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Wednesday, February 08, 2006

Changes in Elderly Disability Rates and the Implications for Health Care Utilization and Cost

One common proposal to help with Social Security solvency is to increase the retirement age. People do live longer, but does that mean they are more able to perform work than in the past during their later years? While not dealing with this issue directly, and I haven't found anything yet that does, one source of information on this is the NCHS statistics on functional status and disability among the elderly. These measure activities of daily living (ADLs), instrumental activities of daily living (IADLs), and other measures of physical function.

Are the elderly healthier? If so, will that lower health care costs? The Department of Health and Human Services has a report on this issue prepared by the Urban Institute. Here's a small part of the executive summary and a link to the actual report:

Changes in Elderly Disability Rates and the Implications for Health Care Utilization and Cost, Executive Summary, Brenda C. Spillman, Urban Institute, February 3, 2003:

BACKGROUND Recent research has provided promising evidence that aggregate age-adjusted disability among older Americans has decreased. There also is evidence that cognitive impairment and physical limitations, such as lifting 10 pounds, walking short distances, and climbing a flight of stairs, which may be precursors to disability, may have declined in recent years. On the other hand, some studies show increases in chronic disease, increases in the use of paid long term care, and increasing disability levels within the disabled population. This study was undertaken in order to better understand these trends...


CONCLUSIONS The disabilities that saw the most improvements over the 15-year study period were not ones that necessarily imply better health and lower health and long term care costs among the elderly. Rather, a substantial part of disability declines may reflect improvements in the external environment that make it easier to perform such activities as managing money, shopping, and telephoning, regardless of physical state. Help with ADLs changed only slightly from the beginning to the end of the study period. ... These findings suggest a need to examine directly both Medicare costs and hours of paid and unpaid long term care for different subgroups of the elderly and the elderly disabled in order to understand the cost implications of disability changes since the mid 1980s.

The growth in the percent of persons who manage various ADL activities with only equipment also suggests the need to know more about which types of equipment are being used and whether the equipment substitutes for or supplements hours of human assistance. ... Better understanding of the real implications of aggregate disability changes is not an academic exercise as policymakers consider changes in Social Security and Medicare to ensure their long-range financial health. Many argue that declines in disability need to be taken into account in projecting future spending. Until there is a better understanding of these trends and their cost implications, however, it is not clear how they should be taken into account.

The Full Report is also available from the DALTCP website (http://aspe.hhs.gov/daltcp/home.shtml) or directly at http://aspe.hhs.gov/daltcp/reports/hcutlcst.htm.

    Posted by on Wednesday, February 8, 2006 at 04:38 PM in Economics, Health Care, Policy | Permalink  TrackBack (0)  Comments (2)


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