Ageing and Disabilities

Introduction[edit | edit source]

Old Man.jpeg

The global population aged 60 years or over numbered 962 million in 2017. The number of older persons is expected to double again by 2050, when it is projected to reach nearly 2.1 billion.[1] Ageing can be viewed as a societal accomplishment, but it also poses a challenge in terms of health care and continuing healthy functioning for this rapidly growing population. As a result, it's critical to ensure that these extra years are not only free of chronic disease or disability but also that mental and physical functionality is maintained. This will lessen the population's massive economic and social responsibilities. Nearly half of all healthcare spending occurs after the age of 65, according to estimates[2].

Successful aging can be defined as "adding life to the years.". There is a growing recognition among biomedical experts that the quality of life may be just as significant as the number of years added to life. While a specific definition of successful ageing has yet to be agreed upon, it is widely agreed that it comprises the freedom from chronic disease and the ability to operate well in old age, both physically and cognitively[2].

Ageing is a multifaceted phenomenon influenced by genetics, constitution, lifestyle, and environmental factors. There are distinct phases of growth in human life: there is a progressive increase in functioning (from infancy to adolescence), there is a type of plateau during adult life, and then there is a physiological drop in functioning as one becomes older. The pace, quantity, and quality of this decline are all influenced by genetic factors (approximately 25%), but they are mostly influenced by lifestyle and environmental factors (about 75%). A progressive reduction of functioning (related to genetics, constitutional variables and to lifestyles), together with negative environmental factors, could lead to diseases, disorders, functional limitations, and to disability.

Disability[edit | edit source]

Disability is viewed in a dynamic way and as a process, according to International Classification of Functioning, Health and Disability (ICF), World Health Organization, and other conceptual models of disability and approved by the United Convention of the Rights of the People with Disabilities According to this vision, disability is the consequence of the relationship of the person, with his/her health conditions, and the environment. There is also an international agreement in the view that “health and active ageing” is not without disorders or without diseases, but it refers to well-being from a biopsychosocial point of view: so it refers to well-being and quality of life, even in the presence of a disease or a disorder. From the more recent conceptual models of ageing and disability, the aim of each kind of intervention is to prevent pathological to reduce the risk of age-related health conditions and their consequences, to promote active and healthy ageing, and to prevent the change from usual to pathological ageing[3].

People with disabilities and people who are ageing with disabilities are on the rise all around the world. According to a report on disability published by the World Health Organization and the World Bank, roughly 15.3 per cent of people had disabilities in 2004 and about 15% of people had disabilities in 2010, with about 2-4 per cent of these persons with disabilities having severe functional difficulties. Age has a significant impact: the older you get, the more likely you are to become disabled. For these reasons, the relationship between ageing and disability has become extremely important, both in terms of its implications for ageing people's involvement, inclusion, and quality of life, as well as its implications for socio-sanitary organizations.

  1. Disability with ageing- which refers to ageing people that become people with a disability only during his/her ageing process, mainly due to age-related conditions.[3]


Consequences between ageing and disability[edit | edit source]

Three kinds of consequences between ageing and disability.

  1. Disability-related secondary conditions- People with disabilities are more likely to develop secondary conditions, either directly or indirectly (any additional physical or mental health conditions that may arise as a result of a primary disabling condition but are not a specific feature of it), which are similar to those that ageing people experience in general, but they occur 20-25 years earlier and are often referred to as premature or atypical[3].
  2. Age-related conditions—these conditions are related to ageing and the long-term consequences of exposure to environmental risks, as well as the effects of poor health behaviours—that may be experienced by ageing persons and also by ageing people with disabilities. Hypertension, high cholesterol, diabetes, osteoarthritis, heart disease, gait and mobility issues, falls, respiratory infections/chronic obstructive pulmonary disease, urine Urinary Incontinence, osteoporosis, skin disease, hearing and vision loss, and dementia are examples of these conditions[3].
  3. Multiple Chronic Conditions- the risk of having two or more chronic conditions at the same time, either in dyads (hypertension and diabetes) or in triads (cholesterol, hypertension, and diabetes).[3]

Anatomical and Physiological changes with Ageing[edit | edit source]

Muscle Strength[edit | edit source]

Muscle strength and Postural alignment plays an important role in an effective functioning in older adults. Loss of muscle strength has been documented in individuals as young as 50 to 59 years old. Reductions in muscle strength is closely associated with an increase in age. Normal changes in the ageing musculoskeletal system include reduced muscle mass, and loss of bone density and can be compounded by physical inactivity. After discontinuing resistance training for almost 2 weeks, more than 5% of the benefits gained are greatly diminished. On recommending the older adults to spend days or weeks exclusively on bed rest due to illness or injury, muscle strength swiftly declines, it is lost at approximately twice the rate it takes to regain it. Reduction in muscle mass leads to an increased rate of disability. For example, quadriceps strength is necessary to rise from a chair or toilet seat. At worst, reduced muscle strength leads to loss of function preventing an older adult from carrying out daily activities independently, assistance either in the home or a care center is warranted.[5]

Bones and Joints[edit | edit source]

More peripheral sites, such as the radius, experience relative stability in density until menopause, whereas the spine and neck of the femur show bone loss 5 to 10 years earlier. Intake of vitamin supplementation by men and women aged 65 years and older can reduce fracture risk and bone loss. Moreover, focusing on weight-bearing exercises can reduce bone loss and diminish the decrease of bone density commonly seen with advancing age. Wear and Tear on the joint are also associated with aging due to loss of joint fluid. Joint changes seem almost inevitable with advanced age in fact osteoarthritis is one of the conditions nearly all aged individuals experience. With ageing, the intervertebral discs lose water, flatten and undergo other deleterious changes. These changes leads to loss of disk height and compression of spinal column. Therefore, increased thoracic spine curvature leading to thoracic kyphosis commonly seen in elder individuals due to loss of height of spinal column.[5]

Psychomotor and Psychological functions[edit | edit source]

In general, there is a slowing in psychomotor performance in older adults, although difference in cognitive processing during the aging process are different among individuals on the basis of intelligence, health and years of formal education.

Examples of some of the commonly observed changes in cognition with aging are as follows:

1) Reduced choice reaction time

2) Increase in processing time for working memory for complex tasks

3) Fluid intelligence [5]

Behavioural risk factors[edit | edit source]

Physical and social exposures, including behaviors, during the life period, have a significant impact on disabilities that appear later in life, resulting in an accumulation of risks as one gets older.

The four main behavioral risk factors:

  1. Smoking,
  2. Excessive consumption of alcohol
  3. Poor diet
  4. Low levels of physical activity

Behavioral risk factors in midlife have been linked to good ageing and the primary prevention or delay of disability, according to research.[6]

Role of physiotherapist[edit | edit source]

By promoting health and well-being throughout ageing and preventing and treating body system impairments and secondary medical disorders, physiotherapist is uniquely positioned to provide age-appropriate anticipatory guidance, assessments, and interventions for individuals with disabilities. Post-secondary education, vocational training and the workplace, and independent/supported living all benefit from the use of supportive technologies and environmental adjustments.[2][7]

The following are examples of potential physiotherapist role:

  • Promote community, leisure, and health-related fitness activities.
  • Help prevent secondary conditions and promotion of wellness by providing anticipatory guidance beginning at the time of transition and continuing as needed.
  • Provide input and intervention for mobility, biomechanics (positioning), materials access, public transportation, assistive technology, and movement dysfunction.
  • Practice problem-solving skills with clients such as asking for help and instructing others to correctly and safely assist in performance of activities.
  • Assist with job development, job coaching, and job placement options through intervention assistance to improve personal management, job supports, or use of assistive technology to negate effects of any physical impairment on job performance.
  • Consider the need for assessment and consultation regarding how to live and work within the community rather than within a segregated setting.
  • Collaborate with other professionals (vocational, educational, adult living, medical, and other community-based agencies) to address barriers to functioning and ensure success.
  • Offer assessments and consultations at community centers.
  • Help prevent secondary conditions while promoting wellness

References[edit | edit source]

  1. United Nation World Population Ageing Available: 2.9.2022)
  2. 2.0 2.1 2.2 Britton A, Shipley M, Singh‐Manoux A, Marmot MG. Successful ageing: The contribution of early‐life and midlife risk factors. Journal of the American Geriatrics Society. 2008 Jun;56(6):1098-105
  3. 3.0 3.1 3.2 3.3 3.4 Pili R, Gaviano L, Pili L, Petretto DR. Ageing, disability, and spinal cord injury: some issues of analysis. Current gerontology and geriatrics research. 2018 Nov 19;2018.
  4. How To Define Aging With A Disability Available from Accessed on 28/9/2021
  5. 5.0 5.1 5.2 Prevention practice and health promotion, Catherine Rush, 2nd edition, 2014, slack incorporated
  6. Lafortune L, Martin S, Kelly S, Kuhn I, Remes O, Cowan A, Brayne C. Behavioural risk factors in mid-life associated with successful ageing, disability, dementia and frailty in later life: a rapid systematic review. PloS one. 2016 Feb 4;11(2):e0144405.
  7. Orlin MN, Cicirello NA, O'Donnell AE, Doty AK. The continuum of care for individuals with lifelong disabilities: role of the physical therapist. Physical Therapy. 2014 Jul 1;94(7):1043-53