Profile of disability among adults
Type of disabilities among
The PALS survey questions allow the identification of the following types of disabilities among adults aged 15 and over:
Hearing: Difficulty hearing what is being said in a conversation with one other person, in a conversation with three or more persons or in a telephone conversation.
Seeing: Difficulty seeing ordinary newsprint or clearly seeing the face of someone from 4 metres (12 feet).
Speech: Difficulty speaking and/or being understood.
Mobility: Difficulty walking half a kilometre or up and down a flight of stairs, about 12 steps without resting, moving from one room to another, carrying an object of 5 kg (10 pounds) for 10 metres (30 feet) or standing for long periods.
Agility: Difficulty bending, dressing or undressing oneself, getting into and out of bed, cutting own toenails, using fingers to grasp or handling objects, reaching in any direction (for example, above one’s head) or cutting own food.
Pain: Limited in the amount or kind of activities that one can do because of a long-term pain that is constant or reoccurs from time to time, for example, recurrent back pain.
Learning: Difficulty learning because of a condition, such as attention problems, hyperactivity or dyslexia, whether or not the condition was diagnosed by a teacher, doctor or other health professional.
Memory: Limited in the amount or kind of activities that one can do due to frequent periods of confusion or difficulty remembering things. These difficulties may be associated with Alzheimer’s disease, brain injuries or other similar conditions.
Developmental: Cognitive limitations due to the presence of a developmental disability or disorder, such as Down syndrome, autism or mental impairment caused by a lack of oxygen at birth.
Psychological: Limited in the amount or kind of activities that one can do due to the presence of an emotional, psychological or psychiatric condition, such as phobias, depression, schizophrenia, drinking or drug problems.
Unknown: The type of disability is unknown if the respondent answered YES to the general questions on activity limitations, but did not provide any YES to the questions about type of disability that followed.
Mobility problems are the type of disability most often reported by adults aged 15 and over. In 2001, nearly 2.5 million or 10.5% of Canadians had difficulty walking, climbing stairs, carrying an object for a short distance, standing in line for 20 minutes or moving about from one room to another. For all age groups, women were more likely to have mobility problems than men. Indeed, among adults aged 15 and over, there was a significant difference in the overall proportion of women (12.2%) and men (8.6%) with a mobility-related disability. Also with respect to motor skills, activity limitations related to agility affect a substantial number of persons aged 15 and over. In all, 2.3 million or 9.7% of adults reported having difficulty with everyday activities that require these skills, such as bending down to pick up an object, getting dressed or undressed, or cutting one’s food. For further information on the different types of disabilities, see the section entitled Type of disabilities among adults.
Rather surprisingly, adults report pain-related disability almost as frequently as mobility-related disability. Some 2.4 million persons aged 15 and over (10.1%) reported having activity limitations related to chronic pain. Pain-related disability is more prevalent among women (11.4%) than among men (8.8%). This may reflect, in part, some reluctance among men to report this type of limitation. It is important to note here that for the purposes of PALS, persons who reported having pain but did not associate it with any activity limitation were not considered to have a pain-related disability. In fact, some 3.2 million adults reported having pain, with or without limitations (data not shown).
Regarding sensory-type activity limitations, just over one million adults (4.4%) reported having a hearing-related disability, about 600,000 (2.5%) had vision difficulties, and some 360,000 or 1.5% of persons aged 15 and over reported a speech-related disability. While a larger proportion of women (3.1%) than of men (2.0%) reported having vision difficulties, activity limitations related to hearing were more common among men (5.0%) than women (3.8%). Men aged 15 and over were also slightly more likely than women to have a speech-related disability.
The 2001 PALS also sought to distinguish certain types of less visible disabilities, such as limitations related to psychological conditions or memory problems, learning difficulties and developmental disability. This distinction in no way ignores the close relationship that exists between some of these disabilities; as well, identification is always subjective, based on the respondent’s perception. Nevertheless, more than half a million persons aged 15 and over (2.2%) reported having activity limitations due to emotional, psychological or psychiatric conditions. Similarly, more than 450,000 adults reported having learning disabilities, representing a proportion of 1.9%. A similar proportion of adults (1.8%) had activity limitations due to frequent memory problems or periods of confusion. Nearly 120,000 persons aged 15 and over had a developmental disability.
According to the most widely held view, the prevalence of any form of disability rises increasingly with age. The PALS findings confirm that this is true for disabilities related to mobility, agility, hearing, vision and pain. For example, while fewer than 2% of young adults aged 15 to 24 have a mobility-related disability, the rate reaches 31.5% for persons aged 65 and over. This increase in prevalence with age is also observed, although to a lesser degree, for other problems more closely associated with aging, such as memory and speech problems.
Activity limitations related to emotional, psychological or psychiatric conditions are relatively frequent in persons aged 45 to 64
However, there are some exceptions to the rule. Thus, persons aged 45 to 64 (3.3%) were more likely to have a disability related to psychological problems than persons aged 65 to 74 (2.0%), although the rate resumed its rise to 3.6% for persons 75 and over. The same is true for learning disabilities, with adults aged 45 to 64 (2.3%) showing a rate higher than among adults aged 65 to 74 (1.5%), but lower than that of seniors 75 years and over (2.8%). With respect to developmental disability, prevalence varies between 0.2%E and 0.7%E according to age, with young adults aged 15 to 24 showing the highest rate, and persons 65 to 74, the lowest. In this regard, it is important to note that a sizable proportion of older adults with a developmental disability are institutional residents and are therefore excluded from the survey population. Younger adults are more likely to live at home and therefore be included in PALS due to the de-institutionalization that has been taking place in Canada for about 25 years.
The strong predominance of some types of disabilities becomes even more obvious when we look at the proportion of persons with disabilities who have these particular types of disabilities. More than seven of every ten persons with disabilities have difficulties related to mobility, and almost as many have pain-related disabilities. Activity limitations related to agility are also very frequent, with two-thirds of persons with disabilities reporting them. More than 30% of adults with disabilities have a hearing-related disability and 17% have vision difficulties.
The results of the 2001 PALS also show how an important proportion of adults with disabilities have activity limitations related to psychological conditions, namely over 15%. Furthermore, some 13% of persons with disabilities aged 15 and over reported having a learning disability, with more than half (54.1%) of them having been diagnosed with learning disabilities by a teacher, a physician or another health care professional. The approximately 420,000 persons with a disability related to memory account for 12% of all persons with disabilities. Speech difficulties, which affect at least one in ten persons with disabilities, and developmental disability (3.5%) complete the PALS profile of persons with activity limitations. However, for just under 100,000 persons reporting a disability, the type of disability could not be identified.
The 2001 PALS distinctly recognizes, along with physical and sensory disabilities, the various types of less visible disabilities (pain, psychological problems, memory, learning and developmental disability). As a result, the survey provides a detailed profile reflecting the complexity of disability in adults aged 15 and over. The number of disabilities reported is ample evidence to that effect. Only 18.2% of persons with disabilities reported having only one disability, whereas a sizable proportion of them reported three (29.0%) or even four or five (27.7%). Indeed, just under 8% of persons with disabilities had six or more.
A profile of disability in Canada would not be complete if it did not consider the degree of severity of disabilities reported. Among the 3.4 million adults with disabilities, the 2001 PALS distinguishes four levels of severity: mild, moderate, severe and very severe. Firstly, the level of severity depends on the frequency and intensity of limitations associated with each type of disability. For example, a person who has no difficulty walking and climbing stairs but cannot stand in line for more than 20 minutes, would have a mild mobility-related disability. A person who can only move around in a wheelchair would have their mobility more severely limited, and one who is bedridden for a long term period would have a very severe mobility-related disability. The number of disabilities also has an impact on the overall level of severity. The PALS distinguishes 10 types of disabilities among adults and the level of severity will increase with the number of disabilities affecting each individual. For further information on the development of the severity scale, see the box entitled Severity of disability.
In 2001, one-third (34.1%) of adults with disabilities had a mild degree of disability. At the other end of the scale, at least one in four persons with disabilities (26.9%) experienced severe activity limitations and 14.0% reported having a very severe disability. Men (36.4%) were more likely than women (32.2%) to report a mild degree of limitation. Conversely, a larger proportion of women than of men with disabilities reported a severe level of activity limitation (28.3% compared with 25.1%). However, the proportion of very severe disabilities was relatively the same for the two sexes.
In terms of the total population aged 15 and over, 5.0% of Canadians had a mild disability, 3.6% a moderate disability and 3.9% a severe disability. Again at the national level, more than 480,000 persons aged 15 and over (2.0%) reported a very severe level of disability.
Severity of disability increases gradually until age 65 and then declines slightly among the 65 and over population. In this regard, it is important to note the significant prevalence of less visible disabilities among the working-age population, which increases the number of disabilities reported for these adults aged 15 to 64. As well, it is generally recognized that a person is more likely to experience the highest level of activity and the widest scope of activities during these working years (home, work, school, leisure); a person would therefore be just as likely to experience during those years, a high level of limitation in these same activities. At the same time, a sizable proportion of elderly persons likely to have a severe or very severe disability reside in an institution and are therefore not included in the PALS population.