They called it the failure of success. As medical scientists got better at treating people with fatal diseases–but not curing them–the nation would be burdened with an accumulation of elderly people who were living longer but were crippled with pain and riddled with disabilities.
That notion called into question what medicine had wrought. But, to nearly everyone’s surprise, the predicted pandemic of pain and disability has not materialized. Instead, new information, some not yet published, on studies of people at all socioeconomic levels show Americans are living longer and developing less chronic disease and disability. The reasons may have as much to do with changing social circumstances, including events in the first decades of life, as with medical advances.
The National Long Term Care Surveys, a federal study that regularly surveys nearly 20,000 people 65 and older, finds every year a smaller percentage of old people are unable to care for themselves, unable to comb their hair, feed themselves or take a walk. The surveys use the Medicare population, which includes about 99 percent of all Americans, regardless of their income levels, who are 65 and older. Data from 1994 have been compiled, and analyses, not yet published, continue to support the picture of the healthier old.
Although the annual declines in disability rates are only about 1 to 2 percent a year, they have continued unabated since 1982, when the survey began, until 1994, the most recent survey. At the same time, the percentage of old people with chronic diseases, such as high blood pressure, arthritis and emphysema, has steadily declined. For example, the number of people over 65 with high blood pressure fell to 39.5 percent in 1989 from 46 percent in 1982, the number with arthritis fell to 63.1 percent from 71.1 percent, and the number with emphysema fell to 6.4 percent from 8.9.
The implications are profound, said Dr. Richard Suzman, who directs demography research at the National Institute on Aging.
“This plays to the general question of what’s going to happen as the older population, and especially the oldest old, mushrooms in size over the next 50 years,” Suzman said.
It could mean the growing elderly group may not be the economic drain it was projected to be. The longer people live, Suzman said, the longer they will need programs such as Medicare. But the new findings indicate Medicare costs might be much less than expected, even with the increased life spans of Americans.
Dr. Kenneth Manton, a demographer at Duke University who analyzed the National Long Term Care Surveys, calculates declining disability rates from 1982 until 1995 have saved Medicare $200 billion. He said that if the disability rates of 1982 had held steady into 1995, there would have been nearly 300,000 more disabled people aged 65 to 74 last year than 13 years ago. Instead, there were nearly 121,000 fewer disabled people in 1995 than in 1982 in this age group, resulting in the Medicare savings.
Some demographers have been wary of the new evidence that disease and disability rates are declining, but many say they believe the decline is real.
There is little doubt the elderly population is growing, in large part because death rates from many chronic diseases are plummeting. The annual mortality rate from strokes dropped 65.2 percent from 1960 to 1990; the death rate from heart disease dropped 46.9 percent. The overall death rate for the group in the U.S. dropped 31.7 percent from 1960 to 1990, Manton said. But the true picture of the steady improvement in these old people’s lives comes from studies that ask about how well they go about their daily activities. The best national data, Wolf and others said, are from the National Long Term Care Surveys. The surveys follow people enrolled in the Medicare program, asking where they live, what their diseases are and whether they are able to care for themselves. The surveys, Manton said, are “the closest thing we have to a national population registry.”
The picture of a robust elderly population that emerges from these surveys is confirmed by a different kind of study, one that looks at the ability to work. Dr. Eileen Crimmins, of the University of Southern California, has been analyzing data from a representative sample of about 12,000 Americans 50 to 69 for the last 11 years. The people in the study are asked whether their physical or mental health affects their ability to work. Over the course of the study, Crimmins and her colleagues found that fewer people said their ability to work was impaired. For example, in 1982 about 27 percent of men 67 to 69 said they were unable to work. But in 1992, 20 percent of men in that age group could not work.
“We regard the ability to work as an indicator of disability,” Crimmins said.
The study was sponsored by the Social Security Administration.
Crimmins said the declines in reported disability she observed applied equally to blacks and whites and to the rich and poor.
