Long-Term Declines in Disability Among Older Men: Medical Care, Public Health, and Occupational Change

Functional disability (difficulty in walking , difficulty in bending, paralysis, blindness in at least one eye, and deafness in at least one ear) in the United States has fallen at an average annual rate of 0.6 percent among men age 50 to 74 from the early twentieth century to the early 1990s. Twenty-four to 41 percent of this decline is attributable to innovations in medical care, 37 percent to reduced chronic disease rates, and the remainder is unexplained. The portion due to reduced chronic disease rates can be subdivided into the 9 percent accounted for by reduced infectious disease rates (particularly rheumatic fever, malaria, typhoid, and acute respiratory infections), the 7 percent accounted for by occupational shifts away from manual labor and to white collar jobs, and the 21 percent that is unexplained.