Growing Older With a Disability: Earlier Health Problems, Services Split by Age

Disabled people who have lived with a disability since childhood or early adulthood are now reaching later life in growing numbers. The evidence shows many of them meeting the conditions of later life earlier than their peers, with secondary health problems that build up over decades, in health and care systems that were built to serve either disabled people or older people, but rarely both.

Much of what is written about disability in later life is about disability that begins in old age: a stroke, arthritis that slowly limits walking. This study is about a different group, people who grew old with a disability they already had: people who survived polio as children, adults with cerebral palsy or spina bifida, people who have lived for decades with a spinal cord injury or multiple sclerosis. For many, reaching older age is itself a gain that earlier generations were not given. What they meet when they get there is too often health care that is slow to tell new conditions apart from the disability itself, and support systems with a line drawn at a set age.

Disability becomes common with age, and hidden inside those figures is a group who grew old with it

Disability is a large part of later life everywhere it is measured well. The WHO estimates that 1.3 billion people, 16% of the world’s population, experience significant disability, and notes that the number is growing partly because people are living longer^[1]. National surveys show how steeply it rises with age. In the European Union in 2025, 10.3% of people aged 16 to 44 reported a long-standing limitation in their usual activities because of a health problem; at 65 to 74 it was 38.6%, at 75 to 84 53.4%, and at 85 and over 72.3%^[2]. In Canada’s 2022 disability survey, 40% of people aged 65 and over had a disability, against 24% of adults aged 25 to 64^[3]. In Australia in 2022, 52.3% of people aged 65 and over had a disability, 2.3 million people^[4]. These are three different survey definitions, so the rates should not be compared country with country; the rise with age is the common thread.

The steep rise with age means much of this disability begins in mid or later life. A smaller group has lived with it for most of their lives, and they are getting older. As long ago as 1999, researchers in the United States wrote that “the majority of individuals with an onset of disability before age 30 can now expect to live into their 60s, 70s and beyond”^[5]. National statistics rarely separate the two groups, because surveys often do not record clearly when a disability began. When researchers tried to find people aging with disability in the US Health and Retirement Study, they identified 719 people reporting a childhood disability; of those, 87% also reported at least one chronic disease in adulthood, 50% functional limitations and 38% an interruption to work because of disability. Their conclusion on the wider data was blunt: “Overall, age at onset is unclear”^[6].

The conditions of later life arrive earlier for many people aging with a disability

Researchers often describe this group as possibly experiencing “accelerated aging”^[7]. The clearest evidence is that conditions usually linked with later life appear sooner. A study at the University of Michigan compared 452 young adults with cerebral palsy, aged 18 to 30, with 448 young adults without it. After adjusting for age, sex, body mass index and smoking, those with cerebral palsy had 6.97 times the odds of musculoskeletal conditions, 1.98 times the odds of cardiometabolic conditions, and 2.67 times the odds of multimorbidity, two or more of the conditions studied. Among those with the most severe motor impairment, the odds of multimorbidity were 3.45 times those of people with milder impairment^[8]. This is a clinic-based sample from one US centre, so it may not represent everyone with cerebral palsy, but it describes people in their twenties already carrying conditions more typical of later life.

Midlife looks like a turning point. A US survey of 1,594 adults with multiple sclerosis, muscular dystrophy, post-polio syndrome or spinal cord injury, surveyed twice 3.5 years apart, found that 14% reported a new diagnosis of arthritis over that time, 9% hypertension and 7% cancer. New conditions were reported most often by people aged 56 to 65, and the authors concluded that “midlife appears to be the period of greatest risk for onset of a new condition”^[7]. There was no comparison group without disability in that study, so it shows when new conditions appear, not how much more often than in other people.

The WHO’s summary of the global evidence puts the overall pattern plainly: people with disabilities have twice the risk of developing conditions such as depression, asthma, diabetes, stroke and obesity^[1]. Its 2022 global report is clear that disabled people “continue to die earlier, have poorer health, and experience more limitations in everyday functioning than others”, and that countries have an obligation under international human rights law to address these inequities^[9]. In other words, the gap is treated as a matter of fairness and of how health systems work, not as an inevitable result of impairment.

Secondary conditions build up over decades, and some disabled people still die years earlier

Alongside the conditions anyone might develop with age, people aging with a disability often face secondary conditions: problems that stem from, or are made worse by, living with the original impairment for a long time, such as pain, fatigue, bladder and bowel problems, and muscle and joint wear. In a survey of 1,862 US adults with spinal cord injury, neuromuscular disease, multiple sclerosis or post-polio syndrome, increasing age was associated with more physical and health problems and poorer function^[10]. A review of research on post-polio syndrome found the most common problems were fatigue, pain, respiratory and sleep complaints and a greater risk of falls, and noted a “marked lack of longitudinal research” following people over time^[11].

One of the few studies to follow older disabled people over several years is the Swedish Aging with Spinal Cord Injury Study. Its 78 participants, followed up from an original 123, had a mean age of 68 and had lived with their injury for an average of 31 years. Over six years, the share with bowel-related problems rose from 31% to 47%, frequent urinary tract infections from 10% to 26%, and other bladder-related problems from 4% to 22%^[12]. The sample is small, but the direction is clear, and the authors call for “a proactive, holistic approach in the long-term follow-up”.

Some of these conditions are serious. In England, a study of 958 adults with cerebral palsy, identified through GP records and linked to death registrations, found 13.59 times the number of deaths from respiratory disease expected in the general population after accounting for age, sex and calendar year, and 3.19 times the expected number of deaths from cardiovascular disease. Deaths from cancer were not significantly raised^[13]. These are standardised mortality ratios, comparing observed with expected deaths. Across all disabilities, the WHO states that some people with disabilities die up to 20 years earlier than people without disabilities^[1]. Our study of older people with a learning disability looks at one group for whom that gap is especially well documented.

Aging well looks different, and support for wellbeing matters as much as treatment

Living for decades with a disability is also associated with poorer mental health in some studies. In a US study of 360 people, 22% of those with post-polio and 41% of those with spinal cord injury had significant depressive symptoms, against 15% of a non-disabled comparison group. On every life-satisfaction scale the non-disabled group scored higher than one or both disabled groups, with the biggest differences in satisfaction with health, finances, work and life overall^[5]. The study is old and small, but the areas where satisfaction differed most, health, finances and work, are ones that services and policy can influence.

People aging with a disability also challenge the usual idea of what aging well means. Many current definitions of “successful aging” emphasise the avoidance of disability, which leaves this group out from the start. When US researchers asked 49 people aged 45 to 80, who had lived with spinal cord injury, multiple sclerosis, muscular dystrophy or post-polio syndrome for an average of 21 years, what aging well meant to them, four themes emerged: resilience and adaptation, autonomy, social connectedness, and physical health, including access to general and specialist health care^[14].

That places the measure of a good later life in things that services, housing and communities can support, such as choice, control, connection and access, rather than in the absence of impairment.

Services are often split by age, and disabled people can fall between them

In many countries, support for disabled people and care for older people are run as separate systems, with different rules, funders and professional cultures. People aging with a disability sit across that line. In the United States, researchers noted in 2017 that the average age of people living with early-acquired physical disabilities was rising, and pointed to recent policy efforts to merge aging and disability services^[14]. The need for assistance in later life is large among older people generally, not only those aging with a disability: in Australia in 2022, 39.8% of people aged 65 and over living at home needed some help with everyday activities, and 16.7% of disabled people aged 80 and over lived in cared accommodation^[4].

Australia also shows what happens when the age line runs the other way. Younger disabled people with high support needs have long been placed in residential aged care built for much older people. As of June 2018, more than 6,000 people under 65 were living in permanent residential aged care in Australia, and between 2008 and 2018 there was no sustained national change in the rates of younger people entering aged care or leaving it to return to the community; most of those admitted never returned to community living before turning 65^[15]. A review of 11 studies found that aged care facilities were unable to meet younger residents’ basic needs, including privacy and social and emotional needs, and that they had little choice about rehabilitation and housing^[16]. We could not reach current Australian Government figures for this study, so these are the latest we could verify.

Money: the poverty gap is widest in working age

Disability is closely tied to poverty, and the European data show how that changes with age. In the EU in 2025, 50.4% of people aged 16 to 64 with a severe activity limitation were at risk of poverty or social exclusion, against 18.1% of those with no limitation. Among people aged 65 and over the gap was smaller but still clear: 25.2% against 15.9%^[17]. The published figures do not explain the narrower gap in later life. What they do show is a much higher poverty risk for disabled people of working age, the years in which most people build up income for later life; these one-year snapshots cannot show how that carries forward for any individual. Our study of older people on low incomes looks at poverty in later life more broadly.

What the evidence asks of us

The starting point is a right, not a favour. Under Article 25 of the UN Convention on the Rights of Persons with Disabilities, disabled people have the right to the highest attainable standard of health without discrimination, and states commit to provide the health services disabled people need because of their disabilities, including services “designed to minimize and prevent further disabilities, including among children and older persons”^[18]. The WHO’s 2022 global report frames the health gap the same way, as an obligation on countries^[9]. Read against that standard, the evidence points to five things.

• Count this group. National disability and aging surveys should record when a disability began, so that people aging with a disability can be seen in the data. Researchers using one of the world’s major aging studies found that age at onset was unclear^[6], and without that, planning is guesswork.
• Screen and prevent early. Conditions such as cardiometabolic disease and multimorbidity appear in young adults with cerebral palsy, and the researchers who found this called for early screening and prevention^[8]. Midlife looks like a period of particular risk^[7], so prevention should not wait for old age.
• Keep long-term follow-up going into later life. Secondary conditions increase over time in people with long-term spinal cord injury, and researchers call for proactive, holistic follow-up^[12]. Specialist knowledge built up in childhood and adult disability services needs to travel with people as they age, rather than stopping at a birthday.
• Remove the cliff edge between systems. Disability and aged care systems need shared assessment and rules that follow need rather than age, and housing and support options that keep younger disabled people out of aged care settings not designed for them. A review of the Australian evidence called for timely rehabilitation and housing and support options for people at risk of admission^[16].
• Fund longitudinal research. Much of the evidence is small, clinic-based and cross-sectional, and the lack of long-term studies is noted directly in the research on post-polio syndrome^[11]. Disabled people and their organisations should help design that research.

Language: this piece says “older people” rather than “the elderly”, and uses both “disabled people” and “people with disabilities”, as disabled people’s organisations in different countries prefer one or the other; international bodies such as the UN and WHO use “persons with disabilities”. “Aging with a disability” means living into later life with a disability that began earlier; “secondary conditions” is the research term for health problems linked to living with an impairment over time.

Why we're publishing this

Growing numbers of disabled people are living into their sixties, seventies and beyond with disabilities they have had most of their lives. That is a success of medicine, rehabilitation and, above all, of disabled people’s own advocacy. It has also exposed gaps: in data that cannot see this group, in health care that is slow to recognise early-onset conditions, and in support systems divided by age. We have brought together the best evidence we could verify, from several countries, so that disabled people’s organisations, disability rights campaigners and the services that work with them have one place to point to. The case set out here is theirs.

How to read this data

The evidence on this group is uneven, and it helps to know what each kind of figure can and cannot show.

• National prevalence figures (Eurostat, Statistics Canada, the Australian Bureau of Statistics) count disability at any age of onset, using different definitions: Eurostat’s measure is a self-reported long-standing limitation in usual activities, while the Canadian and Australian surveys use their own disability questions. They show how disability rises with age within each country, but rates should not be compared between countries. The Eurostat figures cover people in private households, so they leave out people living in care homes.
• Studies of people aging with disability are mostly from the United States, Sweden and England, with almost nothing from low- and middle-income countries, and are often clinic-based or drawn from people already in contact with services, which may not represent everyone. Several are small or cross-sectional, and two (from 1999 and 2014) are older; we use them for patterns, not precise rates.
• Odds ratios and mortality ratios are reported as the studies give them. An odds ratio is not the same as a risk ratio, and a standardised mortality ratio compares observed deaths with those expected in the general population of the same age and sex. All of these figures show associations, not causes.
• The intersection is thin. Very few national statistics separate disability that began early in life from disability that began in old age. Where we could not verify a figure at source, including current Australian Government figures on younger people in aged care and recent United States census figures by age, we left it out.

Use this data

Free to cite with attribution to Understanding Aging. Charities, carers' groups, campaigners and journalists are welcome to reuse these figures and charts. For the underlying figures as a spreadsheet, get in touch.

Important: This article summarises published research and statistics for general information. It is not medical, care or financial advice and cannot be used to diagnose, treat or predict anything about an individual. If you have concerns about your own or someone else's memory or health, please speak to a GP or another qualified health professional.

Sources

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