older workers there are relatively many more discouraged older workers than younger workers. As a consequence the official unemployment figures may understate the number of people with employment problems more for older than younger workers.

Source: U.S. Department of Labor, Bureau of Labor Statistics. Employment and Earnings Vol. 36, No. 1 (January 1989).

Older persons who are unemployed stay out of work longer than younger persons. In fact, persons age 55 to 64 have the longest duration of unemployment of any group in the country. Workers aged 55 to 64 in 1987 had an average of 22 weeks of unemployment compared to 11 weeks for workers age 20 to 24.

Discouraged workers are those who want a job but do not look for work because they think no jobs are available or that they would not be hired. They do not appear in either unemployment or employment statistics. For persons age 60 and over, the number of discouraged workers was 177,000 in 1987. If they were included in labor force statistics, discouraged workers would increase the 1987 unemployment rate for workers 60 years or older from 3 percent to 5.2 percent.

Older job seekers are far less likely to find jobs than younger persons. If they do find jobs, they are more likely to suffer an earnings loss. Longitudinal data and surveys have demonstrated that the wages of rehired older workers are often so low that they discourage many from seeking work after losing a job. Fringe benefits for older worker are employed by small employers who provide only limited, if any, benefits for their workers.

Chapter 4

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 chronic illnesses. However, health and mobility do decline with advancing age. By the eighth and ninth decades 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.

SELF-ASSESSMENT OF HEALTH

OLDER PERSONS HAVE A POSITIVE VIEW OF THEIR PERSONAL HEALTH Contrary to popular opinion, older people, on average, view their health positively. According to results of the 1987 Health Interview Survey conducted by the National Center for Health Statistics, 69 percent of elderly persons living in the community describe their health as excellent, very good, or good compared with others their age; only 31 percent report that their health is fair or poor.1 Although this survey excludes the institutionalized 65-plus population and, therefore, over-samples the healthy elderly, the results are a good indicator of overall status of the elderly in the community.

Income is directly related to one's perception of his or her health (chart 4-1 and table 4-1). About 25 percent of older people with incomes over $35,000 describe their health as excellent compared with others their age, while only 11 percent of those with low incomes (less than $10,000) reported excellent health.2

1 National Center for Health Statistics. "Current Estimates from the National Health Interview Survey, United States, 1987." Vital and Health Statistics Series 10, No. 166 (September 1988).

2 Ibid.

TABLE 4-1.-NUMBER OF ELDERLY PERSONS AND PERCENT DISTRIBUTION BY RESPONDENTASSESSED HEALTH STATUS, BY SEX AND FAMILY INCOME, 1986

3 The categories related to this concept result from asking the respondent, "Would you say-health is excellent, very good, good, fair, or poor?" As such, it is based on the respondent's opinion and not directly on any clinical evidence.

4 Includes unknown family income.

Source: National Center for Health Statistics, Current Estimates from the National Health Interview Survey, United States, 1986, Vital and Health Statistics, Series 10, No. 164. Data are based on household interviews of the civilian, noninstitutionalized population.

PERSONAL HEALTH HABITS

THE ELDERLY TEND TO HAVE BETTER PERSONAL HEALTH HABITS THAN THE NONELDERLY

Findings from the 1985 National Health Survey indicate that the elderly take better care of their health than the nonelderly. Per

sons age 65 and over are less likely to smoke, be overweight, drink, or report that stress has adversely affected their health than the nonelderly. However, the elderly are far less likely to exercise regularly.

The lower rates of smoking and drinking among the elderly can be attributed to the tendency toward discontinuation of these habits in older age, whether spontaneously or in response to medical condition or advice, and to the higher mortality rates (lower survival rates) of those who were smokers and drinkers. For example, the 1979 Surgeon General's Report on Smoking and Health states that males in their thirties who smoke more than two packs of cigarettes a day lose an average of 8 years of life. Slightly over one-half of both elderly and nonelderly persons have ever smoked. However, only one-third of elderly persons who ever smoked still do so compared with two-thirds of nonelderly persons. Thirty-one percent of elderly persons report smoking every day compared to a high of 42 percent of 18- to 29-year-olds. In addition, only 12 percent of the elderly compared to 25 percent of persons 45 to 64 reported taking five or more drinks on any given day.

The elderly are slightly less likely to be overweight than the nonelderly. Thirteen percent of older persons report themselves as being 30 percent or more above desirable weight, compared to 18 percent of those 45 to 64. Nearly three-fourths of both elderly and nonelderly who are trying to lose weight do so by consuming fewer calories. However, while 77 percent of those under age 65 exercise to lose weight, only 53 percent of the elderly do so.

Older people, in general, do not exercise as regularly as younger people-27 percent and 44 percent, respectively. There is no difference between the two groups for light to moderate exercise-approximately 40 percent of both age groups reported walking for exercise, but few elderly reported heavier exercise, such as jogging or running. Differences in perceptions of physical activity vary only slightly by age. At age 75, 10 percent of individuals report that they are less physically active than their contemporaries compared with 15 percent of persons age 65 to 74 (table 4-2).

The elderly have better eating habits than younger people. Nearly 9 out of 10 (87 percent) eat breakfast every day compared to one-half of those under age 65. Only 5 percent of persons age 75 and older report never eating breakfast compared to a high of 30 percent for 18- to 44-year-olds. The elderly are also far less likely to eat between meals-55 percent of the aged compared to 75 percent of the nonaged.

Two other indicators that the elderly take better care of their health than the nonelderly are reduced stress and a regular source of medical care. Stress affects the health of younger people far more often than the elderly. Nearly two-thirds of the elderly reported that stress had little or no effect on their health, compared to 52 percent of younger people. A vast majority of the elderly (88 percent) have a regular source of medical care, compared to 75 percent of the nonelderly.