Estimates of Change in Chronic Disability and Institutional Incidence and Prevalence Rates in the US Elderly Population From the 1982, 1984, and 1989 National Long Term Care Survey

Citation: Manton, Kenneth G., Corder, Stallard Estimates of Change in Chronic Disability and Institutional Incidence and Prevalence Rates in the US Elderly Population From the 1982, 1984, and 1989 National Long Term Care Survey. Journal of Gerontology (RSS)
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Tagged: uw-madison (RSS), wisconsin (RSS), sociology (RSS), demography (RSS), prelim (RSS), qual (RSS), WisconsinDemographyPrelimAugust2009 (RSS)

Summary

Notes: The US elderly (65+) and the oldest-old (85+) populations are growing rapidly as a result of both the larger initial size of the birth cohorts now passing those ages and declines in mortality about age 65 (and 85). The increase in this population, combined with their high per capita acute and long term care needs, will increase total US health care needs. Also important in determining needs is how health and function changes as mortality declines in the elderly population. Recent increases in adult life expectancy have been due to declines in stroke and heart disease mortality. There is controversy, however, about how those declines relate to the health and function of survivors. Manton et al. examine changes in the prevalence and incidence of chronic disability using the 1982, 1984, and 1989 National Long Term Care Surveys, which draw a sample from Medicare files. They use questions that ask about Instrumental Activities of Daily Living (IADLs) including light housework, laundry, meal preparation, grocery shopping, etc and Activities of Daily Living (ADLs) including eating, getting in and out of bed, getting around inside, dressing, toileting. Chronic disability was defined as an inability, lasting (or expected to last) 90+ days, to perform an ADL, without personal assistance or equipment, or an IADL because of a disability or health problem. The total prevalence of US chronically disabled community-dwelling and institutionalized elderly populations declined from 1984 to 1989 overall and for each of three age strata and after mortality adjustment even though the population 65+ grew older. These changes varied over level of disability. For disabled persons, the probabilities of staying at the same disability level for 2 years increased from 1982-4 to 1984-9. Institutionalization declined at all levels of disability during this period. The proportion of nondisabled persons who became disabled after 2 and 5 years is significantly lower in the 1984-9 survey interval. Increases in life expectancy above age 65 were associated with declines in the age-specific prevalence of chronic disability and mortality improvements for disabled persons. It is important to note, however, that even with these declines there will be absolute increases in long term care needs because or population aging. The authors argue that reductions in chronic disability can continue because (1) knowledge of the natural history of, and risk factors for, chronic diseases causing disability increase as studies are completed. And (2) chronic disability declines between 1984 and 1989 cannot be due to recent biomedical innovations instead declines may be due to increased education and income in elderly cohorts.