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Like sensory impairment, older adults have high rates of disability, defined as a deficiency in self‐care such as the ability to perform an activity of daily living or instrumental activity of daily living. As of 2011, the World Health Organization estimated that 15% of the global population lives with some form of disability, up from 10% of the global population in the 1970s.⁴¹ In older adults, disability is most likely the result of multiple chronic diseases. Disabilities are associated with poorer health status, reduced economic productivity, higher rates of poverty, and increased dependency and risk of institutionalized.

In the US and much of the developed world, laws and public policies protect those with a disability, including promoting accessibility in the workplace and community. Ancillary providers such as physical, occupational, and speech therapists can provide rehabilitation and adaptive equipment to help preserve functioning. However, in much of the developing world, such services and protections are lacking. The WHO reports that in four South African countries, for instance, only 26–55% of people received needed medical rehabilitation, 17–37% received assistive devices, and less than 25% were able to receive vocational training. Even in developed countries, older adults may have difficulty obtaining all the recommended resources, particularly adults in rural communities or with financial insecurity. Resources meant to help those with disabilities, such as meal delivery services, may have long waitlists due to inadequate funding. Adults with disabilities also face stigmatization in the workplace and communities. Communities worldwide must commit resources to promote a safe and inclusive environment for those of all abilities to thrive.

Table 4.2 Communication strategies for speaking to patients with hearing loss.

Don’t yell – shouting causes sound distortion.

Maintain a quiet environment with minimal background noise.

Maintain good lighting.

Face the person, and maintain eye contact.

Annunciate.

Speak at a reasonable speed.

Use transition statements, and avoid sudden shifts in conversation topics.

Augment communication with writing, diagrams, etc.

Use ‘teach‐back’ or similar methods to ensure understanding.