As life expectancy has increased in the United States, the number of older adults in the population has also increased. These increases have led older adults (90 and older) to become the fastest growing age group in the country. Older people face many unique challenges due to their age, including disability. Disability among older people has a major impact on society 1 and will continue to represent an increasing burden in the years to come. Although numerous studies show that the disability rate is declining in the United States,2 the rapid expansion of the oldest age group will continue to pose health care challenges for future generations. Disability prevalence rates are very high among older people3 and even reach 97% among centenarians4. These high rates of disability will have a considerable financial impact in the future, as people with disabilities will have much higher healthcare costs5. Due to the increasing concern associated with disability among older adults, many researchers have examined factors that may be associated with risk. disability among the elderly. These factors vary widely, including functional limitations6-9, physical activity level10, 11, depression12-15, cognitive status13, 16, 17, comorbidities18, 19, falls6, 20, self-report health status21, 22, social interactions23 and others24. Understanding the incidence of disability among older people is a crucial step in identifying methods to reduce disability in this at-risk age group. We examined incident disability in a large cohort of participants aged 90 and older, the 90+ Study. As part of their participation in the 90+ study, participants are followed longitudinally, with detailed information on functional abilities obtained...... middle of article ......verestimating disability, in particularly among the elderly47. This manuscript details the alarming increase in disability among older people. With the rapid growth of this age group, problems associated with functional loss have a considerable financial impact around the world. The study identified several risk factors associated with increased incidence of disability, several of which may be modifiable. This is particularly critical because CHF is the most expensive disease in the United States, accounting for more than 5% of the total health care budget48. With the rapid increase in the prevalence and incidence of CHF in the United States, 49 it will be essential to prepare for the resulting dramatic increase in disability. Reducing CHF risk factors, such as hypertension and high cholesterol, would likely be beneficial in reducing incident disability in older people..