Enhancing the Functional Status of the Future Elderly

Disability rates in older persons for both activities of daily living (ADL) and instrumental activities of daily living (IADL) have been falling steadily for more than two decades. Whether these declines will continue or reverse is a major concern of considerable debate as experts argue how the current epidemic of obesity and diabetes among baby boomers and younger cohorts will affect the functional abilities of these generations. Coming decades will likely bring significant technological advances, both medical and nonmedical, that will importantly impact the capacity for the elderly to function. With respect to medical technologies, numerous technologies—from smart prosthetics to distance monitoring devices—will enhance function and independence. However, these technologies are likely to be expensive, and national policies regarding the amount of cost to be absorbed by patients may place many of them out of reach for those in the lowest socioeconomic group, further widening the functional gap between the haves and the have-nots in our society. Nonmedical technologies, such as striking advances in computerization in the workplace and beyond, may either enhance the capacity of older persons to function or outstrip their capacity to adapt—thus aggravating the digital divide between generations. These nonmedical technologies also can enhance general functional status and independence, as can be seen in the increasing use of the Internet by older persons to pay bills, shop, and communicate with friends and family.