Meeting Future Challenges of Disability in Aging Societies

In the early part of the 21 st century, societies around the world are beginning to feel the impact of the demographic anomaly which in the middle part of the 20 th century was called the Baby Boom. During the Baby Boom, the world population expanded exponentially. As a result, the population of people in the world today who are nearing retirement age is larger than any other single population group.

The demographic implications of this mean that an extraordinary number of people nearing the end stage of life will be a part of the population. Because of the natural correlation between aging and disability, most of those people will have at least a short-term disability before the end of their lives and more than half of them may actually have a long-term disability or chronic condition which lasts more than six months during some period before the end of their lives.

The impact of having millions more people with disabilities in society than we have ever had before is immeasurable. Certainly, the approach to caring for older people with disabilities will be forced to change radically in order to accommodate the large numbers anticipated. While many older persons with chronic conditions are now cared for in nursing homes and other sorts of institutions including boarding homes and assisted living facilities, the demand for assistance by older people with needs for care will soon exceed the capacity to provide such care using the current paradigm.

The only foreseeable solution to meeting the long-term care needs of persons with disabilities during the Baby Boom aging wave is to concentrate on the development of comprehensive, community-based provider systems, including home care, and congregate living schemes. Societies will be challenged with the need to develop infrastructures and means to support expanded care needs and demands. In addition to the economic infeasibility of meeting these needs in institutional settings, the practical barriers to doing so would be prohibitive, and the very wishes of the people to be served would be contradicted.

In the Western world, particularly in North America and Europe, and in parts of Asia and the Pacific, the Baby Boom generation has been responsible for extreme technological and social progress. People from this generation generally have been conditioned to be individually responsible for their actions and for any care which they or their families may need. In exchange for bearing these kinds of responsibilities, societies have granted individual members extraordinary autonomy and freedom to make decisions affecting their own lives.

People have become accustomed to asserting themselves within competitive democracies, and they have grown to expect having control over their own lives. This control extends to making decisions about where they live, how they are transported, whom they associate with, how they expend their personal resources, what they eat, and when they go to bed. In a future scenario organized to care for these individuals in institutional settings, they would have control over none of these decisions. Such a scenario would be unacceptable to them.

The new paradigm in long term care for people with disabilities and older adults with needs for daily assistance is that of widely available, reliable, community-based systems of care designed to enable people to live in their own homes and be as independent as possible.

The infrastructure required to facilitate such systems is not generally available and must be quickly developed. Further, for the most part, the economic means to support such systems have not been developed. Priorities must be set by governments to identify the means and build the infrastructures necessary to support the systems of service and care required to meet the impending needs of those people in the Baby Boom Generation.

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