During past few decades, social gerontologists have debated compression of morbidity thesis (Quadagno, 2002). This debate was initiated in 1980 James Fries, a physician teaching at Stanford University. In an article in New England Journal of Medicine, Fries (1980) argued that although there are limits to human expectancy, we could enhance quality of delaying onset of chronic and disabling diseases and conditions until last years, and perhaps months, of life. In short, period of morbidity could be compressed. The ideal is seen as a population in which norm is vigorous and vital physical, mental, and social health until a terminal collapse near end of life (Fries, 1997, p. 214). Recent data from National Long Term Care Survey (NLTCS) (http://nltcs.cds.duke.edu/) and other sources have borne out Fries's thesis. In NLTCS, trained interviewers asked large numbers of institutionalized and noninstitutionalized older adults about impairments in activities of daily living and instrumental activities of daffy living lasting longer than 90 days (Manton, Corder, & Stallard, 1997). In an analysis of most recent of these surveys, Manton and Gu (2001) reported that between 1982 and 1999 percentage of over-65 population with disabilities fell from 26.2 percent to 19.7 percent, a drop of about 2 percent a year; the decline was in 1990s than in 1980s (p. 6354). Although disability increased in African American older population during 1980s, disability fell by a percentage for blacks than for nonblacks between 1989 and 1999 (Manton & Gu, p. 6354). Other studies, using different methods and data sources, have confirmed a decline in percentage of over-65 population with disabilities (Wolf, 2001). It is comforting to think that we have entered an era of compressed morbidity. However, evidence suggests that such a conclusion would be premature. This column examines future of compression of morbidity thesis and its implications for social workers. CAUSES OF COMPRESSED MORBIDITY What explains decline in disability among older adults? Cutler (2001) identified several factors, including changes in health and socioeconomic status (SES), particularly higher education levels (often a proxy for SES). Fries and colleagues (1998) emphasized importance of changing behavior, noting that preventable factors such as smoking, poor diet, and a sedentary lifestyle are at root of most morbidity and mortality. In testimony before U.S. Senate Committee on Appropriations, Fries (2003) cited evidence that a program of vigorous exercise, even if begun in middle age, and weight control could delay onset of disability more than a decade. Education also seems to contribute to declining disability. Cutler (2001) noted that more-educated persons have up to a 50 percent lower disability rate than do less educated (p. 20). Increased access to education and expansion of white-collar jobs have thus contributed to reduction in disability (Cutler). This works in several ways. First, education brings a greater ability and willingness to pursue favorable lifestyles and health behavior (Wolf, 2001, p. 36). Second, education brings a sense of understanding of and control over one's environment, reducing feelings of powerlessness that can lead to morbidity and mortality. Third, and perhaps most important, higher education levels offer access to desirable jobs, which in turn offer a sense of security and control that can protect individuals from vicissitudes of (McEwen & Lasley, 2002). Behavioral interventions work for many individuals, but they do not address needs or realities of entire population. Smoking and other risky behavior, including unhealthy food choices, are often a form of self-medication--a response to environmental stressors, particularly poverty and inequality (Wilkinson, 1996, p. …
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May 20, 2014
Manpreet Singh Tiwana + 6
Open Access