Disability, impairment, handicap. They’re different. While old age is not a disability, the weakening of the body’s resources exacerbates the impact of debilitating trauma or chronic disease that is likely to accompany old age.
One third of disabled Americans are age 65 or older. The most common definition of disability is the inability to participate in socially expected activities. Disability among older people is measured by the ability for self-care. It represents any restriction on performance of or lack of ability (resulting from an impairment) to perform an activity in the manner or within the range considered normal for a person of the same age, culture, and education. Older people with disabilities also include those who acquired an impairment at birth, in childhood, or in middle age.
Impairment is any loss or abnormality of anatomic structure of physiological function at the organ level. When the degree of functional limitation is sufficient, the difficulty or inability to perform daily living activities leads to disability.
Handicap occurs at the societal level when conditions are imposed upon the person through disadvantageous social norms and policy that limit the individual’s fulfillment of expected social tasks.
National surveys report varying numbers of people with disabilities because the surveys have measured disability differently. Laws differ on whether a disability should be defined in terms of an impairment, limitation, or handicap. They reflect the objectives of the program rather than any general or coherent concept of disability. Among people age 64+, disability is often measured by limitations in such activities of daily living as eating, dressing, going outdoors, or shopping. For people of “working age” (18-64), disability is measured by the ability to work for pay and or keep house.
Legislation may provide opportunities for people with disabilities, e.g. The Americans with Disabilities Act (ADA), which requires access and freedom from discrimination.
Others compensate for the inability of people with disabilities to compete with able-bodied people in the market place by providing alternative financial support, e.g. the Social Security Act. Another group provides care for those unable to care for themselves, e.g. Developmental Disabilities Assistance and the Older Americans Act (OAA). Two laws compensate for injuries, regardless of the abilities of individuals to work for pay or to care for themselves, e.g. workers’ compensation and veterans’ service-related pensions.
From middle age onwards, women are more likely than men in the same age group to experience disabilities, a particular concern for women because, as they grow older, they are more likely to have a disability and less likely to have family resources to help them cope. But why, then, do women have higher rates of morbidity and disability but lower mortality than men? Those higher morbidity rates reflect not only physical differences between men and women but also social and psychological factors.
Women are more susceptible to chronic debilitating diseases than are men but are protected from acute lethal diseases by hormonal differences. It also appears that women are more likely to admit disability and to allow their behavior to be affected by health problems. The leading causes of disability among middle-aged and older women are arthritis, osteoporosis, and hypertension. Senility and vision and hearing impairments are also major causes of disability among older women.
The U.S. Census Bureau collects data for the National Health Interview Survey (NHIS). Estimates of the prevalence of disability among older people range from 1.3 million to 2.2 million. (NHIS) data indicate that twenty million Americans have an impairment that limits their activities. 56% are women. 15% of women over age 84 experience two or more limitations of daily activity.
Assumptions abound. The older the person with a disability is, the lower the service provider’s expectations for adaptation, decision-making, learning, rehabilitation, or an improved quality of life. Rehabilitation services for older persons are limited. Few mental health practitioners serve older people. “Care planners,” case managers and social workers may assume dependency on the part of their clients and that “family members” are somewhere in the picture.
Housing, transportation and personal care services are major issues for disabled persons. Paratransit is much more important to them than accessible public transportation. The assurance that they can remain in their homes, despite their disabilities or with increasing disabilities, removes many of the uncertainties of old age. Integration of services and housing can provide this assurance. Senior citizen housing complexes provide a ready market for efficient delivery of such services as in-home aides, physical therapy, congregate meals, case management, counseling, and transportation. Railings on both sides of every floor in senior housing, nursing homes, assisted living facilities, etc. are essential elements that may be ignored by planners.
Housing managers and social service providers should work together. As needs change, the level of service provided through the residence should change so that people do not have to change their residence to receive care.
As the number of older people increases, the need for in-home aides/care-givers will also increase. Steps should be taken (1) to upgrade this occupation (it is not a profession) and (2) to assure respect for clients’ rights. Training, job security and adequate pay are needed for the aides; client empowerment is needed by the service recipients. The disability rights movement has pioneered models for recipient control over the personal care provided by aides.
Until lately, the mostly-women who are expected to provide care have been uncertified and unorganized. A national movement is growing with the purpose of developing standards of care. Professional organizations are forming throughout the country to lobby on behalf of personal care providers, e.g. the Direct Care Alliance. A current and significant issue with which they are concerned is the need to maintain and improve Social Security for workers.
The disability rights movement and the aging network should recognize their common interests in behalf of people with disabilities. Mutual goals include consumer empowerment, an end to ageism, accessible services and housing, respect for the individuality and independence of people with disabilities. As the population of people with disabilities ages, even greater convergence is needed.
“Local Groups Serving People with Disabilities” is the title of a free handout available from the Berkeley Public Library. The two-page annotated list consists of information derived from the Library’s BIN. (Berkeley Information Network.) If you rely on the branch van for your library needs, request the persons staffing the van to bring you a copy next visit.
The responsibilities of the City of Berkeley's Disability Compliance Program are to oversee the City’s efforts to comply with all applicable federal, state and local laws and to ensure that people with disabilities have access to City programs and services. It is based in the Department of Public Works. Berkeley’s Disability Compliance Program and the Commission on Disability (COD) can be reached at: TEL: 510-981-6342; TTY: 981-6345; FAX: 981-6340. Email: email@example.com
There is some mutuality in the concerns and memberships of the COD and the Commission on Aging (COA). Berkeley’s nine-member COD is “Charged with actively promoting the total integration and participation of persons with disabilities into all areas of economic, political, and community life. Membership shall be made up primarily of persons who have disabilities.” At present, there are two COD vacancies, appointments of Councilmembers Capitelli (District 5) and Wozniak (District 8). The COD meets on the second Wednesday at 6:30 P.M. at the North Berkeley Senior Center, 1901 Hearst Avenue. It is, however, essential that one check the City online community calendar to verify.
Occasionally one hears or sees an inadvertent reference to the disabled commission or to the aging commission, e.g. a Planet article titled “Appointee removed from disabled commission.” (Karen Craig, a disabled senior citizen-member of the Berkeley Commission on Disability, who had served as chair, vice chair, and outreach subcommittee chair, had been removed from the Commission by District 1 Councilmember Maio, who had appointed her to it!)
The COA is charged with identifying the needs of the aging, creating awareness of these needs, and encouraging improved standards of services to the aging. Council shall appoint one of its members as liaison; I was unable to learn her/his name. At present, there is one COA vacancy, appointment of District 2 Councilmember Moore. The COA meets on the third Wednesday at 1:30 P.M. at the South Berkeley Senior Center, 2939 Ellis Street. It is, however, essential that one check the City online community calendar to verify.
On November 22, 2011 the Justice Department announced an agreement with Upshur County, Texas to improve access to all aspects of civic life for people with disabilities. The agreement was reached under Project Civic Access (PCA), the Department’s initiative to ensure that cities, towns and counties throughout the country comply with the Americans with Disabilities Act (ADA).
Older people who go to an emergency room in pain are less likely to get medication for it than younger people with similar levels of distress, a new analysis has found. A seven-year, nationwide study that included data on more than 88,000 emergency room found that 49 percent of patients age 75+ were given pain medication, compared with slightly more than 65 percent of those under age 75. Elderly people who were cognitively impaired or otherwise unable to report pain were not included in the analysis, so that does not explain the finding. [Annals of Emergency Medicine, Oct. 2011.]
The 12 members of the Congressional "supercommittee" could not find common ground to reduce the federal deficit. This means that $1.2 trillion in automatic cuts over 9 years will begin in 2013. Medicare cuts are included, but are limited to 2% reductions in the rate of increase in provider payment rates. Social Security and Medicaid are not affected. Cuts in such discretionary programs as the Older Americans Act, Senior Corps, Section 202 housing, and energy assistance could have a major impact on seniors in need.
Sixty-five year old Donald Berwick, M.D., Administrator of the Centers for Medicare and Medicaid Services and the first Medicare chief eligible to be enrolled in the program, has resigned effective December second. A pediatrician before becoming a Harvard professor, Berwick will be replaced by his principal deputy, sixty-year old Marilyn Tavenner, formerly Virginia’s top health care official, a nurse by training who has been at Medicare since early 2010. Forty-two GOP senators asked President Obama to withdraw his nomination of Berwick, whose three-part aim for the health care system includes providing a better overall experience for individual patients, improving the health of such population groups as seniors and African-Americans, and lowering costs through efficiency.
In a June 2011 Bellevue, Washington religious summit about end-of-life choice, the U.S. Conference of Catholic Bishops gathered to affirm its uncompromising opposition to aid in dying for the terminally ill. Their five-page document, To Live Each Day with Dignity, was a statement on physician-assisted suicide. Compassion & Choices released a statement, Dogma vs. Dignity; An Open Letter to the U.S. Conference of Catholic Bishops, to the media.
MARK YOUR CALENDAR: Be sure to confirm. Readers are welcome to share by email news of future events that may interest boomers, elders and seniors (define these any way you like!) Daytime, free, and Bay Area events preferred. firstname.lastname@example.org.
Monday, Nov. 28, 2011. 2 – 3:30 P.M. “Vigee-LeBrun: Woman Artist in an Age of Revolution” presentation by Brigit Urmson. Mastick Senior Center, 1155 Santa Clara Av., Alameda. 510-747-7506.
Monday, Nov. 28. 7 P.M. Book Club. Silas Marner by George Eliot. Kensington Library, 61 Arlington Ave. Free event. 510-524-3043. Each meeting starts with a poem selected and read by a member with a brief discussion following the reading. New members are always welcome.
Wednesday, Nov. 30. 12:15-1 P.M. Gamelan Music of Java and Bali. Performed by classes directed by Midiyanto and I Dewa Putu Berata, with Ben Brinner and Lisa Gold. UC,B Hertz Concert Hall. Free. 510-642-4864.
Friday, Dec. 2. 4:30 P.M. UCB COLLOQUIA IN THE MUSICOLOGIES. Morrison Hall. Holley Replogle-Wong (UC Berkeley) "Tempering the Singing Diva: Hollywood Film Sopranos and the 'Middlebrow Voice'". Free
Saturday, Dec. 3. Noon-1 P.M. UC,B University Chamber Orchestra. Hertz Concert Hall. Mozart "Overture to Don Giovanni" - Miriam Anderson, conductor. Stravinsky "Pulcinella Suite" - Garrett Wellenstein, conductor. Schubert "Symphony No. 5" - Melissa Panlasigui, conductor. Free. Event email contact: email@example.com
Monday, Dec. 5. 6:30 P.M. "Castoffs" Knitting Group. Kensington Library,
61 Arlington Ave. Free. 510-524-3043. An evening of knitting, show and tell and yarn exchange. All levels welcome. Some help will be provided.
Wednesday, Dec. 7. 12:15-1 P.M. Music for the holiday season. UC,B Music Department Noon concert. Hertz Concert Hall. University Chorus and Chamber Chorus
Matthew Oltman, guest director. Free. 510-642-4864.
Wednesday, Dec. 7. 6-8 P.M. Lawyer in the Library. Albany Library, 1247 Marin Av. Free. 510-526-3720.
Monday, Dec. 12. 12 Noon. Senior Center Lecture - J-Sei Center Center - 1710 Carleton Street, Berkeley "Fall Prevention" Speaker: Andrew Teran - Bay Area Vital Link. To place a reservation for the lecture and/or lunch at 11:30 A.M., call 510-883-1106.
Monday, Dec. 12. 7:00 P.M. Swedish Folk Music with Mark and Jennie Walstrom. Their instruments include the Swedish Säckpipa (bagpipe) and Nyckelharpa (key fiddle). Tonight’s music will center on the Swedish winter holidays. Kensington Library, 61Arlington Avenue Free. 510-524-3043.
Wednesday, Dec. 14 6:30-8 P.M. Drop-In Poetry Writing Workshop. Albany Library 1247 Marin Av. Free. 510-526-3720.
Wednesday, Dec. 14. 6:30 P.M. Berkeley Commission on Disability. Meets at North Berkeley Senior Center, 1901 Hearst Avenue. Check the City online community calendar to verify or call the Center, 510-981-5190.
Monday, Dec. 19. 7 P.M. Book Club. Josephine Tey’s Daughter of Time. Tey is known as the mystery writer for those who don’t like mysteries! Kensington Library, 61 Arlington Ave. Free event. 510-524-3043. Each meeting starts with a poem selected and read by a member with a brief discussion following the reading. New members are always welcome.
Wednesday, Dec. 21. 1:30 P.M. Berkeley Commission on Aging. Meets at South Berkeley Senior Center, 2939 Ellis Street. Check the City online community calendar to verify or call the Center, 510-981-5170.
Wednesday, Dec. 21. 7 – 8 P.M. The Adult Evening Book Group will read Water for Elephants by Sara Gruen. In his old age, Jacob Janowski reflects on the tragedy that forced him from his projected life as a veterinarian and his subsequent adventures with a circus traveling through Depression-era America. Rosalie Gonzales facilitates the discussion. Come to one meeting, or all meetings. Albany branch of the Alameda County library, 1247 Marin Av. Books are available at the Library. 510-526-3720 x 16.
Wednesday, Dec. 28. Great Books Discussion Group. Albany Library, 1247 Marin Av. Holiday lunch and selection discussion. 510-526-3720 x 16.