A Summary: Older Americans Update 2006: Key Indicators of Well-Being

This posting summarizes the findings of the Federal Interagency Forum on Aging-Related Statistics’ report, “Older Americans Update 2006: Key Indicators of Well-Being,” which addresses the state of America’s seniors. This report reveals the rapidly escalating growth of this population, identifies their current and future health-related needs, and offers insight into the resources that will address these needs.

A Snapshot of America’s Seniors

The number of people in the over-65 group (henceforth called “seniors”) is rapidly escalating; from 35 million in 2000, the group is estimated to grow to 55 million by 2020 and 72 million by 2030. Certain states and regions have a comparatively higher percentage of seniors than does the rest of the U.S. These areas include Arizona, Florida, Oregon, New Mexico, Alabama, the Midwest corridor from Montana and the Dakotas through Arkansas, as well as West Virginia, New York, Wisconsin, Indiana, Ohio and Tennessee.

The ethnic diversity of seniors will change dramatically as well, from the current numbers to the projected percentages in the year 2050, when it is expected to reach 82 percent for non-Hispanic Whites (currently at 61 percent), 8 percent for Blacks (currently at 12 percent), 6 percent Hispanics (currently at 18 percent) and 3 percent for Asians (currently at 8 percent).

The percentage of seniors who are married varies by age group and sex. The percentage of men who are married at any point in time is higher than that of women. This is due to many factors, including that women tend to live longer. The percentage of men who are married ranges from 79 percent in the 65-to-74 age group to 58 percent in the over-85 group. The percent of women who are married ranges from 57 percent in the 65-to-74 age group to 15 percent in the over-85 group.

The educational levels of seniors are rapidly changing as well. Seventy-three percent of America’s seniors have at least a high school degree, while 19 percent have a bachelor’s degree or higher. College degrees are held by 30 percent of Asians, 20 percent of non-Hispanic Whites, 11 percent of Blacks and eight percent of Hispanics.

Living arrangements show that 72 percent of men and 42 percent of women live with their spouse; 19 percent percent of men and 40 percent of women live alone; and six percent of men live with relatives, compared to 17 percent of women.

Income

The study considered income from all sources when delineating the results into four income levels. Twenty-eight percent of America’s seniors were considered high-income (400 percent or more above the poverty line), 35 percent were middle income (200 to 400 percent above the poverty line), 28 percent were low-income (100 to 200 percent above the poverty line) and 10 percent lived at or below the poverty line. The sources of that income were Social Security in 39 percent (accounting for 83 percent of the income in the lowest income group to 19 percent of the income in the highest income group), 13 percent in income from accumulated assets (18 percent in the highest income group and three percent for the lowest income group), 20 percent from pensions (21 percent in the highest income group to four percent of the lowest income group), 26 percent from earnings (40 percent from the highest income group to one percent in the lowest income group) and less than two percent from other sources. The median net worth for seniors, excluding pension wealth, ranged from $215,000 for whites and $26,300 for blacks. The median net worth varied as well, depending on education; the study found net worth to be $376,500 for college attendees, $161,000 for high school grads and $59,500 for those without a high school diploma. Notably, 28 percent of expenditures from the highest income group went to housing costs, whereas the lowest income group spent 40 percent.

The number of seniors still working varied by age and sex. Twenty-four percent of women and 34 percent of men were still working between 65 and 69 years of age, dropping to seven percent for women and 14 percent for men after age 70.

Health Issues

As one might expect, life expectancy differs by sex and age as well. At age 65, men will live an average of 17 more years, women an additional 20 years. At 85, men will live an average of six additional years, and women an average of seven years.

The percentages of seniors 65 and older who reported good to excellent health range from 60 percent for Blacks to 62 percent for Hispanics and 76 percent in non-Hispanic Whites. Sixty-eight percent of senior women in all ethnic groups received mammography screening for breast cancer. Sixty-seven percent of all seniors needed improvement in their nutrition and dietary quality (ranging from 65 percent above the poverty line to 77 percent below the poverty line). Twenty-eight percent of seniors 65 to 74 engaged in light-to-moderate physical activity regularly (30 minutes a day for five days a week), while that number dropped to 19 percent in the 75-84 age group and 8 percent in the over-85 age group. Obesity was found in 35 percent of men and 36 percent of women in the 65-to-74 age group and 23 to 24 percent of those over-75. Cigarette smoking was reported in 10 percent of senior men and eight percent of senior women overall.

Hearing, vision and dental problems were also measured. Forty-eight percent of men and 34 percent of women reported hearing problems (without hearing aids). Fourteen percent of men and 19 percent of women had visual problems even with corrective glasses or contacts. Twenty-four percent of male seniors and 27 percent of female seniors had lost all of their permanent teeth.

Memory impairment was evaluated for moderate or severe memory loss (recalling four or fewer words out of 20) and it was reported by sex and age group. It was reported that 11 percent of women and 15 percent of men over 65 experienced some form of moderate to severe memory loss. The percentages ranged from eight percent of men and three percent of women in the 65-to-69 age group, 22 percent of men and 17 percent of women in the 80-to-84 age group, and 34 percent of men and 31 percent of women in the over-85 age group.

Causes of Chronic Health Conditions Existing in Seniors

The following percentages measured seniors 65 and older who had been diagnosed with the health conditions outlined below.

• Arthritis: 43% in men and 55 percent in women
• Asthma: 8% in men and 10% in women
• Bronchitis, chronic: 5% in men and 7% in women
• Cancers, all types: 24% in men and 18% in women
• Depressive symptoms, clinically relevant (4 or more of 8 depressive symptoms): 11% in men and 18% in women
• Diabetes: 20% in men and 15% in women
• Emphysema: 7% in men and 4% in women
• Heart disease: 37% in men and 28% in women
• Hypertension: 48% in men and 55% in women
• Stroke: 10% in men and 9% in women

Causes of Death

The report stated the number of seniors dying of a particular cause each year per 100,000 seniors alive at that time, which indicates the changing incidence going forward. In order of incidence:

• Heart disease: 1,750/100,000 (declining)
• Cancer: 1,100/100,000 (flat)
• Stroke: 325/100,000 (flat)
• Pneumonia and chronic respiratory diseases: 250/100,000 (declining)
• Diabetes: 100/100,000 (flat)
• Alzheimer’s: 75/100,000 (increasing)

Disability

The report measured the percent of Medicare enrollees 65 and older who were chronically disabled. There are two categories of disability: those who need help with ADLs and those who require assistance with IADLs.

• ADLs (activities of daily living): e.g., bathing, dressing, getting into bed, toileting and eating
• A person is considered disabled if he or she receives help or supervision or uses equipment to perform an ADL.

• IADLs (instrumental activities of daily living): e.g., housework, laundry, meal prep, grocery shopping, getting around outside, managing money, taking meds and telephoning
• A person is considered disabled if he or she uses equipment to perform the IADL or cannot do it at all.

An individual is considered chronically disabled if he or she has at least one ADL or one IADL limitation that is expected to last longer than 90 days, or he or she is institutionalized. The study listed the percentage of Medicare enrollees 65 and older with some level of disability as follows:

• Overall chronic disability: 20%
• IADL disability only: 3%
• 1–2 ADL limitations: 6%
• 3–4 ADL limitations: 3%
• 5–6 ADL limitations: 3%
• Institutionalized: 5%

The report measured the range of disabilities as defined above in Medicare enrollees and found the following percentages of these seniors who could not perform the actions outlined below:

• Stooping (men = 9%, women = 18%)
• Reaching overhead (men = 3% and women = 4%)
• Writing (men = 1% and women = 2%)
• Walking 2–3 blocks (men = 14% and women = 24%)
• Lifting 10 pounds (men = 7% and women = 15%)
• Any of these 5 actions (men = 18% and women = 32%)

Utilization & Payment for Health Care Services

The report showed the utilization rates for health care services covered by Medicare. Facility-related services were considered first and reported as the number of stays per 1,000 Medicare enrollees (361 had hospital stays, 72 had skilled nursing facility stays).

The average annual health care expenditure per Medicare enrollee was $12,510 in the entire over-65 age group and $19,658 for the over-85 age group. The breakdown of the expenditures for the over-65 group follows. Twenty-six percent of the dollars were spent in inpatient hospital stays, 35 percent was spent on physicians and outpatient visits and procedures, three percent was spent on home health care, 14 percent was spent on nursing home and long-term institutional care, 14 percent was spent on prescriptions and 8 percent on other types of care.

Outpatient services were evaluated separately. Prescription drug costs were found to be rapidly escalating. In 2002, the average cost was $1,740 per Medicare enrollee ($686 was out-of-pocket, $634 was covered by private insurance and $419 was covered by public programs. The number of filled prescriptions per enrollee was 32; this number ranged from an average of 11 if the enrollee had no chronic conditions to 61 if the enrollee had five or more chronic conditions.

Supplemental insurance was also evaluated. The percentage of noninstitutionalized Medicare enrollees who have supplemental insurance was 85 percent. The type of supplemental insurance varied. Thirty-four percent had private supplemental insurance (Medigap), 36 percent had private employer- or union-sponsored supplemental insurance, 15 percent had HMO supplemental insurance and 10 percent had Medicaid. Thirteen percent of seniors had no supplemental insurance.

Out-of-pocket health care expenditures were evaluated and reported as the percentage of total household income spent on medical services. This was eight percent for the entire over-65 age group and 10 percent for the over-85 age group. This increased to 28 percent (over-65) and 32 percent (over-85) for the poor and near-poor.

Sources of payment for all Medicare health-related services per Medicare enrollee were also evaluated. Out of the $12,510 spent on medical care, 53 percent went to Medicare, nine percent went to Medicaid, 19 percent was out-of-pocket and 19 percent went to a combination of private insurance, VA and other public programs.

Residential health care expenditures were examined and evaluated by the type of care and the type of payment. Nursing home expenditures were covered by Medicaid in 48 percent, out-of-pocket in 45 percent and six percent by other means of payment. Short-term institutional costs were reimbursed by Medicare in 80 percent of cases, Medicaid in three percent and out-of-pocket in seven percent. Home health care costs were paid by Medicare in 83 percent of cases and out-of-pocket in 10 percent. Inpatient hospital care was paid for by Medicare in 88 percent of cases, out-of pocket in three percent and other sources in eight percent. Prescription drugs were paid for by Medicare in three percent of cases, Medicaid in 10 percent, out-of-pocket in 33 percent and other private and public programs in 55 percent. Hospice was 100 percent paid for by Medicare.

Nursing Home & Residential Health Services

The study also examined the percentage of Medicare enrollees living in various residential settings. Ninety-three percent of the over-65 age group and 75 percent of the over-85 age group were found to live in traditional community settings, three percent of the over-65 age group and eight percent of the over-85 age group in community housing with services (retirement communities, senior apartments, senior citizen housing, continuing care retirement communities, assisted living facilities and board and care homes that provide one or more of the following services: meal preparation, cleaning or housekeeping services, assistance with dressing or medicine, and laundry service). Four percent of the over-65 age group and 17 percent of the over-85 age group lived in long-term care facilities that were licensed as nursing homes or long-term care facilities.

The rate of annual nursing home stays among 1,000 seniors was 43/1,000 for the over-65 group. It ranged from 11/1,000 in the 65-to-74 age group to 183/1,000 for the over-85 age group. The percentage of seniors who were nursing home residents who received assistance with ADLs ranged from three percent, who receive no assistance with ADLs, to 77 percent, who receive help with four to six ADLs. The same analysis was done for the other types of residential settings. In traditional community settings, 59 percent of residents had no functional limitations, while nine percent had three or more. In community housing with services, 31 percent of seniors had no functional limitations, and 19 percent had three or more). In licensed long-term care facilities (including nursing homes), only 4 percent had no functional limitations, while 66 percent had three or more.

Of those Medicare enrollees living in the traditional community, or unlicensed residential facilities who received various forms of personal care for chronic disability, 88 percent received informal unpaid assistance only, 26 percent received a combination of informal paid and unpaid assistance and nine percent received paid assistance only.

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