Disability amongst the elderly in Sri Lanka: comparison of disability rates in the censuses of 1981 and 2001

Abstract

The incidence of disability in Sri Lanka has been increasing during the period 1981 to 2001 due to the process of population ageing and the civil strife that the country has experienced during that period and it is likely that the disability rates would continue to increase in the future. Thus the objectives of this study on disability of elderly (50 years and over) are to examine the recent trends, in age-sex specific disability rates, possible determinants of the change in rates, and also the spatial variations of the prevalence of disability. The 1981 and 2001 census data on disability were used to analyse disabilities in seeing, hearing and speaking as well in hands, and legs. Even though the total blindness has increased marginally among the elderly, there is a conspicuous increase in the disabilities in hearing and speaking. The disability of the latter type has more than trebled among the females from 15 per 10,000 population in 1981 to 53 in 2001, while males reported a higher level of prevalence (59 per 10,000) than females in 2001. Among the disabilities in hands too females have reported a higher increase than males during the intercensal period, but in 2001 the disability rate of the male (62) is almost twice that of the females (37). The increase in disability in legs is greater among the females, recording 26 in 1981 and 59 in 2001, in comparison to males, where the figures stand at 49 and 87, respectively. Apart from the gender difference, the level of disability increases with age, which indicates the impact of ageing on the overall level of disability of the Sri Lankan population. Disability rates have increased dramatically among the elderly primarily due to exogenous factors, while the disabilities at birth declined significantly due to the change in endogenous factors, particularly with the improvement and expansion of maternal health services. Environmental factors such as noise and air pollution, largely through urbanization, and also behavioural changes leading to change in dietary patterns, including heavy consumption of liquor and tobacco, have lead to higher level of disabilities through higher incidence of non-communicable diseases, such as diabetes and pre-vascular disorders. Apart from the occupational injuries, violence and civil war casualties would have also contributed to the increase in disabilities. Finally, it is not only incidence of disability that has increased significantly over the intercensal period, but the spatial variations of disability. The 2001 census data demonstrate large variations between districts which lead to an examination of yet another dimension of disability in Sri Lanka.