Sunday, January 15, 2006

dependence

As a general rule older people maintain their independent living status and autonomous control over their lives as long as they are physically able to do so. For example, only a small proportion (probably not more than 7 percent or 8 percent according to statistics in the General Social Survey) of older people share homes with their children or people other than their spouse. Ten percent of the housebound and bed-ridden population over age 80 maintain a residence in the community rather than going to a nursing home.
Throughout life people successfully cope with and adapt to their circumstances, maintain their own homes, and do not depend on others. In age they do likewise, and extensive dependence on others is the exception, not the rule.
Yet it is also true that all individuals at some time in life rely on a social network for some measure of support, and age is no exception. Probably most people at some time have turned for help to parents, children, relatives, friends, churches, hospitals, nurses, physicians, and others, as well deriving support from the entire economic, political, and social community in which they live. In age this normal level of dependence may increase for individuals who become disabled.
Statistics show that there are approximately 22 million disabled persons in the United States, and that the elderly make up about 40 percent of this number, or approximately nine million persons. About 3.5 percent of those over 65 are severely disabled; and, although only about 5 percent of the population over 65 resides in a nursing home, the rate of nursing home residence rises to about 20 percent after age 85, when older people make up 85 percent of the population living in this type of facility. Not all nursing home residents are elderly however; young people with serious disabilities may also live in nursing homes.
Conditions that interfere with performance of major activities, such as going to work, keeping house, or performing an activity of daily living (known as ADL-dressing, bathing, feeding oneself, toileting, walking, and the like) are the most likely causes of dependency. Even though 39 percent of all people over 65 have a limitation in a major activity (most often due to heart or blood pressure problems), less than one million persons over age 65 living outside nursing homes need help with an activity of daily living.
Because most people feel constrained and frustrated when they must rely extensively on others for help, loss of independence can be a very difficult experience. Not only may an individual be unable to drive a car, go shopping, or get about the house, but performance of such routine self-care activities as bathing, cooking, shaving, and controlling bodily functions may require assistance. Irritability, depression, and withdrawal may accompany loss of independence.
Occasionally individuals lose their complete sense of competence when they become dependent on others. Researchers have proposed a way to reverse this condition by creating a' 'social reconstruction syndrome." The key to this form of therapy lies in providing environmental supports, which increase the individual's sense of competence.
Recently this therapeutic approach has been applied to families that have suddenly faced problems of increased dependency of an older member. By supplying various "inputs," such as help through respite care, family members as well as dependent individuals themselves can adjust to and deal with the problems caused by dependency. Older people who need help have sometimes been referred to as the frail elderly. Assistance provided to these individuals most commonly involves practical chores of daily living-shopping, doing errands, providing escort service and transportation, and managing of financial affairs. Yet, studies of the array of tasks performed for the frail elderly show that morale boosters, such as visiting, sitting and talking, keeping company, watching TV together, also represent important forms of support.
Most of the help provided to older people comes from a spouse or other close family members (according to Ethel Shanas, a leading gerontologist and co-editor of The Handbook of Aging and the Social Sciences, family members provide about 80 percent of all such assistance), and is given willingly, even under conditions of considerable stress. For frail people the amount of time of help in hours per week may range up to: 35 hours by spouses; 18 hours by children; five hours by relatives. From all sources together for all dependent people, the average time of help provided is about 11 hours per week. These data show that though dependency is fairly common in late life, it is by no means universal nor is it usually disdained by family members as too burdensome. It is the family and, surprisingly, disabled individuals themselves who are the first line of support in cases of dependency.
For additional information write or call:

National Council on Aging
409 3rd St. SW 2nd floor
Washington, DC 20024
(202) 479-1200

Administration on Aging
Dept. of Health, Education and Welfare
Washington, DC 20402
(202) 619-0724

Cantor, M., and Little, V. "Aging and Social Care," in Binstock, R. H., and Shanas, E., eds. Handbook of Aging and the Social Sciences, 2nd ed. New York: Van Nostrand Reinhold Co., 1985.
Crichton, J. Age Care Sourcebook. New York: Simon & Schuster, Inc., 1987
Kemp, B. "Rehabilitation and the Older Adult," in Birren, J. E., and Schaie, K. W., eds. Handbook of the Psychology of Aging, 2nd ed. New York: Van Nostrand Reinhold Co., 1985. Lester, A. D., and Lester, J. L. Understanding Aging Parents. Philadelphia: The Westminster Press, 1980.
National Center for Health Statistics, Dawson, D. A., and Adams, P. F. Current Estimates from the National Health Interview Survey; United States, 1986. Vital and Health Statistics. DHHS Pub. No. (PHS) 87-1592. Series 10, No. 164. Public Health Service. Washington, D.C.: U.S. Government Printing Office, 1987.

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