RATES OF LIMITATION INCREASE WITH AGE

Although 60 percent of people over age 65 have no limitation of activity, the chance of being severely limited increases for the oldest age groups. In fact, for the oldest-old, the 85-plus generation, the rates reverse, as 60 percent of this group is limited to some degree. Almost one-quarter of persons over age 85 are unable to perform usual activities compared to 11 percent of those in the 65 to 74 age group (table 4-2). For those 75 years and over, 10 percent of men and 12 percent of women are unable to perform daily activities.

TABLE 4-2. PERCENT OF THE 65-PLUS POPULATION LIVING IN THE COMMUNITY WITH ACTIVITY

Source: National Center for Health Statistics, National Health Interview Survey, Supplement on Aging, 1984.

Another measure of activity limitation is the number of days a person is confined to bed. Again, we find differences in this health indicator within the 65 and over population. For those aged 85 and over living in the community, 3.4 percent are always confined to bed. In contrast, only 1 percent of the 65 to 74 age group was similarly limited. Sixty-two percent of the total older population spent no days confined to bed in 1984 (table 4-3).

TABLE 4-3-PERCENT OF THE 65-PLUS POPULATION IN THE COMMUNITY CONFINED TO BED

Source: National Center for Health Statistics, National Health Interview Survey, Supplement on Aging, 1984.

D. MORTALITY

DEATH RATES FOR THE ELDERLY HAVE IMPROVED DRAMATICALLY IN THE LAST FOUR DECADES

The last four decades have seen tremendous improvement in life expectancy (see chapter 1). The age-adjusted death rate for the elderly decreased by 47 percent, 39 percent for men and 55 percent for women, from 1940 to 1985 (chart 4-4).

SOURCE: Social Security Area Population Projections 1986, Actuarial Study No. 97

(NOTE.-Analysis of trends in mortality is enhanced by examining age-adjusted death rates which are relatively free from the distortions associated with a changing age composition. Age-adjusted death rates show what the level of mortality would be if there were no changes in the age composition of the population from year to year.)

An examination of the crude death rate, the actual number of people who died per 100,000 population, reveals that the death rate has increased slightly from its low point in 1982. In 1985, 874.8 deaths per 100,000 persons were recorded as compared to 852.0 in 1982 and 878.3 in 1980 (table 4-4).

HEART DISEASE, CANCER, AND STROKE ARE THE LEADING CAUSES OF DEATH FOR THE ELDERLY

In the United States, three out of four elderly persons die from heart disease, cancer, or stroke. Heart disease was the major cause of death in 1950, and remains so today even though there have been rapid declines in death rates from heart disease since 1968, especially among females. Death rates from cancer continue to rise in comparison to heart disease, especially deaths caused by lung cancer (chart 4-5). In 1985, however, heart disease accounted for 38 percent of all deaths among persons 65 to 74, while cancer accounted for 30 percent of all deaths in this age group.13 Even if cancer were eliminated as a cause of death, the average life span would be extended by only 2 or 3 years because of the prevalence of heart disease. Eliminating deaths due to major cardiovascular-renal diseases, on the other hand, would add an average of 11.4 years to life at age 65, and would lead to a sharp increase in the proportion of older persons in the total population.

CHART 4-5

DEATH RATES FOR PERSONS AGE 65-74
FOR HEART DISEASES AND MALIGNANT NEOPLASMS

SOURCE: U.S. Dept. of Health and Human Services, Public Health
Service, "Health-U.S." 1983

The third leading cause of death among the elderly-stroke (cerebrovascular disease)-has been decreasing over the past 30 years. Reasons for the dramatic decline are not fully understood. Part of

13 National Center for Health Statistics: Annual summary of births, marriages, divorces and deaths, United States, 1985. Monthly Vital Statistics Report. Vol. 34, No. 13.

the decline may be attributable to better control of hypertension. Better diagnosis and improved management and rehabilitation of stroke victims may also be related factors.14 In 1985, cerebrovascular disease accounted for only 6 percent of all deaths in the 65 to 74 age group.

Table 4-5 shows the 10 leading causes of death for three subgroups of the older population.

TABLE 4-5.1-DEATHS BY OLDER AGE GROUP FOR 10 LEADING CAUSES OF DEATH, 1984 [Rates per 100,000 population specified group]

Source: National Center for Health Statistics; advance report of final mortality statistics, 1984. Monthly Vital Statistics Report. Vol. 35, No. 6 Supp. (2). DHHS Pub. No. (PHS) 86-1120. Public Health Service, Hyattsville, Md., September 26, 1986.

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, control of lifethreatening disease could produce a healthier older population. But, if the life-span 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.)

E. 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

14 National Center for Health Statistics: Health, United States, 1985.

15 National Center for Health Statistics Tabulations. Reported in U.S. Senate Special Committee on Aging. Developments in Aging: 1984, vol. 1.