PHYSICIAN SERVICES Use of physician services increases with age. In 1987, persons age 45 to 64 averaged 6.4 doctor contacts a year, while persons age 65 to 74 averaged 8.4 contacts and those age 75 and over averaged 9.7 visits. The likelihood of seeing a doctor at least once during a given year increases slightly with age. Among those in the 65 to 74 age group, 83.2 percent reported seeing a doctor during the last year, compared to 87.8 percent of those age 75 or older (table 4-13). Šince the enactment of Medicare, the average number of physician contacts and the percentage of persons 65 and over reporting that they had seen a physician in the last year have increased significantly, particularly for persons with low income.22 TABLE 4-13.-NUMBER OF PHYSICIAN CONTACTS AND INTERVAL SINCE LAST PHYSICIAN CONTACT, BY AGE: 1987 Note. Data include office visits, telephone consultations, hospital contacts (including emergency room and outpatient visits but excluding inpatient visits), and other modes of contact. Source: National Center for Health Statistics. "Current Estimates from the National Health Interview Survey, United States, 1987." Vital and Health Statistics Series 10, No. 166. The aging of the population will create a greater demand for physician care (table 4-14). According to projections based on 1986 physician contact rates and projections of the noninstitutionalized elderly population, the demand for physician contacts will increase 22 National Center for Health Statistics. Health Interview Survey. Unpublished tabulations, 1983. by 22 percent, from 250 million to 304 million contacts by the year 2000, and by 129 percent, to more than 570 million visits by 2030.23 The disparity between the elderly and nonelderly populations in the use of physician services is not as great as the disparity for other forms of health care. In 1986, persons 65 and older, 11.7 percent of the noninstitutionalized population, accounted for 19.6 percent of physician contacts. TABLE 4–14.—PROJECTED PHYSICIAN VISITS AND PERCENT CHANGE IN VISITS FOR 2000 AND 2030 [Number of persons and total visits in thousands] Only about 5 percent of the elderly population are in nursing homes at any given time, but many more will live in nursing homes during their lifetimes. The risk of institutionalization at age 65 is widely debated, with recent estimates ranging from 36 percent 24 to 65 percent.25 Women are more likely than men of comparable ages to enter a nursing home. The lifetime risk of institutionalization for women at age 65 has been estimated at 52 percent and that for men at 30 percent. 26 In 1985, an estimated 1.3 million elderly persons lived in nursing homes during the year. An estimated 1 percent (212,100) of those ages 65 to 74 were residents, compared to about 6 percent (509,000) of persons age 75 to 84, and about 22 percent (594,700) of persons age 85-plus.27 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. Nursing home residents are disproportionately very old, female, and white. Nearly 84 percent of nursing home residents are without a spouse, as compared to 45 percent of the noninstitutionalized elderly. Also, only 63 percent of older nursing home residents have children, compared to 81 percent of older people in the community. Such statistics, along with those which show that nursing home 23 U.S. Administration on Aging. Unpublished projections. 24 Liang, Jersey and Edward Jow-Ching Tu. "Estimating Lifetime Risk of Nursing Home Residency: A Further Note." The Gerontologist Vol. 26, No. 5 (October 1986). 25 McConnel, Charles E. "A Note on the Lifetime Risk of Nursing Home Residence." The Gerontologist Vol. 24, No. 2 (April 1984). 26 Cohen, Mark A., Eileen J. Tell, and Stanley S. Wallack. "The Lifetime Risks and Costs of Nursing Home Use Among the Elderly." Medical Care Vol. 24, No. 12 (December 1986). 27 Hing, Esther. "Use of Nursing Homes by the Elderly: Preliminary Data from the 1985 National Nursing Home Survey." Advance Data No. 135, National Center for Health Statistics (May 14, 1987). 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 informal support for health and maintenance requirements is the most critical factor in the institutionalization of an older person. The majority of nursing home residents do not stay in a facility over 179 days (table 4-16). However, length of stay varies by marital status. For example, according to a recent study by the Brookings Institution and ICF, Inc., the probability that a married person would leave a nursing home within 29 days of admittance is almost 1 in 3, but the probability for an individual who is not married is 1 in 2. TABLE 4-15.-SELECTED CHARACTERISTICS OF NURSING HOME AND COMMUNITY RESIDENTS 65 YEARS AND OLDER: 1985 AND 1984 3 Although comparable data are not available, the 1984 SOA (see source) found that six percent of the community-resident older population had difficulty with urinary control or had urinary catheters. (NA) Not available. Source: National Center for Health Statistics. Data from the National Health Interview Survey, Supplement on Aging, 1984, and the 1985 National Nursing Home Survey, Advance Data Nos. 115, 121, 133, and 135; and unpublished data. TABLE 4-16.-NURSING HOME LENGTH OF STAY PROBABILITIES BY AGE OF ENTRY AND MARITAL Source: Brookings Institution and Lewin/ICF calculations using data from the 1985 National Nursing Home Survey. It is likely that the nursing home population will continue to grow rapidly, primarily because of the growth in the size of the very old population. Current projections indicate that between 1985 and 2000, the nursing home population will increase from 1.3 to 2 million, and will more than double again to 4.6 million by 2040 (chart 4-6). Chart 4-6 PROJECTIONS OF ELDERLY NURSING HOME Source: Donald Fowles, U.S. Administration on Aging. Based on utilization COMMUNITY HEALTH SERVICES "INFORMAL SUPPORTS" PROVIDE THE MAJORITY OF COMMUNITY SERVICES TO THOSE ELDERLY WHO ARE DISABLED Friends, spouses, and other relatives provide valuable "informal" unpaid assistance to elderly persons who have disabling health problems but live outside of institutions. Data from the Health Care Financing Admninistration's 1982 Long-Term Care Survey demonstrate that, for the disabled older population living in the community, relatives represented 84 percent of all caregivers for males and provided 90 percent of days of care; likewise, relatives represented 79 percent of caregivers and provided 84 percent of days of care for older disabled females (table 4-17). More wives than husbands provided care to disabled spouses, reflecting the fact that women outlive men by an average of 7 years. More than onethird of all elderly disabled men living in the community in 1982 were cared for by their wives, while only 1 in 10 elderly disabled women were cared for by their husbands. TABLE 4-17.—PERCENT DISTRIBUTION OF CAREGIVERS AND DAYS OF CARE FOR PEOPLE 65 AND OLDER WITH LIMITATIONS IN ACTIVITIES OF DAILY LIVING, BY RELATIONSHIP TO RECIPIENT: 1982 Note.-Formal caregivers typically receive payment for services compared with informal caregivers (usually relatives) who are not compensated. Source: Manton, Kenneth and Korbin Liu. "The Future Growth of the Long-Term Population: Projections Based on the 1977 National Nursing Home Population and the 1982 Long-Term Care Survey." Paper prepared for the Third National Leadership Conference on Long-Term Care Issues: Washington, D.C., March 7-9, 1984. Children of aging parents provided care to about one-quarter of elderly disabled males in 1982, and to slightly more than a third of elderly women. Other relatives such as siblings or nieces gave also substantial care to elderly disabled family members, representing 23 percent of all community caregivers for men and 35 percent for women. With increasing age, the support given by spouses decreases as other family members and "formal" caregivers compensate for the loss. Analyses of the 1982 data on informal caregivers show that approximately 2.2 million caregivers age 14 and older were providing unpaid assistance to 1.6 million noninstitutionalized elderly dis |