Using data from recent national disability surveys in Australia, Canada, France, the Netherlands, South Africa, and the United States, an international team of researchers coded indicators of several types of disability using the International Classification of Functioning, Disability, and Health. This article discusses the Disability Tabulations (DISTAB) project and presents and evaluates the estimates of the prevalence of visual impairments.

Objectives. We investigated the health, activity, and social participation of people aged 70 years or older with vision impairment, hearing loss, or both.Methods. We examined the 1994 Second Supplement on Aging to determine the health and activities of these 3 groups compared with those without sensory loss. We calculated odds ratios and classified variables according to the International Classification of Functioning, Disability and Health framework.Results. Older people with only hearing loss reported disparities in health, activities, and social roles; those with only vision impairment reported greater disparities; and those with both reported the greatest disparities.Conclusions. A hierarchical pattern emerged as impairments predicted consistent disparities in activities and social participation. This population's patterns of health and activities have public health implications.

We wish to applaud the authors of the editorial “Public Health and the Second 50 Years of Life” in the August 2002 issue of the Journal for highlighting the need to bring more attention to public health and aging.1 The Journal editors are to be congratulated, as well, for printing an article that uses the recent publication record of the Journal itself as evidence for the paucity of published public health research that includes older adults. Because public health is in large part responsible for the unprecedented gains in life expectancy seen in the past century,2 we hope that public health will enthusiastically take up the challenge of improving the health and quality of life of older adults. The authors also propose a conceptual framework for public health research in aging. One particularly valuable contribution of the proposed framework is the illustration (in Albert et al.’s Figure 1 ▶) of the authors’ statement “More than likely, some combination of true senescence and greater exposure to risk factors is likely to be responsible for the changes we consider ‘aging.’ ”1 This schematic is especially helpful for making the case for prevention efforts targeting older adults. However, we suggest that the proposed model would have even more usefulness if disability were portrayed not as an outcome, but as a complex process, like aging. The model would then avoid any suggestion that disability is a negative, undesirable end state and, by implication, a circumstance less amenable to public health intervention. This is particularly important because of the growing population of persons with disabilities who are not only aging, but aging with existing health disparities.3 For an expanded research role in public health and aging to take shape effectively, we believe that aging and disability need to be modeled together. FIGURE 1 —Interaction between the components of the International Classification of Functioning, Disability and Health. The authors state that disability is “typically defined as difficulty with household and personal self-maintenance activities severe enough to threaten independent living.”1 This overstates what is, in fact, only some convergence of agreement regarding what constitutes disability beyond the “activities of daily living” and “independence” (“instrumental activities of daily living”)4 used by the authors. In practice, we do not have uniform, standard definitions for disability.5 In May 2001, the World Health Organization completed a project spanning more than 20 years when it approved the International Classification of Functioning, Disability and Health (ICF)6 as a companion to the International Classification of Diseases (ICD). This classification includes a framework that, like the one proposed for aging, recognizes the interaction of multiple, complex processes (Figure 1 ▶). In this classification, disability is more accurately characterized as a nonlinear, multidimensional experience having implications for body function as well as abilities to perform various tasks, from meal preparation to toileting. The disability framework also includes the potential effect on a person’s ability to participate in social roles, that is, attending religious services, working, and being with friends and family. Clearly, the old men in the photograph published with the editorial are involved in social roles that are important to them, yet we do not know if any or all have “disabilities.” We do know they are having a good time. The ICF would allow public health research to map the environment and social participation, as well as function and morbidity. The ICF moreover shares the emphasis of Albert et al on the importance of the environmental and personal factors that can serve as barriers or facilitators for people with and without disabilities. Regardless of disability status, environmental barriers have the potential to rob older people of independence. Bathroom doors too narrow for a walker or wheelchair may be the sole factor forcing an older person from his or her home, independent of other functional issues. Curb cuts can allow both a person who uses a wheelchair and a young, vigorous mother manipulating a stroller to navigate a street. Cognitive decline may outweigh any number of mobility issues. Similarly, social environments that are welcoming or discouraging also serve as facilitators or barriers. An older person with a disability who is welcomed into a community aging program is more likely to participate. Demographic trends alone leave little doubt that public health research should attend to older people. We would assert that the research must involve all older people, including those with disabilities. To that end, public health must appreciate the nuances of “the second 50 years.” Our public health messages promoting increased exercise, better nutrition, and reduced smoking and drinking are of equal value to older people even after they have acquired a disability. Other efforts, such as interventions that target secondary conditions, may need to be tailored to the requirements of specific disabilities. Research that examines the social context of becoming older and research that examines the social context of acquiring a disability share common domains. These are all topics worthy of the prominence given to public health and aging in the recent editorial by Albert et al.

This paper has two objectives: 1) to provide an epidemiological analysis of the 1994 Health Interview Survey Second Supplement on Aging (SOA Il), 2) to present those findings within the theoretical framework of revisions of the international Classification of Impairments, Disabilities, and Handicaps (ICIDH 2). The 1994 Second Supplement on Aging, released in the fall of 1998, samples 8,767 community dwelling people over age 70. These data are population based. An analysis reveals that 18.1% of the non-institutionalized U. S. population over age 70 (3,652,626 individuals) report vision problems. Moreover, 8.6% of the population (1,724,277 individuals) report significant hearing and vision problems. Recent research in the U.S. indicates that the rates of disability may be declining among the elderly; these findings do no appear to support those estimated declines. The international Classification of Impairments, Disabilities, and Handicaps, initially published by WHO in 1980, has gone through considerable revisions. The ICIDH 2 embraces the complexity of disability. Findings from the SOA II suggests that older people reporting vision problems indicate higher rates of comorbidities and secondary conditions than people without vision problems. Moreover, people reporting compromised vision, report dramatically greater differences in activity limitations and greater participation restrictions. People reporting both hearing and vision problems indicate much greater rates of activity limitations and participation restrictions than people without vision and hearing problems.

Data from the Second Supplement on Aging (1994) were analyzed to evaluate the presence of selected medical conditions, performance of basic and instrumental activities of daily living, and participation in life situations in two groups of visually impaired elders (persons aged 70–74 and persons aged 85 years or older) and two other groups of elders in the same age groups who are not visually impaired. Results indicated that, for both age groups, visual impairment is a significant risk factor for additional medical conditions, activity limitations, and participation restrictions.

Increases in life expectancy in the United States are accompanied by concerns regarding the cumulative impact of chronic disease and impairments on the prevalence of disability and the health status and quality of life of the growing number of older adults (defined as persons aged > or =65 years). Although older adults are the focus of these surveillance summaries, persons aged 55-64 years have also been included, when data were available, as a comparison. One important public health goal for an aging society is to minimize the impact of chronic disease and impairments on the health status of older adults, maintain their ability to live independently, and improve their quality of life. This report examines three dimensions of health status: sensory impairments, activity limitations, and health-related quality of life among older adults.This report examines data regarding activity limitations and sensory impairments for 1994 and health-related quality of life for 1993-1997.The 1994 National Health Interview Survey (NHIS) Core, NHIS disability supplement (NHIS-D1), and the 1994 NHIS Second Supplement on Aging (SOA II) were used to estimate vision impairments, hearing loss, and activity limitation. Data from the Behavioral Risk Factor Surveillance System (BRFSS) for 1993 through 1997 were used to estimate two general measures of health-related quality of life: a) the prevalence of self-rated fair or poor general health and b) the number of days during the preceding 30 days when respondents reported their physical or mental health was "not good."Sensory impairments are common among older adults. Among adults aged > or =70 years, 18.1% reported vision impairments, 33.2% reported hearing impairments, and 8.6% reported both hearing and vision impairments. Although older adults who reported vision and hearing impairments reported more comorbidities than their non-hearing-impaired and nonvisually impaired peers, impaired adults with sensory loss were able to sustain valued social participation roles. Advancing age was associated with increased likelihood of difficulty in performing functional activities and instrumental and basic activities of daily living, regardless of race/ethnicity, sex, and region of residence in the United States. Unhealthy days (a continuous measure of population health-related quality of life) was consistent with self-rated health (a commonly used categorical measure) and useful in identifying subtle differences among sociodemographic groups of older adults. An important finding was that adults aged 55-64 years with low socioeconomic status (i.e., less than a high school education or an annual household income of <$15,000) reported substantially greater numbers of unhealthy days than their peers aged 65-74 years.Sensory impairments are common in adults aged > or =70 years, and prevalence of activity limitations among older adults is high and associated with advancing age. Health-related quality of life is less closely related to age, particularly when health-related quality of life includes aspects of mental health.

This article presents the demographic characteristics of a large group of older people who are blind, briefly reviews the literature on caregiving to aging persons, and presents the concerns reported by 47 family members who have a spouse or parent who is blind. Changes in the reported concerns were measured before and after blind rehabilitation services were provided to the older persons.

This article explains the process of strategic planning for organizations that facilitate independent living for older blind people in light of the complex, rapid changes that are occurring in this society. It describes two types of changes that take place in society and organizations, presents a model of the strategic planning process, and discusses the values that drive that process.

The first national survey of state blind rehabilitation units provides baseline data regarding independent living services for older and multiply disabled blind persons. The paper examines history and existing services, and defines policy and planning concerns. Ninety-one percent of 53 states and territories responded to the survey, and the article reveals directions for public policy.