The Availability of Care for Late-Middle-Aged Adults With Chronic ...

Seven of the top 10 causes of disability in the United States in 2001 were the same for 21–64-year-olds and those older than 65 (Freedman et al., 2002). In 2000 approximately 20% of those aged 55–64 had activity limitations that were caused by chronic conditions (Pastor et al., 2002). This percentage rose to 26% among 65–74-year-olds and 45% among those 75 and older (Pastor et al.). The median age of detectable chronic disability is estimated to be 55 (Bruce & Fries, 2003). Clearly, functional limitation prior to retirement is a reality for many Americans.

Late middle age is a particularly vulnerable time for individuals needing help with ADLs or IADLs. This is true for three main reasons: members of the potential support group available to those in late middle age have many competing demands for their time; access to appropriate health insurance is often limited; and the safety net of federal and state services designed to provide nutrition and transportation to those in need is age-based, making most late-middle-aged people ineligible. Each of these reasons is examined in further detail next.

First, just as late-middle-aged adults with functional limitations at the time of the study were in a different stage of life compared with their older counterparts, so too were members of their social networks. While persons of late middle age were more likely to have a spouse present than older persons (U.S. Census Bureau, Public Information Office, 2001), that spouse was likely working-aged and participating in the labor force. Additionally, although middle-aged adults were more likely than older persons to have living parents, these parents may have been functionally limited themselves and unable to assist in the care of an adult child. Furthermore, children of those in late middle age were likely to be in a busy life stage themselves, limiting their ability to help functionally limited parents.