Aging and the Macroeconomy Long-Term Implications of an Older Population (2012) / Chapter Skim
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4 Health and Disability in the Working-Age and Elderly Populations
4 Health and Disability in the Working-Age and Elderly Populations
Pages 62-74
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From page 62... ...
The functional status of the working-age and elderly populations has very significant societal and economic consequences. For while it is certainly clear that the use of health care resources increases dramatically and progressively with advancing age after age 65, these increases are seen predominantly in those with disabilities.
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From page 63... ...
For instance the earliest stage is marked by the presence of preclinical markers, such as measures of inflammation or altered physiologic control such as high weight, blood pressure, or cholesterol. These risk factors may be followed by the presence of an identifiable disease, such as arthritis, hypertension, diabetes, heart disease, or peripheral vascular disease, which can progress.
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From page 64... ...
These are measures of fairly severe disability and predict need for personal care services and residence in a nursing facility for long-term care. · Instrumental activities of daily living (IADL)
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From page 65... ...
, a panel survey conducted every 2 years beginning in 1992, focuses on people aged 51 and older living in the community. Functional measures include ADL, IADL, and mobility.
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From page 66... ...
Many obese patients seem to avoid heart disease despite the presence of biomedical risk factors like high blood pressure and high cholesterol as these factors are very commonly treated with effective pharmacologic agents (Martin, Schoeni, and Andreski, 2010)
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From page 67... ...
, have long been associated with increases in a number of important biomedical risk factors such as blood lipids, blood pressure, and blood sugar and have been shown to increase the risk for diabetes and a number of forms of cancer and cardiovascular disease. Over the last 30 years of the twentieth century, the prevalence of overweight tripled among children and adolescents while the prevalence of obesity in adults doubled to reach 33 percent (Ogden et al., 2007)
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From page 68... ...
Poverty poses special risks as it is associated with significant increases in many biological risk factors for ill health and disability, especially dur ing midlife. Poverty is related to not only the onset but also the course of disability, leading to the widely accepted view that the poor may age as much as a decade sooner than those who are well off (Crimmins, Kim, and Seeman, 2009; Taylor, 2010)
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From page 69... ...
. 4-2.eps 2.5 bitmap with vector type Number of high-risk biological risk factors 2 1.5 1 0.5 0 20-29 30-39 40-49 50-59 60-69 70-79 80+ Household income Household income <1.25 x poverty level >1.25 x poverty level FIGURE 4-3 Mean number of high-risk biological risk factors, by poverty status 4-3.eps and age, 1999-2004.
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From page 70... ...
, using data from the NHIS for 1997-2008, found no changes over time in the proportion of people aged 40-64 who display difficulty in physical function. It should be noted that this study employed a much less strict measure of functional impairment (difficulty with any of nine measures, including walking a quarter mile, climbing 10 steps, standing 2 hours, sitting 2 hours, stooping, bending, or kneeling, reaching over one's head, grasping small objects, and carrying 10 pounds or moving large objects)
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From page 71... ...
reported disability resulted from a balance between the adverse effects of increasing obesity and the benefits of declining smoking rates. The Elderly One of the strongest and most durable findings in disability research was the significant progressive reduction in functional impairment that occurred in older Americans from the 1980s into the early 2000s (Figure 4-5)
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From page 72... ...
During the last decade, however, the picture has become quite murky, with disparate results and methodologic questions leading to uncertainty about whether these improvements were continuing. Recently several leading scholars in the area joined together in a robust analysis of all five of the large-scale databases noted earlier to evaluate trends in the functioning of older persons during the period 2000 to 2008.
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From page 73... ...
The authors found, as did others who work in this area, that the effect of education was important and that the increase in educational attainment for the elderly during this time mitigated what would otherwise have been an increase in the prevalence of these limitations. LOOKING FORWARD The leveling off of disability decline in the older population, combined with apparent increases in disability among the working age population, complicates the forecasting of disability and related health care costs.
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From page 74... ...
Continued advances in biomedicine, especially a cure for cancer or Alzheimer's disease, could have remarkable effects, as would basic advances that slow the process of aging, which remains the major risk factor for disability. Of course, the committee is not interested in disability for its own sake but rather for its effect on the need for personal care services and its impact on the capacity of individuals to work.
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