Does getting older mean becoming dependent and limited in everyday activities?

The aging of the population is a worldwide phenomenon, even though we can easily spot large differences between various regions (or even districts, which we can analyse in future posts), with strong effects on the demographic composition and age structure in the population. These changes cause other effects that have a great impact on labour market, politics, economy, family structure (as well as family relationships) and even the concept and experience of the old age itself.

As we already commented in a previous post, with these effects associated with demographic changes arose new voices against the old age that claim it to be excessive and dangerous for maintaining the welfare system. In order to respond to these criticisms it is important to know the situation in which seniors find themselves, with a series of erroneous beliefs, such as heterogeneity among elderly people. The ideas of heterogeneity that we apply to different groups lead to misconceptions, especially when they are based on few observations. I will give you a very simple example: one of my American friends assumes that everything I do or like is an accurate representation of everything that is being done or liked in Spain. So this person, unfortunately, believes that everybody loves a pineapple pizza. And as much as I tried to undeceive him, I think this battle is lost. But there are many more that are worth fighting for.

This is what I mean when I say that from one (or various) particular cases we can’t assume a generality.

Among the wrong ideas about the old age there is the assumption of interchangeability of the terms “old age” and “dependence”. It is an extension of opinions from the past on the fragility of elderliness. Furthermore, there is a tendency to assume that the majority of elderly people live as dependent, with disabilities or even believe that those two terms (dependence and disability) are interchangeable. This is why a quick reflection on these concepts will help us understand better the other topics that we will discuss later.

Are disability and dependence interchangeable terms?

According to the preamble of the UN Convention on the Rights of Persons with Disabilities (New York, 13th December 2016, approved and ratified by the Spanish state), “disability is an evolving concept and that disability results from the interaction between persons with impairments and attitudinal and environmental barriers that hinders their full and effective participation in society on an equal basis with others”. This definition brings us to an especially relevant concept that applies not only to those aged 65 or more, but also to every person with a disability. It also underlines the importance and effect that barriers have on the environment and the attitude - and attitude barriers sometimes turn out to be even deeper and more profound.

A person with disability is understood as “one that suffers from physical, mental, intellectual or sensory long-term impairments that during interactions with different barriers can prevent them from their full and effective participation in the society with equal conditions as the rest of its members”. I am fully aware that nowadays this definition (and designation) is under revision, but it is the one stated by the Spanish law (Royal Legislative Decree 1/2013 approving the Text of the General Law on the rights of persons with disabilities and their social integration). A person with a recognised disability degree superior to 33% is also considered disabled and for that they qualify for a disability pension: for permanent partial, total or absolute incapacity.

In the end people with disabilities form a heterogeneous sector of the population, but they all have in common the additional assurance that they receive to live with full rights or to participate in the economic, social and cultural activities under the same conditions as he rest of the citizens of their country. Undoubtedly, this is the responsibility that lies on the rest of us if we aspire to create an inclusive society.

The presence of a disability is being is assessed based on incapacity codes that include a total of 105 items (grouped in: osteoarticular; neuromuscular; visual; hearing; expressive; intellectual; mental; of internal organs and skin; mixed; and others), with the possibility for a person to suffer from more than one of them. But not all disabled people are dependent nor older than 65 years. Also not every disability are incapacitating or restrain a person’s self-sufficiency. This will be an important issue later on when we discuss the independent living of the elderly people.

Nowadays, according to IMSERSO, there are 2.998.639 people in Spain with a recognised disability. Out of them 50,21% (1.505.645 people) are women and 49,79% (1.492.946 people) are men (source: state database of people with disabilities, IMSERSO). If we analyse the age distribution among the total number of people with recognised disabilities degree superior to 33%, we can see that 56,84% of them are younger than 65 years, 25,80% are between 65 and 75 years old and 17,35% of them are aged 75 years and older.

As for the dependence, it means that a person needs help of others to carry out basic everyday activities (such as taking a shower, eating, dressing up, etc.). This loss of autonomy can happen due to a disability (or an accumulation of various disabilities) but might also result from an illness. In other words, not all people with disabilities find themselves in a dependent position. And not every person with a recognised dependency - there are three degrees (moderate, severe and heavy dependence) and severe disability - have the need to of continuous support or experience limitations and constraints in every aspect of their everyday life.

Returning to the connection between elderly people and dependence: is every senior person dependent? There is a problem with dependence data as some analysis are limited and we are interested in knowing who has to overcome barriers and limitations on a daily basis. That is why we will rephrase the question: is it true that majority of elderly people suffer from limitations in their everyday activities?

First of all we need to distinguish the age group, as a situation of a 66 year old and this of a 92 year old will not be the same. Data provided by the National Health Survey (ENS) states that 61,99% of people aged from 65 to 74 years do not suffer from any limitations (this number is higher in the case of men, 67,82%) and 32,08% suffer from not serious limitations. It is clear that these numbers decrease as the age increases and the presence of severely restricted people reaches its highest point in the group of those aged 85 years or more (27,2%). However, this data helps us understand that not every person aged 65 and over suffer from limitations in their everyday activities.

The advanced age is often associated with the functional dependence because a great part of people affected by disabilities can be encountered in the group of those aged 65 and over. Also this group shows more everyday life limited capacities, which we can see in the following table:

Table: EVERYDAY LIFE ACTIVITIES LIMITATIONS OF THE PAST 6 MONTHS. Spain, 2017.

Just because the majority of people with disabilities are elderly people doesn’t mean that the majority of seniors suffer from any kind of disability, nor that every disabled person is an elderly person, nor that those previous terms are interchangeable. Knowing the reality we can suggest necessary regulations and support essential to create an inclusive society that can effectively address the issues of dependency, disability and everyday life activities. Apart from that we will also be able to know that the reality of senior citizens in Spain is more complex than it is often assumed in various generalizations.