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Older Is Better

Study finds disability on wane in older Americans

TUESDAY, May 8 (HealthScout) -- Chronic disability among America's seniors is in retreat, thanks in large part to gains in eye care and the treatment of crippling arthritis, a new study shows.

The decline in disability could have important consequences for both the nursing home system and government programs like Social Security and Medicare. Waning disability, for example, means more people are able to work longer and more productively, says Kenneth Manton, a Duke University population researcher and lead author of the study, which appears in the May 8 issue of the Proceedings of the National Academy of Sciences.

"The broad-scope implications have to do with improved human capital at later ages. Those people are capable of staying in the labor force longer," Manton says. The results of the latest survey, which covered 42,000 people, will be presented this week at a hearing of the U.S. Senate Committee on Health, Education, Labor, and Pensions.

Manton and his colleague, XiLiang Gu, reviewed data from the 1999 National Long-Term Care Survey, which assesses activities of daily living for Americans over age 65 who are disabled or live in nursing homes or other treatment facilities.

Between 1982 and 1999, the proportion of seniors with severe disabilities fell from about 26 percent to 19.7 percent, a 24 percent decline, the researchers say. What's more, the rate of decline appears to have accelerated in recent years, dropping more than twice as fast as it did in the 1980s. People 85 and older had the most rapid rate of improvement.

The share of elderly in institutions declined from 6.8 percent in 1982 to 4.2 percent in 1999, a decrease of 38 percent, the survey shows.

Sharper drop for blacks

In addition, while disability among blacks was once on the rise, it also appears to be in decline. Disability among elderly African Americans fell more sharply between 1989 and 1999 than it did for whites and other ethnic groups, according to the study.

Many factors help explain the decrease, the researchers say, but two major improvements in elderly health were cited. One was the increasing availability of cataract surgery to restore vision. The other was drug treatments, such as non-steroidal anti-inflammatory medications, to control the pain and swelling associated with osteoarthritis.

Osteoarthritis continues to afflict most of America's elderly, and treating it is getting costlier. A new report from the National Institute on Health Care Management Foundation, a nonprofit group, shows that the costs of prescription drugs soared almost 19 percent last year largely because of the increased use of two blockbuster arthritis drugs, Celebrex and Vioxx. Much of the jump, to $132 billion, was also due to a handful of other popular medications for conditions like high cholesterol and diabetes.

Declines in smoking and reduced fat intake have also improved the health of older Americans. And the growing use of devices like canes and walkers has given previously confined people more freedom in their daily lives.

Earlier shifts in disability rates resulted chiefly from beneficial changes in diet, food and water quality. Social factors, like improved education, were linked to a reduction in Alzheimer's and dementia, Manton says. "But that effect will probably play itself out over the next 10 to 15 years," he says.

When those benefits are exhausted, Manton says, gains in disability must come from advances in drugs and other treatments. "Prevention is very good, but that's a behavioral change that's difficult" to sustain over a lifetime, he says.

The report offers an encouraging picture of old age in America, says David M. Cutler, a Harvard University economist and author of an editorial accompanying the journal article.

"The old fear was that [the elderly] would live longer but be a great drain on the public budget. Nothing in this report argues about how long we'll live, but it suggests that we're living in higher quality," Cutler says. "If you're going to have people living longer, you should at least have them living healthier."

Cutler, who is currently on sabbatical at the Center for Advanced Study in the Behavioral Sciences at Stanford University, say it's not clear how much, if any, the reduction in disability will trim the country's cost of health care. Less disability reduces the relative needs of the elderly, he says, but the costs of health care have gone up for everyone regardless of their health status.

Still, "having a future with many more healthy elderly who aren't as needy and are enjoying it more is actually a much better situation," he says.

What To Do

For more getting old, try the government's Administration on Aging. To learn more about how to cope with disability, check out the Center for an Accessible Society.

Sample other HealthScout articles about aging.

SOURCES: Interviews with Kenneth Manton, Ph.D., research professor, Center for Demographic Studies, Duke University, Durham, N.C. and David M. Cutler, Ph.D., professor of economics, Harvard University, Cambridge, Mass.; May 8, 2001 Proceedings of the National Academy of Sciences
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