Is the prospect of falling over at The Changing Dynamics of Aging with Polio home or on the street something you would enjoy, just to make Margaret L. Campbell, PhD, California State University-LosAngeles your ego happy? Does being ambulant give you and those that "Aging with polio" refers to two early 1980s, their primary focus you love and care for, more or interrelated phenomena. On a less independence? has been on the cluster of new macro level, it refers to dramatic polio-related symptoms (e.g ., The answers to these questions improvements in life expectancy, fatigue, muscle or joint pain, cold need to be carefully thought which are part of the "longevity sensitivity, etc.), impairments through. If the answer is "less revolution" that is simultaneously (muscle weakness), and functional independence, " you should con- altering the landscape of aging losses known as "post-polio syn- sider a life that includes some time and disability (Jones et al., 1997; drome" or PPS (Halstead & in a wheelchair. Seelman & Sweeney, 1995). Grimby, 1995). But the health Some of the things to consider Thanks to recent advances in risks of aging with polio are not are : medical rehabilitation, emergency limited to changes in symptoms medicine, and consumer educa- and/or declines in function. Living - Can you rise from a chair easily tion, for the first time in history with the long-term effects of polio without assistance? persons with significant disabili- also places survivors at potentially - Can you use a street crossing ties, like their nondisabled counter- increased risk for age-related without fear of falling over? parts before them, are surviving chronic diseases and health condi- - Can you get more than halfway long enough to experience both tions, such as diabetes, high blood across a set of traffic lights before the rewards and challenges of pressure, heart disease, emphy- the DON'T WALK sign stops mid- to later-life (Ansello & Eustis, sema or COPD, osteoporosis, flashing? 1992). No where are the chang- and obesity, to name just a few - Can you climb a small flight of ing demographics of disability (Maynard et al., 1991). While steps which has no handrail? more evident than for persons these conditions affect the rest of aging with the long-term effects the aging population, they may - Can you climb a larger flight of of polio. Estimates from the most occur more frequently, and at steps without feeling exhausted? recent National Health Interview younger ages, for persons with - Can you easily catch a bus or Survey indicate that there are physical disabilities because of train? Can you easily get in and between 430,000 and 1,000,000 their "narrower" margin of health out of a car? Do you feel safe in polio survivors alive today in the and the barriers they face in main- the shower or bath? USA, and more than half of these taining their health (DeJong, 1995; This is not a definitive list, but a individuals are 55 years of age or Marge, 1988; Pope & Tarlov, 1991). starting point. older (NHIS, 1994-95). The significance of both post- To conclude, this question of The changing dynamics of polio polio syndrome and early onset when to stop walking shows that have not come without their age-related chronic diseases lie "swimming against the tide" of "costs," however. In exchange for in their potential to "accelerate" society in the long run only hurts the personal benefits of increased the aging process and produce "the swimmer," and society loses longevity, many polio survivors, "excess" or secondary disabilities the opportunity of receiving our as they age into mid-life and (Lollar, 1994). Because of the valuable input. beyond, experience the onset of costs of these consequences for new, and frequently unexpected, individuals as well as society, pre- We need to be part of society, not health problems and functional venting the new health risks of apart from it just because we can- changes that threaten to erode aging with polio, and other long- not walk. . independence and reduce quality term disabilities, has become a of life (Maynard, Frchheimer, & major public health objective of Roller, 1991; Campbell, Kemp, & the 2 1st century (Healthy People Reprinted with the permission of the author. First published in the Winter Brummel-Smith, 1994). Clinicians 2010: Draft for Public Comment, Edition, June 1998, of Talking Point, treating polio survivors were some 1998; Brandt & Pope, 1998; newsletter of the Muscular Dystrophy of the first to call attention to the Guralnik et al., 1996; Marge, 1988). Association of New South Wales, health problems associated with Australia. Recent findings from the Aging long-term disability (Maynard, with Disability (AwD) Survey 1981; Halstead, 1985).Since the Study*illustrate the types of the population at large. The dis- Campbell, M.L., Kemp, B.J., & Brummel- chronic health conditions persons parity in rates of high blood pres- Smith, K. (1994). Later life effects of early life disability: Comparisons of age-matched with polio are at risk for as they sure (HTN) is even greater. 41.0% controls on indicators of physical, psycho- age, and document the health of younger polio survivors report logical and social status. Final report to the disparities that exist between per- a diagnosis of HTN compared to National Institute of Disabilityand Rehabili- sons aging with polio and their 22.2% for this cohort in the pop- tation Research. Rehabilitation Research and non-disabled counterparts. To test ulation at large; and, among those Training Center on Aging with Disability, Rancho Los Amigos Medical Center, for evidence of "accelerated aging ," 65 and older, the frequency of Downey, CA. the frequency of selected chronic HTN is 54.0% among polio sur- DeJong, G. (1995). Preventing and managing conditions reported by polio parti- vivors compared to only 36.4% secondary conditions in an era of managed cipants in the AwD Study was for the population at large. care. Presentation to the conference on "Secondary Conditions and Aging with a compared to national estimates Together, these findings document of these same conditions for age- Disability," Department of Physical the health disparities of persons Medicine and Rehabilitation, SUNY Health matched cohorts from the 1994- aging with polio and highlight Science Center at Syracuse, Syracuse, NY. 1995 National Health Interview their changing needs for health Guralnik, J.M., Fried, L.P., & Salive, M.E. Survey. The polio sub-sample of care. To reduce the risks of (1996). Disability as a public health outcome the larger AwD Study consisted in the aging population. Annual Review of "accelerated aging," these find- Public Health, 17,25-46. of 2 18 individuals, who ranged in ings suggest that persons aging Halstead, L.S., & Grimby, G. (Eds.) (1995). age from 42 to 89, and had been with polio and their families need living with the effects of polio for Post-polio syndrome. Philadelphia, PA: access to: more preventive ser- Hanley and Belfus, Inc. an average of 50 years. vices and at younger ages; more Halstead, L.S., & Rossi, C.D. (1985). New Out of the 14 chronic conditions informed medical and allied health problems in old polio patients: Results of a examined in both studies, polio providers who are knowledgeable survey of 529 polio survivors. Orthopedics, survivors reported significantly about the new health risks associ- 8(7), 845-850. higher rates for almost all mortali- ated with aging with disability; Healthy people 20 10: Draft for public com- ment (Sept. 15,1998). Office of Disease ty and morbidity diagnoses com- and, more targeted health promo- Prevention and Health Promotion, Depart- pared to national estimates for tion programs that incorporate ment of Health and Human Services (HHS), age-matched cohorts. This pat- training in self-care and self-advo- Washington, DC. tern is most pronounced for the cacy, as well as education on risk Jones, M., Sanford, J., Arch, M., & Bell, R.B. youngest group of 45- to 64-year- factors and the prevention of (1997). Disability demographics: How are olds, where frequencies of chronic chronic disabling disease. they changing. Team Rehabilitation Report, conditions are two to ten times 8(10), 36-44. Lollar, D.J. (1994). Preventing secondary greater for those aging with polio *The AwD Study was conducted conditions associated with spina bifida or than for their same-age counter- between 1993 and 1998, under cerebral palsy: Proceedings and recommen- parts in the population at large. the auspices of the Rehabilitation dations of a symposium. Washington, DC: Key findings from this analysis are Research and Training Center on Spina Bifida Association of America. summarized below. Aging with Disability, located at Marge, M. (1 988). Health promotion for per- Rancho Los Amigos Medical sons with disabilities: Moving beyond reha- - "LOWvision/blindness" was bilitation. American Journal ofHealth reported by 2 1.0% of younger Center, Downey, California. The Promotion, 2(4), 29-35. polio survivors compared to esti- full study involved a cross-section- Maynard, F.M. (Ed.). (1981). Defining the mates of only 4.5% for 45 to 64- al, group comparison study of issue: Post polio aging problems. Rehabilita- year-olds in the population at large. persons aging with cerebral palsy, tion Institute of ChicagoIMarch of Dimes. polio, rheumatoid arthritis, and Maynard, F.M., Frchheimer, M., Roller, S., et - 14% of polio survivors in each stroke. The total achieved sample al. (1 991). Secondary conditions associated age group reported a diagnosis of was 555. with declining functional abilities among emphysema/COPD compared to polio survivors. Archives of PhysicalMedicine national estimates of only 1% and References &Rehabilitation, 72,795. 4.6% for corresponding age Ansello, E.F., & Eustis, N.N. (1992). A com- Pope, A.M., & Tarlov, A.R. (Eds.) (1991). groups. mon stake? Investigating the emerging Disabilityin America: Toward a national 'intersection' of aging and disability. agenda forprevention. Washington, DC: - For mortality risk factors, Generations, 16(1), 5-8. National Academy Press. 14.0% of polio survivors in the Brandt, E.N., & Pope, A.M. (1997). Enabling Seelman, K., & Sweeney, S. (1995). The 45 to 64 age group reported a America: Assessing the role of rehabilitation changing universe of disability. American diagnosis of diabetes compared to science and engineering (pp. 40-61). Institute Rehabilitation, Autumn-Winter, 2-1 3. only 6.3% for this same cohort in of Medicine, Washington, DC: National Academy Press. CONTINUED ON PAGE 6