ife but that of those caring for them as well. Stroke, which occurs more frequently in persons aged 65 years and over, can be a major cause of disability for individuals who were previously fully functional. As women are now a regular part of the workforce in most countries, and as keeping our disabled elderly at home seems the best way to maintain their quality of life, there is an evident need for community support programmes. We need strategies for protecting the quality of life of carers and their dependants. While it is true that health promotion for the elderly is producing good results, and that we can look forward to having a healthier older population in some countries in the

The principal carer of an elderly person who has suffered a stroke and returned home disabled from hospital is usually a woman (elderly spouse, daughter, or daughter-in-law), and the event is usually accompanied by a disruption in that person's lifestyle as well as the patient's, and indeed in the entire household. It is also apparent that the principal carer, in the long term, is subject to depression, stress and ill health. The carer's reduced well-being in its turn affects the person cared for, and in fact seems to cause depression in the patient (3).

At present, among persons 65 years and older; eight of the ten principal causes of death are related to chronic diseases.

coming years, the sad fact remains that with greater age comes a greater probability of disabling disease. Maintaining the quality of life of the disabled elderly and those who care for them should become one of the principal priorities in efforts to meet the needs of the world's growing elderly population.

Fried LP, Wallace RB. The complexity of chronic illness in the elderly: from clinic to community. In: Wallace RB, Woolson RF, eds. The epidemiologic study of the elderly New York, Oxford University Press, 1991.
Guralnik JM et al. Aging in the eighties. The prevalence of comorbidity and association with disability. In: Advance data, vital and health statistics, No.170. Hyattsville, MD, National Center for Health Statistics, 1989.
Gil del Real MT, Belza MJ, Kalache A. Disability in older age: the burden on the principal caregiver. (Forthcoming).