Disability Among Older Americans Declines Significantly: Good News For Medicare?
Chronic disability among older Americans has dropped dramatically, and the rate of decline has accelerated during the past two decades, according to a new analysis of data from the National Long-Term Care Survey.
The study, published in this week's Proceedings of the National Academy of Sciences, found that the prevalence of chronic disability among people 65 and older fell from 26.5 percent in 1982 to 19 percent in 2004/2005. The findings suggest that older Americans' health and function continue to improve at a critical time in aging of the population.
The study was funded by the National Institute on Aging (NIA), a component of the National Institutes of Health (NIH). A caregiving component of the survey was supported by the Office of the Assistant Secretary for Planning and Evaluation. All are part of the U.S. Department of Health and Human Services. Kenneth G. Manton, Ph.D., and colleagues at Duke University conducted the research.
In addition to a drop in the percentage of older Americans reporting disability, the analysis found that the average annual rate of the decline has accelerated. The decline in disability averaged 1.52 percent annually over the 22-year time span, but the rate of change shifted gradually from 0.6 percent in 1984 to 2.2 percent in 2004/2005.
"This continuing decline in disability among older people is one of the most encouraging and important trends in the aging of the American population," says NIA Director Richard J. Hodes, M.D.
The report is an eagerly anticipated update of the last assessment of NLTCS data in 2001. "The challenge now is to see how this trend can be maintained and accelerated especially in the face of increasing obesity," says Richard Suzman, Ph.D., director of NIA's Behavioral and Social Research Program. "Doing so over the next several decades will significantly lessen the societal impact of the aging of the baby-boom generation."
The analysis also showed that from 1982 to 2004/2005:
Chronic disability rates decreased among those over 65 with both severe and less severe impairments, with the greatest improvements seen among the most severely impaired. The researchers note that environmental modifications, assistive technologies and biomedical advances may be factors in these declines.
The proportion of people without disabilities increased the most in the oldest age group, rising by 32.6 percent among those 85 years and older.
The percentage of Medicare enrollees age 65 and older who lived in long-term care institutions such as nursing homes dropped dramatically from 7.5 percent to 4.0 percent. The emergence of assisted-living options, changes in Medicare reimbursement policies and improved rehabilitation services may have fueled this decrease in institutionalization.
If they continue as anticipated, the downward trends in chronic disability rates among older adults could help bolster the Medicare program's fiscal health, the researchers suggest.
Funded through a cooperative agreement between the NIA and Duke University, the NLTCS is a periodic federal government survey of approximately 20,000 Medicare enrollees.