munity. For instance, in 1982, relatives provided approximately 80 percent of all community care to disabled elderly men. -Only about 5 percent of the elderly live in nursing homes at any given time. In 1985, an estimated 11.5 million elderly persons will reside in nursing homes.

-The elderly are the heaviest users of health services. They account for 29 percent of all hospital discharges and one-third of the country's personal health care expenditures even though they constitute only 11 percent of the population. Health care utilization is also greatest in the last year of life and among the old-old.

-Out-of-pocket health expenses for the elderly are now the same as they were prior to the enactment of Medicare and Medicaid. Today, the average out-of-pocket expense to the elderly is $1,059 annually.

-Per capita spending for health care for the elderly was $4,202 in 1984.

Social characteristics:

-Most elderly men are married and live in a family setting, while most older women are widows. In 1982, 67 percent of women age 75-plus were widowed and 55 percent lived alone while 67 percent of men in this age group were married and 65 percent lived with their wives.

-The gap in educational attainment between the elderly and nonelderly is closing. In 1980, the proportion of the population aged 55 to 64 years which had completed high school nearly equaled that of the younger population.

-In 1980, 72 percent of the households maintained by an older person were owner-occupied and about 80 percent of these were owned free and clear.

-With increasing age, Americans tend to rent rather than own. -The elderly are most likely to live in older homes. In 1980, 40 percent of both elderly owners and elderly renters lived in housing structures built in 1939 or earlier.

-Significant numbers of elderly persons live in inadequate housing and do not have telephones. In 1980, one out of ten elderly persons lived in homes infested with rats and mice, 30 percent lived in housing with bedrooms which lacked privacy, and almost 15 percent of male renters aged 65 to 69 were without telephones.

-The elderly and the near elderly are the most likely age groups to vote. Data for the 1984 election are incomplete. Data for the 1980 and 1982 elections demonstrate that about onethird of all voters are age 55 or older.

Federal expenditures on the elderly:

-Federal spending on the elderly has nearly doubled since 1960.
In 1985, 28 percent of the Federal budget, $263.5 billion, is ex-
pected to be of direct benefit to older Americans.
Today, rising health care costs have overtaken Federal spend-
ing for retirement income as the source of greatest increase in
Federal spending on the elderly. Projections for 2030 indicate
that spending, as a percent of GNP, will equal 5.7 percent for

Social Security and disability payments, compared to 6 percent for Medicare financing and other Federal health care programs. In 1983, spending for Social Security and disability equaled 5.2 percent of GNP. Federal health spending was only 2.7 percent of GNP in 1983.

The age group 65-plus is used most often in this report to represent the elderly population. While the attainment of age 65 no longer marks the point of retirement for most workers, it is the age of eligibility for full Social Security benefits and for Medicare coverage. Also, after age 65, many characteristics of the population show marked differences from younger age groups (e.g., sex composition, morbidity rates, work participation, living arrangements). Perhaps most importantly, 65 is the age traditionally used to demarcate the older population for many statistical analyses. The characteristics of this broad age group are, when possible, compared with those of persons in subgroups such as 55-plus, 75-plus, or 85-plus. Occasionally, the age groups 60-plus or 55-plus are used as descriptors of the "older" population for certain purposes. Unfortunately, the available data often limits the amount of age detail that can be presented.

Chapter 1

SIZE AND GROWTH OF THE OLDER

POPULATION

The older population has increased far more rapidly than the rest of the population for most of this century. In the last two decades alone, the 65-plus population grew by 54 percent while the under-65 population increased by only 24 percent. Since 1960, an average of 149,000 persons a month have joined the ranks of the elderly. This type of demographic change is unprecedented and bears one dramatic conclusion: America is growing older.

1

The following chapter describes this trend towards people living longer and its impact on the country's age distribution. Selected characteristics of the elderly population and the international impact of the aging of the population are also provided. Please note that the projections presented in this section and throughout this report do not imply certainty about future events. They represent forecasts based on continued patterns from the past and assumptions about future trends in fertility, mortality, and net immigration.

A. 1984 AGE DISTRIBUTION

1984 POPULATION STATISTICS REFLECT THIS CENTURY'S GROWTH IN THE OLDER POPULATION

At the beginning of this century, less than one in ten Americans was age 55 and over and one in 25 was age 65 and over. By 1984, one in five Americans was at least 55 years old and one in nine was at least 65.

This century's dramatic increase in the number and proportion of older persons is reflected in the 1984 population estimates prepared by the U.S. Census Bureau. In 1984, there were an estimated 50.2 million Americans age 55 or older and 28 million who were at least age 65. About 9 percent (22.2 million) of the total population was 55 to 64 years old, 7 percent (16.6 million) was 65 to 74 years old, 3.7 percent (8.8 million) was 75 to 84 years old and 1.1 percent (2.6 million) was 85 years old and over (table 1-1).

1 Soldo, Beth J. and Kenneth G. Manton. The Graying of America: Demographic Challenges for Socioeconomic Planning. The Journal of Socio-Economic Planning Sciences, 1984, in press.

TABLE 1-1-DISTRIBUTION OF THE POPULATION BY OLDER AGE GROUPS, 1984

Chart 1-1 displays the country's age distribution in 1984 and gives a glimpse into the future. The "baby-boom" generation (age 20 to 39) which dominates the picture, is the result of increased fertility after World War II-from 1946 to 1962. This generation will dominate the age distribution of the country well into the next century. In fact, when this group begins to collect Social Security benefits in the early part of the 21st century, they will swell the ranks of the 65-plus generation to the point that one in five Americans will be elderly.

Series P-25, No. 952.

Chart 1-1 also provides a graphic representation (by 5-year age intervals) of the size of the older population in relation to the