Aging America: Health and Health Care

1
Aging America Health and Health Care

• David Oliver, PhD
• Steven Zweig, MD, MSPH

2
Profile of Older Americans

• In 1996, there were 34 million 65 and over in the
  US (12.8 of the population)
• 1.45 more women than men (14 million)- for
  persons 85 and older, 2.57 women for for each man
  in the same age cohort
• Since 1900, percentage tripled from 4.1 to 12.8
  - 3.1 million to 34 million - 85 group is 31
  times larger (3.8 million)

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Charateristics of 65

• 43 of women and 76 of men are married (33
  difference is all widows)
• 6 living with children or other relatives
• 30 live alone (42 women, 17 men)
• 4 (1.4 million) in nursing homes, 1 65-74 and
  15 for 85
• 7 of minority and Hispanic were 65, compared
  with 15 nonhispanic whites

4
Life expectancy

• A child born in 1996 would have life expectancy
  of 76.1 year, 29 years longer than in 1900
• At 65, life expectancy 19.2 years for women and
  15.5 years for men
• Life expectancy at age 65 increased 2.4 years
  between 1900 and 1960, and 3.4 years since 1960

5
Poverty in older Americans

• 3.4 million live below the poverty line
• Rate same as with younger persons (10.8), but
  25.3 Blacks and Hispanics, and 47.5 of black
  women living alone are below the poverty line

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Health and Health Care

• In 1994, 28 rated health as fair or poor,
  compared with 10 for all persons (43 Blacks)
• Average 35 restricted activity days in 1994, 14
  of these in bed
• 54 have IADL or ADL limitation

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Distribution of Elderly Population by Age Groups
of Population 65-84
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Percentage of Population gt 84 years
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Prevalence of Disability

• In 1990, 13.2 million Americans (70.5 per 1000)
  adults could not go out alone or had a dependency
  in ADL, 1/2 were 65
• Prevalence of disability increases with age,
  women over 75, lower education and income levels,
  and ethnic minorities
• Incidence in men and women same, but women live
  longer accounting for greater prevalence

10
Deaths in Missouri for 65, 1998 (77 of all
Missouri deaths)
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Measures of Functional Status

• Instrumental Activities of Daily Living (IADLs)
• preparing meals
• shopping
• managing money
• using phone
• doing housework
• taking medications

• Activities of Daily Living (ADLs)
• bathing
• dressing
• eating
• toileting
• mobility
• transfer ability

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Disease and Disability

• Mortality rates increase with disability
• Number of chronic health conditions strongly
  related to disability
• Osteoarthritis 34 stroke, visual impairment,
  heart dx, dementia 50 and PVD, lung dx,
  depression, diabetes, hearing dx, and
  hypertension 15

13
Do years of life add years of disability?

• Will recent increases in longevity result in more
  disability?
• Theory of compression of morbidity predicts a
  future decrease in the number of years with
  severe disease and disability
• Outcomes should measure disability-free or active
  life expectancy
• Some disabled transition back to active

14
Dependency in one or more ADLs, 1994
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Mortality and Morbidity

• Future improvements in health will result in
  compression of morbidity at end of life span
• Reductions in mortality at old age may have been
  achieved by postponing the lethal effects of
  chronic diseases, e.g. dementia
• Best predictors of mortality are markers of
  established diseases and degree of functional
  incapacity

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Implications for the heath system

• Health work force
• Organization of health care
• Financing medical vs. social care
• Benefits of prevention
• Genetic counseling
• Assistive technologies
• Advance care planning