# Transcript

INTERVIEWER:

I would like to start by noting that when we at PRB write about ageing in the United States we often say that the elderly are leading longer and healthier lives, but the conclusion that you and your co-authors seem to have reached in your recent article in Medical Care, when I read it, said that continued improvements in elderly health should not be taken for granted. Can you explain more about that and tell us what your concerns are, given that what we think we’ve been seeing are improvements in elderly health?

DR JAY BHATTACHARYA:

We have been seeing improvements in elderly health and that’s part of the great news for people that are older today, and so for the last 30 years there’s been a very sharp, a sharp decline in the rates of severe disability, by which I mean, you know an inability to dress yourself or to bathe yourself, and so on.

Those rates have come way down in 30 years among the elderly population, and there are many reasons for that including improved, you know, improved technology, prevention of chronic diseases, improved technology to assist the elderly, and so on. The caveat in what my article focused on is that that same decline which we saw in the elderly population does not hold true in younger populations, in working age populations.

In working age populations, actually, you’ve seen increases in severe disability, and so that’s the reason why you might not expect this decline to continue forever. The set of people who are now in their fifties that have seen the increase in disability are going to be 65 in 10 or 15 years, in 15 years, and they’ll be more disabled than the people that are in their sixties now. So it’s not a given that the disability rates will continue to decline forever into the future. The gains have been substantial, and that’s wonderful. The question is can we sustain them in going forward?

INTERVIEWER:

Define what you mean by working age population.

DR JAY BHATTACHARYA:

Sure. So in this article we looked at people between age 30 and age 60. We also extended past that in other work to 65 and older, and that we confirmed the well-known finding in literature that there have been large declines in disability rates in the older populations.

INTERVIEWER:

What do you see as major differences, or what do you see as different kinds of disabilities in, let’s say, the younger part of working age population versus older?

DR JAY BHATTACHARYA:

So for the most part in my work I focused on severe disabilities so that we’ve used this, we meaning I and my colleagues, we’ve used the same definition of disability that people use for older populations. These disabilities are called activities of daily living limitations, you know the inability to bathe yourself, to dress yourself, and so on, and the goal of my work has been to look at how those rates of disability that are traditionally seen as pertaining mainly to the older population to the extent to which they also pertain in the younger population, and the results are what you’d expect. The rates of those kinds of severe disabilities are much lower in the younger population than in the older population, but those rates have been increasing very sharply over the last 20-30 years, say 25, 20 years, but not in the younger population.

INTERVIEWER:

And why do you think those rates are increasing?

DR JAY BHATTACHARYA:

So, let me tell you what I know, and then I’ll tell you what I don’t know. So one obvious idea about this is that disability doesn’t tend to happen to people who are free of, especially in younger populations, doesn’t happen to people who are free of other conditions, chronic conditions. It tends to happen to people who have other chronic diseases, you know, people who have diabetes, severe diabetes, people who have had strokes, people who have had Chronic Obstructive Pulmonary Disease, so one obvious hypothesis is to look to say okay, have the rates of those diseases in the younger populations gone up over time?

Another hypothesis is that among the people with those diseases have the rates of disability gone up? So you see the distinction, right, so that the rates of the diseases themselves could have gone up, or the rates of disability among the people who have these diseases could have gone up. The answer that I found in my work with my colleagues is that, in particular, the rise in obesity rates in this population has played a substantial role in fuelling the increase in disability rate, and obesity is associated with lots of other very severe chronic conditions – diabetes, hypertensions, and so on – and you know so that it’s not that obesity directly leads you to get this, but that it may cause other conditions that leads you, that then leads you to be more likely to become disabled. That explains about half of the rise.

The other half of the rise is that for some conditions, in particular for Chronic Obstructive Pulmonary Disease, the rates of disability have been going up, so compared to 20 years ago, if you take someone, a patient with Chronic Obstructive Pulmonary Disease, and you compare them with another patient today, that person with Chronic Obstructive Pulmonary Disease today is more likely to be disabled than the person 20 years ago, again using this definition of severe disability.

INTERVIEWER:

The pulmonary disease, COPD I guess is the acronym, is that mainly caused by smoking?

DR JAY BHATTACHARYA:

For the most part, yes. Now the rates of COPD have come down but the rates of the remaining COPD population disability have gone up by disability among the people who have COPD still. And actually, there’s an interesting twist which is that improvements in technology, improvements in medical care for people with chronic disease can actually lead to increasing disability rates among those populations so a set of people today who have diabetes, say, and if you, like, take 50 year olds, 50 year olds with diabetes today are more likely to be disabled than people, 50 year olds, 20 years ago, that’s a fact. People that are 50 years olds today with diabetes are more likely to be disabled than people who were 50 years old 20 years ago.

INTERVIEWER:

Who also had diabetes?

DR JAY BHATTACHARYA:

Who also had diabetes.

INTERVIEWER:

Twenty years ago?

DR JAY BHATTACHARYA:

Right. Now the reason, an ironic reason for that is that we’re much better at taking care of diabetics, so the set of people who have diabetes are more ill, right, though some of the patients with diabetes would have died off 20 years ago, and those people potentially are alive with disabilities today. So, you know, I’m not sure how to look at that. I mean, so in one sense is good news, in one sense it’s something that we really should be concerned about, you know how do you support populations like this?