The emerging science of functional assessment: Our tool for outcomes analysis

Abstract

The need for medical rehabilitation is great and is growing. 1 Hoffman et al analyzed the 1987 National Medical Expenditure Survey 2 and showed that the relative risk of needing medical care or experiencing disability days because of a chronic condition increases with age. The risk for noninstitutionalized persons was 24.6% for ages 0 to 17 years, 35.1% for ages 18 to 44, 67.7% for ages 45 to 64, and 87.6% for ages 65 years and older. Use of health care services was dominated by persons with chronic conditions in terms of home care visits (96.1%), number of prescriptions (83.3 %), hospital days (79.9%), hospital admissions (68.6%), emergency room visits (55.1%), physician visits (66%), and visits to other health practitioners (70.3%). The picture was reinforced by the annual health care costs for noninstitutionalized persons in 1987. As expected, total costs increased with age, but in each age bracket, the costs for chronic conditions exceeded by far the costs for acute conditions. Looked at another way, of the population incurring health care costs, less than half (45.8%) had chronic conditions but they accounted for three fourths (76.1%) of the costs. Over the years, the proportion of the population with limitations in activity due to chronic health conditions and impairments has increased. Also, the elderly population has been increasing. However, the rate of disability for persons 65 years of age or older has remained constant. Thus, the increase in disability is because more people are surviving into old age. 3 Similarly, the proportion of disabled persons in the age range of 45 to 64 years has remained relatively constant. Before 1990 the rate of disability among persons under age 45 was constant, but since then, the proportion of persons under age 45 with disability has increased. Because 70% of the population is under age 45, these rate increases are significant. These changes may be due to increases in asthma and mental disorders, including attention deficit, retardation, and learning disabilities. Also, rates of orthopedic impairments and mental and nervous disorders have increased. Between 1990 and 1994 the number of children with disabilities increased by 1.5 million and the number of working-age adults with disabilities increased by 3.1 million. Of those presumably eligible, only 40% of children and 55% of adults were added to the public support rolls between