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Preliminary findings from a groundbreaking new study of disabled older women show that the lives of some of these women are quite bleak: they live in isolation, challenged by enormous difficulty in performing everyday activities like walking or bathing. In sharp contrast, however, many more older women with functional problems are able to adapt, trying their best to stay out of nursing homes and to maintain a sense of independence. These findings are among the first to be reported from the Women's Health and Aging Study, one of the largest efforts to understand the causes and course of disability in older women.
According to the study, more than half of disabled older women, despite considerable physical limitations, venture beyond their neighborhoods for a variety of activities during the week, and about 60 percent report that they participate in some weekly exercise activity. Most continue to shop, walk up stairs, or prepare meals, but less frequently and often with some help. A surprising three-quarters of disabled older women say they are basically satisfied with their quality of life.
The study is being conducted by investigator Linda P. Fried, M.D., M.P.H., and colleagues at The Johns Hopkins University School of Medicine, Baltimore, Maryland, in collaboration with the National Institute on Aging (NIA). Started in 1991, the 7-year study is aimed at developing effective treatments and interventions for preventing or delaying disability. The initial findings, providing a snapshot of the lives of older women, appear in a new monograph published by the NIA's Epidemiology, Demography, and Biometry Program.
"This study is already challenging certain misconceptions about disabled older women," says Jack Guralnik, M.D., Ph.D., chief of NIA's Office of Epidemiology and Demography and project officer for the contract with Johns Hopkins. "In many women with moderate to severe disability, there appear to be great reserves and a view that life can be full and satisfying."
Overall, the initial findings highlight the "heterogeneity," or diversity, among the participants. Although the women are among the most disabled in the community, there are tremendous differences in abilities and in what disabled women are able to accomplish in a day, according to Guralnik and Fried.
The longitudinal nature of the study will allow researchers to understand what these and other baseline findings may mean for preventing and managing disability. "As the study proceeds," Guralnik says, "we will analyze diseases, functional problems, and attitudes to see what contributes to disability and what plays an important role in keeping the most devastating effects of disability at bay."
These efforts will be critical as older women make up an ever greater proportion of the elderly population. In 1995, women made up 59 percent of the population age 65 and older and 72 percent of the population age 85 and above. A higher proportion of older women are disabled than older men. "This, combined with women's longer life expectancy, leads to greater use of health care and long-term care services by older women. Reducing disability among older women will be a critical part of any efforts to contain health care costs for an aging population," says Guralnik.
The 1,002 Baltimore women participating in the study represent the one-third most disabled women age 65 and older living in the community. Women in Baltimore were evaluated for mobility, upper arm function, ability to conduct "instrumental" activities of daily living like shopping and preparing meals, and everyday activities of daily living such as bathing or dressing. Women with difficulty in two or more of these areas were classified as disabled and qualified for participation in the study.
Among women participating in the study, everyday tasks proved difficult. About 75 percent said they had trouble walking 2 or 3 blocks, 26 percent even found it hard to walk across a small room, 37 percent had problems using their fingers to grasp or handle small objects like coins, and about 12 percent said they had trouble turning a key in a lock. Eighty-five percent received at least some assistance from a family member, friend, or health professional.
The women had a myriad of physical problems. Medical tests given to the participants in their homes showed that 25 percent had reduced lung function, a third had major abnormalities on electrocardiograms, 24 percent had hip pain, and 20 percent had decreased blood flow to their legs. Nearly three-quarters of the women reported having some kind of arthritis, 20 percent had diabetes, and about 59 percent had high blood pressure.
Greater disability was found in women with less education and low incomes. Thirty-four percent of the participants reported incomes under $8,000 per year, while nearly 41 percent had less than a ninth grade education. About 25 percent of women in the study were married, 57 percent widowed, and the rest divorced, separated, or never married. Thirty percent of the participants were African American.
Guralnik and Fried noted with particular interest the attempts by disabled older women to preserve their energy and independence by doing things differently, less often, or adapting in some other way. In fact, Fried points out, many women with major physical difficulties just don't see themselves as disabled. For instance, although 48 percent of the participants indicated they had no trouble walking up 10 steps without resting, 37 percent of this group walked up stairs less often than before. In comparison, of the 39 percent who did report difficulty walking up steps, about 85 percent said they did it less often or differently. A small percentage -- about 12 percent -- had stopped using one or more rooms in their homes because of a health or physical problem, reducing the actual living space used by an average 30 percent to 40 percent.
"As long as they can get around, these women don't appear to view themselves as disabled. They are doing everything they can to stay in their homes and make do," Fried notes. "As we look at ways to reduce disability, we also hope to understand how people make successful adaptations to cope with the disabilities they do have."
The monograph evaluates baseline data in a number of areas. It includes analyses of health status, such as cardiovascular disease and diabetes, respiratory diseases, musculoskeletal disease, and neurological conditions. It also contains results from blood samples. In addition, data are presented on the general well-being of the women, including a look at mental health, emotional support, and use of health services and insurance, as well as a detailed look at their daily lives.
The NIA, part of the National Institutes of Health, leads the Federal effort supporting and conducting basic, clinical, and behavioral and social research on aging and the needs of older people and their families. The Women's Health and Aging Study is one of a number of projects nationwide, including research at the Claude D. Pepper Older American Independence Centers, to find ways to improve the functioning of older people and to promote independence and well-being.