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Disability discrimination and avoidance in later life: prevalence, disability differentials and association with mental health

Published online by Cambridge University Press:  07 December 2018

Jeromey B. Temple*
Demography and Ageing Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
Margaret Kelaher
Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
Ruth Williams
Demography and Ageing Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
Correspondence should be addressed to: Jeromey B. Temple, Melbourne School of Population and Global Health, 207 Bouverie St, University of Melbourne, Melbourne, Victoria, 3010 Australia. Phone: +61 3 90359900. Email:



Later life is a period of increased risk of disability, but there is little quantitative evidence regarding the exclusion of older people (through discrimination and avoidance) due to their health conditions. This study aims to (1) measure the prevalence of disability exclusion in later life, (2) examine how experiences of exclusion differ by disability type, and (3) investigate the association of exposure to exclusion with psychological distress.


Using data from the 2015 ABS Survey of Disability, Ageing and Carers, we calculated the prevalence of people aged 55 years and over with a disability experiencing discrimination and engaging in avoidance behaviors, disaggregated by 18 detailed disability types. Modified Log-Poisson models were fitted to estimate Prevalence Ratios to measure the association between exclusion and psychological distress, stratified by disability type.


In 2015, about 5% of Australians aged 55 years and over with a disability reported experiencing an instance of disability discrimination, and one in four reported avoiding a situation or context due to their disability. Accounting for psychosocial comorbidities and with extensive demographic controls, exposure to disability avoidance (PR = 1.9, 95% CI 1.7, 2.1) or discrimination (PR = 1.7, 95% CI 1.4, 2.1) almost doubled the probability of experiencing psychological distress. Effects were heightened for individuals reporting specific disabilities including sensory and speech and physical disabilities as well as those reporting a head injury, stroke, or acquired brain injury.


Despite protections against disability discrimination in legislation, discrimination and avoidance due to disability is prevalent and is associated with poor mental health outcomes.

Original Research Article
© International Psychogeriatric Association 2018 

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ACT Disability Advisory Council. (2004). Snapshot of Community Attitudes on Disability in the ACT. Canberra: ACT Disability Advisory Council.Google Scholar
Ali, A. et al. (2013). Discrimination and other barriers to accessing health care: perspectives of patients with mild and moderate intellectual disability and their carers. PLOS one, 8, e70855. doi: 10.1371/journal.pone.0070855.CrossRefGoogle ScholarPubMed
Anderson, T. et al. (2013). The 10-Item Kessler psychological distress scale (K10) as a screening instrument in older individuals. American Journal of Geriatric Psychiatry, 21, 596606. doi: 10.1016/j.jagp.2013.01.009.CrossRefGoogle ScholarPubMed
Andrews, G. and Slade, T. (2001). Interpreting scores on the Kessler psychological distress scale (K10). Australian and New Zealand Journal of Public Health, 25, 494497. doi: 10.1111/j.1467-842X.2001.tb00310.x.CrossRefGoogle Scholar
Australian Bureau of Statistics. (2014). Australian Aboriginal and Torres Strait Islander Health Survey: First Results, 2012-13 Australia. Catalogue Number 47270D007_20122013. Canberra: Australian Bureau of Statistics.Google Scholar
Australian Bureau of Statistics. (2016). Disability, Ageing and Carers, Australia: Summary of Findings. Catalogue Number 4430.0. Canberra: Australian Bureau of Statistics.Google Scholar
Australian Human Rights Commission. (2015). National Prevalence Survey of Age Discrimination in the Workplace. Sydney: Australian Human Rights Commission.Google Scholar
Australian Human Rights Commission. (2016b). Willing to Work: National Inquiry into Employment Discrimination Against Older Australians and Australians with Disability. Sydney: Australian Human Rights Commission.Google Scholar
Backer, C., Chapman, M. and Miller, D. (2009). Access to secondary healthcare for people with intellectual disabilities: a review of the literature. Journal of Applied Research in Intellectual Disabilities, 22, 514525. doi: 10.1111/j.1468-3148.2009.00505.x.CrossRefGoogle Scholar
Barros, A. and Hirakata, V. (2003). Alternatives for logistic regression in cross-sectional studies: an empirical comparison of models that directly estimate the prevalence ratio. BMC Medical Research Methodology, 3, 21. doi: 10.1186/1471-2288-3-21.CrossRefGoogle ScholarPubMed
Biggs, S. and Haapala, I. (2013). Elder mistreatment, ageism and human rights. International Psychogeriatrics, 25, 12991306. doi: 10.1017/S1041610212002372.CrossRefGoogle ScholarPubMed
Department of Health. (2011). Victorian Population Health Survey of People with an Intellectual Disability 2009. Melbourne: Victorian Department of Health.Google Scholar
Frohmader, C. (2002). There is No Justice– THERE’s JUST US. The Status of Women with Disabilities in Australia. Canberra: Women with Disabilities Australia.Google Scholar
Giles, L., Cameron, I. and Crotty, M. (2003). Disability in older Australians: projections for 2006-2031. Medical Journal of Australia, 179, 130133.CrossRefGoogle ScholarPubMed
Guzman-Castillo, M. et al. (2017). Forecasted trends in disability and life expectancy in England and Wales up to 2025: a modelling study. Lancet Public Health, 2, e307e313. doi: 10.1016/s2468-2667(17)30091-9.CrossRefGoogle ScholarPubMed
Han, C. et al. (2015). Stress and coping with racism and their role in sexual risk for HIV among African American, Asian/Pacific Islander, and Latino men who have sex with men. Archives of Sexual Behavior, 44, 411420. doi: 10.1007/s10508-014-0331-1.CrossRefGoogle ScholarPubMed
Hughes, K. et al. (2012). Prevalence and risk of violence against adults with disabilities: a systematic review and meta-analysis of observational studies. Lancet, 379, 16211629. doi: 10.1016/S0140-6736(11)61851-5.CrossRefGoogle ScholarPubMed
Kelaher, M. A., Ferdinand, A. S. and Paradies, Y. (2014). Experiencing racism in health care: the mental health impacts for Victorian aboriginal communities. Medical Journal of Australia, 201, 4446. doi: 10.5694/mja14.00273.CrossRefGoogle ScholarPubMed
Kessler, R., Mickelson, K. and Williams, D. (1999). The prevalence, distribution and mental health correlates of perceived discrimination in the United States. Journal of Health and Social Behavior, 40, 208230. doi: 10.2307/2676349.CrossRefGoogle ScholarPubMed
Kraus, L. (2017). 2016 Disability Statistics Annual Report. Durham: University of New Hampshire.Google Scholar
Krnjacki, L. et al. (2018). Disability-based discrimination and health: findings from an Australian-based population study. Australian and New Zealand Journal of Public Health, 42, 172174. doi: 10.1111/1753-6405.12735.CrossRefGoogle ScholarPubMed
Lyons, A. et al. (2017). Experiences of ageism and the mental health of older adults. Aging and Mental Health, 10, 19. doi: 10.1080/13607863.2017.1364347.Google Scholar
Moscoso-Porras, M. and Alvarado, G. (2018). Association between perceived discrimination and healthcare seeking behavior in people with a disability. Disability and Health Journal, 11, 9398. doi: 10.1016/j.dhjo.2017.04.002.CrossRefGoogle ScholarPubMed
OECD. (2008). Modernising sickness and disability policy: OECD thematic review on sickness, disability and work issues paper and progress report. Available from, accessed 17/04/18.Google Scholar
Papworth Trust. (2016). Disability in the United Kingdom. Available from, accessed 17/04/18.Google Scholar
Paradies, Y. et al. (2015). Racism as a determinant of health: a systematic review and meta-analysis. Plos One, 10, e0138511. doi: 10.1371/journal.pone.0138511.CrossRefGoogle ScholarPubMed
Pascoe, E. and Richman, S. (2009). Perceived discrimination and health: a meta-analytic review. Psychological Bulletin, 135, 531554. doi: 10.1037/a0016059.CrossRefGoogle ScholarPubMed
Paul, K. and Moser, K. (2009). Unemployment impairs mental health: meta-analyses. Journal of Vocational Behavior, 74, 264282. doi: 10.1016/j.jvb.2009.01.001.CrossRefGoogle Scholar
Rogers, S., Thrasher, A., Miao, Y., Boscardin, W. and Smith, A. (2015). Discrimination in healthcare settings is associated with disability in older adults: health and retirement study, 2008-2012. Journal of General Internal Medicine, 30, 14131420. doi: 10.1007/s11606-015-3233-6.CrossRefGoogle ScholarPubMed
San Jose, J. and Amado, C. (2017). On studying ageism in long-term care: a systematic review of the literature. International Psychogeriatrics, 29, 373387. doi: 10.1017/S1041610216001915.CrossRefGoogle Scholar
Sargent-Cox, K. (2017). Ageism: we are our own worst enemy. International Psychogeriatrics, 29, 18. doi: 10.1017/S1041610216001939.CrossRefGoogle ScholarPubMed
Schroyen, S., Missotten, P., Jerusalem, G., Giles, C. and Adam, S. (2016). Ageism and caring attitudes among nurses in oncology. International Psychogeriatrics, 28, 749757. doi: 10.1017/S1041610215001970.CrossRefGoogle Scholar
Temple, J. and Kelaher, M. (2018). Is disability exclusion associated with psychological distress? Australian evidence from a national cross-sectional survey. BMJ Open, 8, e020829. doi: 10.1136/bmjopen-2017-020829.CrossRefGoogle ScholarPubMed
Temple, J. and Williams, R. (2018). Multiple health conditions and barriers to healthcare among older Australians: prevalence, reasons and types of barriers. Australian Journal of Primary Health, 24, 8289. doi: 10.1071/PY17038.CrossRefGoogle ScholarPubMed
Tinney, J. et al. (2015). Mental health issues and discrimination among older LGBTI people. International Psychogeriatrics, 27, 14111416. doi: 10.1017/S1041610214002671.CrossRefGoogle ScholarPubMed
Wamala, S., Bostrom, G. and Nyqvist, K. (2007). Perceived discrimination and psychological distress in Sweden. British Journal of Psychiatry, 190, 7576. doi: 10.1192/bjp.bp.105.021188.CrossRefGoogle ScholarPubMed
Werner, P. and Giveon, S. (2008). Discriminatory behaviour of family physicians toward a person with Alzheimer’s disease. International Psychogeriatrics, 20, 824839. doi: 10.1017/S1041610208007060.CrossRefGoogle Scholar
World Health Organization. (2011). Global Health and Aging, NIH Publication no. 117737.Google Scholar
World Health Organization. (2012). Projections of mortality and causes of death: 2015 and 2030. Available at, accessed 17/04/18.Google Scholar
Zou, G. (2004). A modified Poisson regression approach to prospective studies with binary data. American Journal of Epidemiology, 159, 702706. doi: 10.1093/aje/kwh090.CrossRefGoogle ScholarPubMed