Ranks of disabled elderly drop sharply

From the January-February ACP Observer, copyright © 2007 by the American College of Physicians.

Chronic disability among older Americans has dropped dramatically, and the rate of decline has accelerated during the past two decades, according to a new analysis of data from the National Long-Term Care Survey (NLTCS). The study, published in this week's Proceedings of the National Academy of Sciences, and online, found that the prevalence of chronic disability among people 65 and older fell from 26.5 percent in 1982 to 19 percent in 2004-2005. The findings suggest that older Americans' health and function continue to improve at a critical time in the aging of the population.

In addition to a drop in the percentage of older Americans reporting disability, the analysis found that the average annual rate of the decline has accelerated. The decline in disability averaged 1.52 percent annually over the 22-year time span, but the rate of change shifted gradually from 0.6 percent in 1984 to 2.2 percent in 2004-2005.

"The challenge now is to see how this trend can be maintained and accelerated especially in the face of increasing obesity," said Richard Suzman, Ph.D., director of National Institute on Aging's Behavioral and Social Research Program. "Doing so over the next several decades will significantly lessen the societal impact of the aging of the baby boom generation."

The analysis also showed that from 1982 to 2004-2005:

• Chronic disability rates decreased among those over 65 with both severe and less severe impairments, with the greatest improvements seen among the most severely impaired. The researchers note that environmental modifications, assistive technologies and biomedical advances may be factors in these declines.

• The proportion of people without disabilities increased the most in the oldest age group, rising by 32.6 percent among those 85 years and older.

• The percentage of Medicare enrollees age 65 and older who lived in long-term care institutions such as nursing homes dropped dramatically from 7.5 percent to 4.0 percent. The emergence of assisted-living options, changes in Medicare reimbursement policies and improved rehabilitation services may have fueled this decrease in institutionalization.

If they continue as anticipated, the downward trends in chronic disability rates among older adults could help bolster the Medicare program's fiscal health, the researchers suggest.

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