Living at Home with a Chronic Condition

Consider these facts.

By the year 2030, 20% of all U.S. residents will be over age 65. At that time, 32 states will have populations that look like Florida today. Census, 2000

Thirteen percent of homeowners age 62 and older (2.5 million) need help with Activities of Daily Living (ADLs) or Instrumental Activities of Daily Living (IADLs). Sixteen percent have difficulty with these everyday activities, but can still do them on their own. National Council on Aging, 2005

More than two-thirds of all older people who need help with everyday tasks live at home, including more than 70% of those with Alzheimer’s disease. U.S. Dept. Health and Human Services 2003, Alzheimer’s Association 2005

Level of Impairment

A chronic health condition can limit a person’s ability to age in place. Impairments can result from everyday aches and pains due to arthritis, to serious and progressive health problems such as diabetes or Alzheimer’s disease. Medication interactions and side effects, along with sudden events such as a fall or a stroke, can also lead to loss of function and mobility.

Active life expectancy

Americans are living longer, but not all those extra years will be spent in good health. The life expectancy of a 70-year-old with no functional impairment is about 14 years. Healthy elders can expect to be active (with no impairments) for almost 9 of those remaining years. People age 70 who are in poor health can expect to live another 10 years, but only 2 of those years will likely be without some impairment that could make it hard to continue to live at home.

Changes in physical ability

ADLs (Activities of Daily Living) and IADLs (Instrumental ADLs) are important measures of functionality. They reflect a person’s ability to manage their environment and perform self-care.

  • IADLs—Limitations with activities such as shopping, cleaning, cooking, using the telephone, and money management. These can often be accomplished with intermittent help. Difficulty with household activities is often a sign that the elder is becoming frail and will need more help in the future.
  • ADLs—Limitations that require daily attention for aging in place. These include feeding oneself, bathing, dressing, transferring from a bed to chair, and using the bathroom safely.

The greater number of ADLs/IADLs, the more you will need support services. Medicaid and private long-term care insurance typically use ADLs to define losses in ability that may qualify a person for benefits. People who are unable to perform two or more ADLs without help are regarded as having a severe impairment and usually qualify for benefits.

Changes in cognitive ability

About 10% of Americans over age 65, and up to half of those over age 85, have some form of dementia. Among elders with dementia, most have Alzheimer’s disease. Many other health problems can also mimic dementia. People with Alzheimer’s disease typically live for 8 years, and may live for up to 20 years, after the onset of symptoms. They may need supervision and cueing to make sure that everyday activities are done appropriately.