When I started my practice as an arthritis doctor, I hoped I'd be able to prevent disability. I even imagined that some of my patients would no longer need their canes, walkers or wheelchairs.
To some degree, it's happened. People with some types of arthritis are able to get back to a high or even normal level of functioning after treatment. Most people with canes, however, are stuck with them.
It might seem that modern medicine should be reducing the number of people with disabilities. In fact, the number of disabled persons is actually increasing. Here's why.
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The Aging Population
As our population grows and ages, there are more and more people with disabilities.
According to the Centers for Disease Control and Prevention, the number of people in the United States with disabilities increased from 44.1 million to 47.5 million between 1999 and 2009, representing about 20% of the population.
These numbers will likely increase as baby boomers reach their older years, especially if the population continues to increase.
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The Success of Modern Medicine
Oddly enough, modern medicine is another reason why there are more people with disabilities. Due to medical success stories, fewer people in this country are dying. For example:
- A recent analysis found that between 2002 and 2007 there were 23% fewer hospital admissions for heart attacks among Medicare recipients. This means nearly 90,000 fewer people were admitted to the hospital for heart attacks in 2007 than expected.
- Death rates from some of the most common types of cancer have gone down in recent years. Examples include prostate, breast and colon cancers.
- About 1 in every 18 deaths in the United States is due to stroke. But, over the last decade, the death rate has fallen nearly 45%. Between 1997 and 2007, the number of strokes in this country fell nearly 15%. Less smoking and other improvements in heart disease risk factors, as well as treatment (particularly clot-busting drugs), have improved the outlook for those at risk and for stroke survivors.
All of this is good. But some of these advances may actually contribute to an increasing prevalence of disability: People who used to die of these diseases are surviving. For example, surviving a stroke may come with an inability to walk, think clearly or care for oneself. Others survive these diseases in good shape but live long enough to develop other disabling problems, such as arthritis.
Longer life spans and better disease treatment means more opportunities for a variety of disabilities. And caring for these folks is costly. The cost of caring for disabled people and their lost productivity adds up to nearly $400 billion each year in the United States.
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Live Long and Live Well
While living a long life is a worthy goal (and doctors can do a lot to help!), we also should be concerned about helping people live well.
I believe it's less important to focus on how many years a person lives and more important to focus on "successful aging" instead.
Geriatricians — specialists in medical care for the elderly — are studying healthy and not-so-healthy elderly people to figure out why some people live to age 80, 90 or older with their mental and physical abilities intact and others do not.
Based on past studies (and common sense), it's likely that you can increase your chances of living a long, healthy life through a combination of:
- Good genes
- Good luck (such as avoiding some unpredictable injury or natural disaster)
- Good medical care
- Social connectedness (that is, having friends and family as social supports)
- A healthy lifestyle
Lifestyle changes can reduce the chances of becoming disabled. Two of the biggest changes are getting more exercise and not smoking. These steps could greatly reduce the incidence of diabetes, obesity, high blood pressure and high cholesterol. These conditions contribute to disabling conditions, such as cardiovascular disease, osteoporosis and arthritis.
Researchers are hard at work to figure out which, if any, vitamins or supplements can lower cancer and cardiovascular disease risk. Developing better screening tests to detect illness at a curable or reversible stage remain major priorities for researchers as well.
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The Bottom Line
It's one of the paradoxes of our times: The medical advances that help us to live longer and survive diseases that used to cut lives short may actually contribute to more, not less, disability over time.
An ever-growing number of people who are living longer, the aging of baby boomers and medical advances that keep people alive even in the face of serious illness are "conspiring" to increase the number of disabled persons.
But, rather than despair over the predicted increases in the number of disabled people (or lack of a falling number), I think we should celebrate medical progress and continue to support research regarding how to maintain function and quality of life well into advanced age.
Chen, J et al. "Recent declines in hospitalizations for acute myocardial infarction for Medicare fee-for-service beneficiaries: Progress and continuing challenges." Circulation. 2010; 121:1322-1328.
Eheman C et al. "Annual report to the nation on the status of cancer, 1975–2008, featuring cancers associated with excess weight and lack of sufficient physical activity. Cancer. Published Early Online: March 28, 2012.
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Robert H. Shmerling, M.D. is associate physician at Beth Israel Deaconess Medical Center and associate professor at Harvard Medical School. He has been a practicing rheumatologist for over 20 years at Beth Israel Deaconess Medical Center. He is an active teacher in the Internal Medicine Residency Program, serving as the Robinson Firm Chief. He is also a teacher in the Rheumatology Fellowship Program.