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Who Are the “Frail Elderly”? Ettinger and Beck developed a functional definition of the elderly based upon an older person’s physical ability to seek dental services. The categorization that they developed is threefold:
• The functionally independent older adult
• The frail older adult
• The functionally dependent older adult.
Another way to classify the frail elderly is to count the seniors who have one or more physical or mental disabilities. National surveys have tracked the numbers of older adults with disabilities, and although these numbers are helpful, they are also problematic. The concept of disability includes several dimensions of health and functioning, and several conceptual frameworks have been used to define this term. With this caveat in mind, more than half the population (52 percent) in 1994-95 reported having at least one disability. One-third had at least one severe disability. About 4.4 million older adults (14 percent) had difficulty in carrying out activities of daily living such as bathing, dressing, and eating, and 6.5 million (21 percent) reported difficulties with instrumental activities of daily living, which include preparing meals, shopping, managing money, using the telephone, doing housework, and taking medication. The percentages with disabilities increase sharply with age. The percentage of those age 80 or older having difficulty with activities of daily living is about double that of the 65 or older population. For purposes of the following discussion, older adults who face great dental access barriers due to physical limitations and functional dependence will be referred to as the “frail elderly.” This includes the medically compromised and homebound living in the community, as well as those institutionalized in nursing homes.
What Are Their Characteristics?
The frail elderly are predominantly female and over age 75. As early as age 65, females outnumber males by a ratio of 141:100. By age 85, this ratio increases to 237:100. Not surprisingly, many of the frail elderly are alone, having outlived spouses and sometimes their children. In addition to decreased social and financial resources, chronic diseases limit daily activities of the frail elderly. For some older adults, dependencies resulting from chronic illness are managed by a combination of family and/or professional services provided in their homes. Although homebound, these individuals maintain some level of independence. Strayer characterizes the homebound elderly as:
• Dependent in physical function.
• Cognitively impaired.
• Incontinent.
• Economically disadvantaged.
• Users of home services.
• Less likely to be living alone.
Chronic Condition %
Arthritis 56
Hypertension 34
Heart disease 25
Diabetes 11
Respiratory diseases 11
Stroke 9
Cancer 4