Beyond survival: a life-course perspective on skeletal evidence of disease, disability and care

Palaeopathological evidence provides important insights into disease and impairment in past populations, but skeletal remains offer only a partial view of how these conditions affected people's lives. The Bioarchaeology of Care has advanced the study of disability by offering approaches to reconstruct caregiving and support, however survival and care alone reveal little about participation, autonomy, or how experiences changed over the life course. This paper proposes a life-course framework that extends the Bioarchaeology of Care by considering the interactions between impairment, functional limitations, resources, care and support, participation, and changing social and environmental circumstances. It emphasises that disability should not be understood as a fixed consequence of skeletal pathology or as synonymous with dependency. Comparative, multi-proxy approaches integrating osteological, isotopic, archaeological, funerary and documentary evidence can help investigate different life trajectories, including whether individuals with impairments experienced different childhood conditions, opportunities for participation or access to care. The framework also highlights the effects of selective survival, preservation and the limited visibility of disability in the archaeological record. Placing care within a broader life-course perspective provides a framework for investigating not only whether individuals survived and received support, but also how impairment interacted with biological and social circumstances throughout life.