The Cost of Disability in Older Women and Opportunities for Prevention

Although women's life expectancy exceeds that of men, older women bear a higher burden of morbidity and disability. The purposes of this study were to determine the association between physical disability and levels of health care use and costs in older women and to investigate several potential risk factors for the development of physical limitations that may be amenable to clinical and public health interventions. The study population was 1337 women aged 65 and older who were members of a large health maintenance organization and who agreed to participate in a randomized controlled trial of health promotion interventions. Level of physical function at baseline was measured by the number of reported restricted activity days during the past year and by a six-item physical function scale that determined ability to perform a range of functional tasks from vigorous activity to daily hygiene. Level of physical function at baseline and the trajectory of functional status during 1 year of follow-up were both major determinants of health care use and costs. Overall costs were 62% lower among older women who maintained high function compared to their counterparts whose functional status worsened. Risk factors for the development of physical limitations among those women with high function at baseline included low income, the number and severity of chronic diseases, number of alcoholic drinks at a sitting, lack of physical activity, lack of positive affect, and use of tranquilizers. These findings indicate that the onset and progression of disability in older women are costly and may be preventable. Randomized controlled trials are urgently needed to identify safe, effective, and affordable interventions to prevent disability in older women.