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) Profile of Older Americans, 1997

3. 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

6. 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

7. Distribution of Elderly Population by Age Groups % of Population 65-84

8. Percentage of Population > 84 years

9. 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)

11. 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 Measures of Functional Status

12. 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

15. 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

16. 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