Unemployment is a serious problem for those elderly persons who have to work for economic reasons or because they want to stay active. Based on third quarter figures for 1984, the unemployment rate for the elderly was 3.1 percent (table 4-6). Of Americans age 60 and over, 300,000 were out of work in the third quarter of 1984; 92,000 of these were age 65 or over. These numbers are not large compared to younger age groups, but because duration of unemployment is longer among older workers and there are many more discouraged older workers than younger workers, the official unemployment rate is a poor indicator of the seriousness of the problem.

TABLE 4-6. UNEMPLOYMENT BY AGE AND SEX, THIRD QUARTER 1984

Source: U.S. Department of Labor, Bureau of Labor Statistics, Current Population Survey, unpublished.

Older persons who are unemployed stay out of work longer than younger persons. In fact, persons age 55 to 64 have the longest spells of unemployment of any group in the country. For inprogress spells of unemployment in which the job seeker has not yet found a job or given up the search for one, workers aged 55 to 64 have an average of 18.3 weeks of unemployment as compared to 13 weeks for workers age 20 to 24.

Discouraged workers are those who have given up looking for jobs and no longer appear in either unemployment or employment statistics. For men age 65 and over, the percentage of discouraged workers is comparable to the percentage unemployed. If added together, discouraged workers would add 3.2 percentage points to unemployment rates for males 65-plus and 4.7 percentage points for females 65 and older. This would, in effect, double current unemployment rates for older workers.1

Ölder job seekers are far less likely to find a job than younger persons. If they do find a job they are likely to suffer an earning loss. Longitudinal data and surveys have demonstrated that the wages of rehired older workers are often so low that it discourages many from seeking work after losing a job. Fringe benefits for older workers are also less common, largely because most older workers are employed by small employers who have only limited, if any, benefits for their workers.

1 Rones, Phil, 1983.

Chapter 5

HEALTH STATUS AND HEALTH SERVICES

UTILIZATION

The majority of elderly persons in their younger retirement years are relatively healthy and are not as limited in activity as frequently assumed-even if they have a chronic illness. However, health and mobility does decline with advancing age. By the eighth and ninth decade of life, the chance of being limited in activity and in need of health and social services increases significantly.

This section describes the health status, health utilization patterns, and health expenses of the older population.

A. SELF-ASSESSMENT

OLDER PERSONS HAVE A POSITIVE VIEW OF THEIR PERSONAL HEALTH Contrary to popular opinion, older people, on the average, view their health positively. According to results of the 1982 Health Interview Survey conducted by the National Center for Health Statistics, 65 percent of elderly persons living in the community describe their own health as excellent, very good, or good compared with others of their own age; only 35 percent report that their health is fair or poor.1 Although this survey excludes the institutionalized 65-plus population and, therefore, oversamples the healthy elderly, the results are a good indicator of overall health status of the elderly in the community. According to the National Center for Health Statistics:

Self-assessed health status has been found to be highly associated with an individual's utilization of healthcare services. For instance persons who reported excellent health spent 3.3 days in bed per person per year due to illness or injury and made 2.5 doctor visits per person per year, while the corresponding estimates for persons assessed to be in poor health were 64.2 bed days and 15.3 doctor visits per person per year.2

Income is directly related to one's perception of his or her health (chart 5-1). More than 40 percent of those with incomes over $25,000 described their health as excellent compared with others of their own age, but less than 25 percent of those with low incomes (less than $7,000) reported excellent health.3

1 2 3 U.S. Senate Special Committee on Aging, Aging America, 1984.

Source: National Center for Health Statistics, Health Interview Survey

1981

B. DISABILITY

ONE OF FIVE ELDERLY PERSONS HAS SOME DEGREE OF DISABILITY WHILE A SMALL PROPORTION ARE SEVERELY DISABLED

The severity of any disease can differ tremendously from person to person, causing varying degrees of limitation in activity. For example, one person with arthritis may become housebound, while another only suffers from occasional flare-ups. According to recent estimates, one out of five elderly persons has at least a mild degree of disability (table 5-1). A small proportion are severely disabled (chart 5-2). A widely used measure of disability among older persons is the number of people with an activity of daily living limitation (ADL). According to the ADL scale, disabled individuals are mildly disabled (an ADL of one to two), disabled (an ADL of three to four) or severely disabled (an ADL of five to six). The 1982 National Long-Term Care Survey (NLTCS) sampled the noninstitutionalized disabled population to determine, among other things, the sources and amounts of long-term care provided to the disabled elderly population. Preliminary data from this study demonstrate that about 19 percent of 65-plus persons have some degree of limitation (mild to severe), 16 percent of males and 21 percent of females. Four percent of the elderly population is severely disabled, 3 percent of males and 4 percent of females.4

4 Manton, Kenneth G. and Korbin Liu. The Future Growth of the Long-Term Care Population: Projections Based on the 1977 National Nursing Home Survey and the 1982 Long-Term Care Survey, 1984.

Source: Manton and Liu, Preliminary data from the 1982 Long
Term Care Survey

female male

TABLE 5—1.—PERCENT OF THE 65 PLUS POPULATION IN THE COMMUNITY WITH ADL LIMITATIONS

RATES OF DISABILITY INCREASE WITH AGE

Although more than half of the oldest-old, the 85-plus generation, are not disabled, cross-sectional data demonstrates that the chance of becoming at least mildly disabled increases for the oldest age groups (table 5-1). In fact, males and females 85 and older are four times more likely to be disabled than those age 65 to 74. Almost half, about 46 percent, of persons 85-plus are mildly-to-severely disabled compared to about 13 percent of persons age 65 to 74 and 25 percent of persons 75 to 84. Females more than males are likely to have activity limitations when they live beyond age 85. For instance, about 49 percent of women age 85 and older are limited to some degree, compared to about 41 percent of men. About 12 percent of women in the oldest age category are severely disabled compared to less than 8 percent of men.5

C. CHRONIC CONDITIONS AND HEALTH PROBLEMS CHRONIC CONDITIONS, ALTHOUGH NOT NECESSARILY LIMITING, ARE THE BURDEN OF OLDER AGE

The pattern of illness and disease has changed in the past 80 years. Acute conditions were predominant at the turn of the century, chronic conditions are now the most prevalent health problem for elderly persons. There has also been a change in the pattern of illness within an individual's lifetime. As individuals grow older, acute conditions become less frequent and chronic conditions become more prevalent. Cross-sectional data has shown that the likelihood of suffering from a chronic illness or disabling condition increases rapidly with age. More than four out of five persons 65 and over have at least one chronic condition and multiple conditions are commonplace in the elderly.

The leading chronic conditions causing limitation of activity for the elderly in 1982 were arthritis and hypertensive disease, hearing impairments, and heart conditions (chart 5-3). In most cases, the rates for these diseases are much higher for the elderly population than for persons 45 to 64. For instance, the likelihood of suffering from arthritis is 80 percent higher for those 65 and over than for those age 45 to 64; the likelihood of hypertension is 59 percent higher for the oldest age group.

5 Manton and Liu, 1984.

6 National Center for Health Statistics. 1981 National Ambulatory Medical Care Survey. Reported in U.S. Senate Special Committee on Aging. Aging America. 1984.