Census: Americans Face Less Disability, Receive Better Care


Americans age 65 and older are living longer with fewer disabling health problems, according to a report from the U.S. Census Bureau.

The decline in disability is partly due to increased education levels among seniors, better treatments for cardiovascular diseases, and improvements in the management of chronic conditions, Richard M. Suzman, Ph.D., associate director of behavioral and social research for the National Institute on Aging said at a press briefing sponsored by the National Institutes of Health.

“Education is a particularly powerful factor in both life expectancy and health,” Dr. Suzman said.

The report, “65+ in the United States: 2005,” draws on existing data to examine the growth of the senior population, longevity and health, economic characteristics, geographic distribution, and social characteristics. The National Institute on Aging, a part of the National Institutes of Health, commissioned the report.

Census officials predict that the number of people age 65 and older will double within the next 25 years, leaving policy makers with more decisions to make on how to pay for and provide care to the senior population.

By 2030, nearly one of every five Americans—about 72 million people—will be 65 or older, said C. Louis Kincannon, director of the U.S. Census Bureau, and already the fastest-growing segment of the U.S. population is seniors age 85 and older.

But if current trends are any indication, those seniors could experience less disability from disease. A number of surveys compiled for the census report show an overall decline in disability among seniors over the past two decades. For example, one study estimates the level of disability at about 20% in 1999, compared with 26% in 1982.

Studies that assess instrumental activities of daily living, such as cooking, light housework, and using the telephone, show declining trends in disability. However, studies evaluating activities of daily living such as bathing, eating, and dressing show mixed results, according to the report.

Evidence from four surveys shows that about 20% of seniors have chronic disability, 7% to 8% have severe cognitive impairments, and about 30% experience difficulty with mobility.

“There still is a huge burden of disability once you look at the oldest old group,” Dr. Jane F. Potter, president-elect of the American Geriatrics Society said in an interview.

Prevention, including encouraging older patients to exercise regularly, is key in combating disability from chronic conditions, said Dr. Potter, who is also the section chief of geriatrics and gerontology at the University of Nebraska in Omaha.

About 80% of seniors have at least one chronic health condition and half have at least two chronic conditions.

Arthritis and heart disease are among the top chronic conditions affecting seniors. In 1998–2000, 19.3% of people age 75 years and older and 11.8% of those age 65 to 74 had activity limitations caused by arthritis and other musculoskeletal conditions. Heart and circulatory diseases affected 11.1% of seniors age 65 to 74 and 17.1% of seniors age 75 and older, according to data collected between 1998 and 2000.

Improvements in socioeconomic and living conditions in the first part of the 20th century and more recently advancements in public health and biomedical research have led to improvements in U.S. life expectancy. Life expectancy in the United States has reached 76.9 years, compared with 47.3 in 1900 and 68.2 in 1950.

But there are still racial differences in life expectancy, and the United States is lagging behind other populous countries, especially Japan and some Western European countries.

Continued progress on life expectancy will require advances in the prevention and treatment of heart disease, improved knowledge of the genetic links to cancer, and the need to adopt healthy lifestyles, according to the report.

The census report also analyzed how seniors were receiving medical care and other support. Individuals age 65 and older were less likely to have a regular source of medical care than younger people. And seniors were more likely to seek care at the emergency departments. The highest rates of emergency department use were among people age 75 and older, according to the report.

Among long-term care arrangements, home and community-based care are the most common. About 70%–80% of noninstitutionalized seniors receive their care from friends and family, frequently with help from a paid provider. But more than 65% of seniors who are noninstitutionalized depend on unpaid help only. Those who received paid care generally get fewer hours of care per week, according to the report.

More than 90% of institutionalized older individuals live in nursing homes, according to the report, and most of those residents are age 85 and older.


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