Most Elderly 90+ Dependent on Government Programs

Social Security payments made up almost half of the group’s income. In 2006-2008, about 15% lived in poverty, 81% of whom were women. This translates to 16% of women and 10% of men aged 90 years and older living in poverty.

Whites were most financially secure, with the lowest poverty rate (13%). The rate was 16% for Asians, 21% for Hispanics, and 25% for blacks.

Most (85%) of the sample reported some type of disability, from sight problems (24% of noninstitutionalized elders) to difficulties with doing errands, including visiting the doctor (60% of the noninstitutionalized group). Those living in nursing homes were much more likely to have a disability than were those living independently (98% vs. 81%).

"We talk about ‘compression of morbidity,’ which means keeping healthy as long as possible until you simply drop dead on a certain day," Dr. Chun said. "We have not yet compressed morbidity to the point that we can continue to live fully until that given day. There is often a long period of multimorbidity that can occur in the 90s, and we need to invest in ways to reduce that."

The report also noted the degree to which these elders relied on government health care services. "Almost everyone (99.5%) was covered by health insurance ... 99% had Medicare coverage and 28% also received Medicaid benefits in 2008."

Government entitlement services have "a huge impact" on health care access and quality of life for the oldest old, and will continue to do so as the baby boomers age into their 90s, Dr. Chun said. "To take away or change these entitlements will [have] a big impact on health care and people’s access to health. Right now, most of our elderly are able to get good medical care in most areas of the country." Changes in the way these programs are run, however, could alter their health and maybe even life expectancy, she said.

"The policy challenge that lies ahead is how to provide cost-effective ways for our older adults to get the best care. This might mean keeping them out of the hospital by coordinating care and allowing them to stay at home, living with dignity and comfort. But this has to be thoughtfully considered. There are better ways to deal with the problem than by throwing money at it heedlessly or by taking things away without considering the long-term implications,"

Dr. Chun reported no financial conflicts of interest.