SOURCE: Manton and Soldo, "Dynamics of Health Changes in the F. 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. 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 4-9).26 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 1 in 10 elderly disabled women are cared for by a husband. 26 Manton and Liu, 1984. TABLE 4-9.-PERCENT DISTRIBUTIONS OF CAREGIVERS BY RELATIONSHIP TO 65-PLUS INDIVIDUAL 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 of women. OTHER HEALTH SERVICES Utilization of health care other than hospital, nursing home, or physician services varies by service (nursing home utilization is discussed in a seprate section). Elderly persons visit dentists less often than the younger population.27 For instance, in 1981, only 35 percent of the 65 and older population had seen a dentist in the last year compared to 52 percent of the population 45 to 64.28 However, for prescription drugs, vision aids, and medical equipment and supplies, the older population have higher rates of usage than the younger population.29 According to the 1977 National Medical Care Utilization Survey conducted by the National Center for Health Statistics, 75 percent of the elderly had been prescribed at least one prescription drug as compared to 58 percent of the total population. The elderly also had slightly higher rates for use of vision aids and twice the rate for use of medical equipment and supplies than the younger population. 27 National Center for Health Statistics, Health Interview Survey, unpublished tabulations, 1983. 28 Ibid. 29 Waldo and Lazenby, Demographic characteristics and health care use and expenditures by the aged in the United States: 1977-84. Health Care Financing Review. Fall 1984, vol. 6, No. 1. Home health care is a small but rapidly growing segment of the health care delivery system, increasing at an estimated average annual rate of 20-25 percent in recent years. Forty-two percent of the Nation's hospitals offer home health services. In 1984, 1.5 million Medicare beneficiaries received 41 million home care visits, representing an 80-percent increase since 1980.30 Use of home health services varies by age. Out of every 1,000 Medicare enrollees 65 and 66 years of age, 14 received Medicare-reimbursed home health care in 1980 compared with 74 out of every 1,000 persons who are 85 years or older.31 G. HEALTH CARE EXPENDITURES ALMOST ONE-THIRD OF ALL PERSONAL HEALTH CARE EXPENDITURES BENEFIT THE ELDERLY Persons 65 and over, 12 percent of the population, account for one-third of the country's total personal health care expenditures (total health care from all sources exclusive of research). Per capita spending for health care for the elderly reached $4,200 in 1984, representing a 13-percent annual growth rate from 1977. Of this total, the elderly paid over one-third through direct payments to providers or indirectly through premiums for insurance. Total personal health care expenditures of the elderly were $119.9 billion million in 1984 (table 4-10). TABLE 4-10A. PERCENT DISTRIBUTION OF PERSONAL HEALTH CARE EXPENDITURES PER CAPITA FOR PEOPLE 65 YEARS OF AGE OR OVER, BY SOURCE OF FUNDS AND TYPE OF SERVICE: UNITED STATES, 1984 30 Waldo and Levit, National Health Expenditures, 1985, Health Care Financing Review, Fall 1986, vol. 8, No. 1. 31 Waldo and Lazenby, 1984. 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 SOURCE: U.S. Dept. of Health and Human Services, Public Health 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. |