All causes TABLE 5-3.-TEN LEADING CAUSES OF DEATH BY OLDER AGE GROUPS, 1982 [Rates per 100,000 population in specified group] Diseases of the heart. Malignant neoplasms.. Cerebrovascular diseases. Accidents and adverse effects.. Chronic obstructive Pulmonary disease Pneumonia and influenza. Diabetes. Suicide Chronic liver disease and cirrhosis. Source: National Center for Health Statistics; Advance Report of Final Mortality Statistics, 1982, vol. 33, No. 9; Dec. 20, 1984. The factors which have led to reductions in mortality may or may not also lead to overall improvements in health status. If Americans continue to live only to about age 85, life-threatening disease could produce a healthier older population. But, if the lifespan is increased dramatically in future years beyond age 85, the onset of illness may only be delayed, without an actual shortening of the period of illness. (NOTE: It should be noted, that data for causes of death is based on information taken from death certificates and that, frequently, underlying causes are not listed but a secondary illness will be recorded.) G. COMMUNITY HEALTH SERVICES "INFORMAL SUPPORTS" PROVIDE THE MAJORITY OF COMMUNITY SERVICES TO THOSE ELDERLY WHO ARE DISABLED Friends, spouses, and other relatives provide valuable assistance to elderly persons who have disabling health problems but live outside of institutions. Preliminary data from the Health Care Financing Administration's Long-Term Care Survey demonstrate that, for the disabled older population living in the community, relatives provide 84 percent of all care to males and 79 percent to females (table 5-4).13 More wives than husbands provide care to disabled spouses, reflecting the fact that women outlive men by an average of 7 years. More than one-third of all elderly disabled men living in the community are cared for by a wife, while only one in ten elderly disabled women are cared for by a husband. 13 Manton and Liu, 1984. TABLE 5-4-PERCENT DISTRIBUTIONS OF CAREGIVERS BY RELATIONSHIP TO 65 PLUS INDIVIDUAL WITH ACTIVITY LIMITATIONS With increasing age, the support given by spouses decreases as other family members and "formal" caregivers compensate for the loss. Children of aging parents provide care to about one-quarter of elderly males in this category and to slightly over a third of elderly women. Other relatives such as siblings or nieces are also giving substantial care to elderly disabled family members, providing 23 percent of all community care to men and 35 percent to women. H. NURSING HOMES SMALL NUMBERS OF ELDERLY LIVE IN NURSING HOMES Only about 5 percent of the elderly population are in nursing homes at any given time, but 20 percent will spend time in a nursing home during a given year. In 1985, an estimated 1.5 million elderly persons will reside in nursing homes. 14 In this year, an estimated 2 percent (295,000) of those aged 65 to 74 years will be in a nursing home compared to about 7 percent (627,000) of persons aged 75 to 84 years, and about 16 percent (489,000) of persons 85plus. The rate of nursing home use by the elderly has almost doubled since the introduction of Medicare and Medicaid in 1966, from 2.5 to 5 percent of the over-65 population. Nearly 75 percent of nursing home residents are without a spouse, as compared to just over 40 percent of the noninstitutionalized elderly. Such statistics, along with those which show that nursing home residents tend to have health problems which significantly restrict their ability to care for themselves, suggest that the absence of a spouse or other family member who can provide infor 14 Manton and Liu, 1984. mal support for health and maintenance requirements is the most critical factor in the institutionalization of an older person. Source: Manton and 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, March, 1984 It is likely that the nursing home population will continue to grow rapidly, partly because of the growth in the size of the very old population, and partly because of the increasing gap in life expectancy between husbands and wives. Projections compiled by demographers Manton and Liu predict that between 1985 and 2000, the nursing home population will increase by 47 percent from 1.5 to 2.1 million, and, by 2040, it will more than double to 4.4 million (chart 5-7). Nursing home residents are disproportionately very old, female, white and currently unmarried. I. HEALTH SERVICES UTILIZATION THE ELDERLY ARE THE HEAVIEST USERS OF HEALTH SERVICES With a greater prevalence of chronic conditions than in the population at large, older persons use medical personnel and facilities more frequently than younger persons. On the average, persons 65plus visit a physician six times for every five visits by the general population. They are hospitalized approximately twice as often as the younger population, stay twice as long, and use twice as many prescription drugs. 15 Health care utilization is greatest in the last year of life and among the oldest of the old. According to the recent work of Lawrence Branch at Harvard Medical School, those 85 and older have a three-fold greater risk of losing their independence, seven times the chance of entering a nursing home and two-and-a-half times the risk of dying compared to persons 65 to 74 years of age. 16 HOSPITAL USAGE Although total short-stay hospital admissions for the elderly have decreased slightly in the last 2 years, use increased between 1965, the year Medicare was enacted, and 1983 by more than 50 percent versus a 10 percent increase for the total population (chart 5-8). In 1983, the hospital discharge rate (number of discharges over 1,000 population) for those 85 and over was over 84 percent higher than that for the 65- to 74-year-old group (table 5-5). The average hospital stay for persons age 65 to 74 was about 9 days in 1983 compared with about 11 days for the 85-year-and over group (chart 5-9). For the elderly, the average length of stay in hospitals has been declining somewhat as it has for all age groups. While the length of stay has been growing shorter, it is offset somewhat by an increase in multiple admissions during a year. TABLE 5-5.-UTILIZATION OF SHORT-STAY HOSPITALS FOR SELECTED AGE GROUPS, 1983 15 National Center for Health Statistics Tabulations. Reported in U.S. Senate Special Committee on Aging. Developments in Aging: 1984, vol. 1. 16 Soldo and Manton, 1984. |