Aging America: Health and

Health Care
David Oliver, PhD
Steven Zweig, MD, MSPH
 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

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

18
16
14
12
10
8
6
4
2
0
1900 1920 1940 1960 1980 2000 2020 2040
 Percentage of Population > 84 years

4
3.5
3
2.5
2
1.5
1
0.5
0
1900 1920 1940 1960 1980 2000 2020 2040
 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
Deaths in Missouri for 65+, 1998 (77%
of all Missouri deaths)
Cancer 21% 8885
Heart Disease 36% 15031
CVD 8% 3545
COPD 6% 2373
All others 29% 42143
 Measures of Functional Status
• Instrumental Activities • Activities of Daily
of Daily Living Living (ADLs)
(IADLs) – bathing
– preparing meals – dressing
– shopping – eating
– managing money – toileting
– using phone – mobility
– doing housework – transfer ability
– taking medications
 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%
 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
 Dependency in one or more
ADLs, 1994
40
35
30
25 White men
20 White women
Black men
15
Black women
10
5
0
70-74 75-84 85+
 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
 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