It is not news that each of us grows old. What is relatively new, however, is that the average age of the American population is increasing. More and better information is required to assess, plan for, and meet the needs of a graying population. The Aging Population in the Twenty-First Century examines social, economic, and demographic changes among the aged, as well as many health-related topics: health promotion and disease prevention; quality of life; health care system financing and use; and the quality of care—especially long-term care. Recommendations for increasing and improving the data available—as well as for ensuring timely access to them—are also included.
- The Aging Population in the Twenty-First Century
- Copyright
- Contents
- Preface
- ORIGIN OF THE STUDY
- EARLY PANEL ACTIVITIES
- CONCURRENT ACTIVITIES
- ACKNOWLEDGMENTS
- 1 Introduction and Summary of Recommendations
- BACKGROUND
- HEALTH POLICY ISSUES
- The Changing Policy Agenda
- Implications for the Panel's Approach
- RECOMMENDATIONS
- Priority Recommendations
- General Recommendations
- A Word about Costs
- ORGANIZATION OF THE REPORT
- Structure of the Report
- Chapter 2: Social, Economic, and Demographic Changes among the Elderly
- Chapters 3 and 4: Health Status, Quality of Life, and Health Transitions
- Chapter 5: Health Promotion and Disease Prevention
- Chapter 6: Quality of Care
- Chapter 7: Long-term Care
- Chapters 8 and 9: Financing and Utilization of Health Care Services
- Chapter 10: Enhancing the Usefulness of National Statistical Systems
- Chapter 11: Methodological and Statistical Issues
- Projecting and Determining Statistical Needs
- Information on the Healthy Elderly
- Data on Functioning to Supplement Diagnostic Information
- Longitudinal Data on the Elderly
- Information on the Responsiveness of Both Acute and Long-term Care Systems
- Better Information about Long-term Care Services
- Data on Risk Factors for the Elderly
- Better Data on Special Subgroups of the Elderly
- Characteristics of Future Cohorts of Elderly
- Important Data Bases Outside the Scope of the Report
- 2 Social, Economic, and Demographic Changes among the Elderly
- THE CHANGING DEMOGRAPHIC STRUCTURE OF THE POPULATION
- Population Forecasts
- Forecasts by Sex
- Forecasts by Race
- Geographic Distribution of the Elderly Population
- Marital Status and Living Arrangements
- Education
- Income
- Labor Force Participation
- Dependency Ratio
- Morbidity Patterns
- THE LIMITATIONS OF AVAILABLE DATA
- IMPLICATIONS FOR THE STUDY
- 3 Health Status and Quality of Life
- HEALTH STATUS
- Characteristics of Health Status and Data
- Successful Aging
- Longevity Extension and Compression of Morbidity
- Transitions from Morbidity to Disability and Mortality
- The Need for Acute and Chronic Care
- Determinants of Disease in Old Age
- Special Characteristics of Illness Behavior in the Elderly
- Underreporting of Health Conditions
- Multiple Pathology
- Atypical or Altered Presentation of Disease
- HEALTH DATA
- Major Sources of Health Statistics
- The National Health Interview Survey
- The NHIS Supplement on Aging
- The Longitudinal Study on Aging
- The Integrated System of Health Interview Surveys
- The National Health and Nutrition Examination Surveys
- The NHANES I Epidemiologic Follow-up Survey
- Data on Cause of Death
- The Importance of Longitudinal Studies
- FUNCTIONAL STATUS
- Characteristics of Functional Status
- Physical Function
- Cognitive Function
- Mental Health Function
- Social Function
- Assessing Functional Status
- QUALITY OF LIFE
- The General Concept
- Some Dimensions of Quality of Life
- Health Status
- Satisfaction with Life
- Functional Status
- Availability of Social Support System
- Productive Activity
- Quality of Life for the Institutionalized Elderly
- Conclusion
- 4 Health Transitions and the Compression of Morbidity
- DATA NEEDS AND RECOMMENDATIONS
- 5 Health Promotion and Disease Prevention
- INTRODUCTION
- DEFINITIONS, FEDERAL INITIATIVES, AND GOALS
- HEALTH PROMOTION AND DISEASE PREVENTION FOR THE ELDERLY
- The Plasticity of the Aging Process
- Risks Associated with Normal Aging
- The High Incidence of Chronic Disease and Illness among the Elderly
- Increases in Average Life Expectancy and Individual Variability
- CRITICAL ISSUES
- DATA NEEDS
- Public Knowledge about Health Promotion and Disease Prevention
- The Role of Physicians
- Providers of Health Maintenance and Disease Prevention Services to the Elderly
- 6 Quality of Care
- A FRAMEWORK FOR QUALITY OF CARE ASSESSMENT
- THE ROLE OF NATIONAL INFORMATION SYSTEMS
- 7 Long-term Care
- INTRODUCTION
- DEFINITIONS OF LONG-TERM CARE
- UTILIZATION OF LONG-TERM CARE SERVICES BY THE ELDERLY
- Functional Disability
- Longitudinal Studies
- SERVICE STATISTICS
- Providers of Care
- Types of Care
- Informal Supports
- STANDARDIZATION OF MINIMUM DATA SETS
- EXPENDITURE DATA ON LONG-TERM CARE
- 8 The Financing of Health Care Services for the Elderly
- INTRODUCTION
- Sources of Funding
- Medicare
- Medicaid
- The Veterans Administration
- Other Government Programs
- Private Insurance Programs
- Expenditures on Health Care
- The Frail Elderly
- Future Changes
- DATA REQUIREMENTS
- Timely Data on Expenditures for the Elderly
- National Medical Expenditure Survey
- Follow-Up Studies of the Elderly in the NMES through Administrative Records
- Outreach Program for the NMES and Timely Release of NMES Tapes
- Timely Data from the Medicare Statistical System
- Improved Access to Medicare Data
- The Health Care Financing Administration Data System for Capitation
- Disability-Medicare Linked File
- Data for Policy Analysis of the Prospective Payment System
- Medicaid Data
- Medicaid Eligibility Quality Control System
- Data Resources Required to Study the Medicaid Spend-down Phenomenon
- Private Insurance Data
- Cost-of-Illness Data
- 9 Health Services Utilization
- INTRODUCTION
- Need for Services
- Impact of Public Policies
- Supply of Alternative Sources and Types of Care
- Living Arrangements and Access to Informal Care
- Availability of Trained Personnel
- Technological Advances or Changes
- Attitudes and Values of Potential Recipients and Providers of Care
- DATA SOURCES ON HEALTH CARE UTILIZATION
- Data Related to Health Personnel Trained to Work with the Elderly
- Measuring the Effects of Changes in the Organization, Provision, and Coverage of Health Care Services
- Changes in Provider Characteristics
- Changes in Utilization Patterns
- Relationship between Health Status and Health Services Utilization
- Access to Care
- 10 Enhancing the Utility of Statistical Systems
- INTRODUCTION
- NATIONAL DATA
- Background on Federal Statistical Policy
- Legislative Authority for Statistical Policy
- Office of Management and Budget
- Administration on Aging
- Informal Coordination Activities
- COORDINATING, PLANNING, AND SETTING PRIORITIES FOR STATISTICS ON THE ELDERLY
- Resources
- Decentralized Responsibility for Statistics on Aging
- Content
- Coverage
- Data Detail
- Uniform Definitions, Concepts, and Classifications
- Periodicity
- Data Access
- Confidentiality
- Administrative Records
- Data Linkages
- Enhancement of National Surveys
- Survey of Income and Program Participation
- FEDERAL-STATE DATA ISSUES
- Background
- Vital Statistics and Data on Mortality
- Disability Statistics
- Age Detail
- Dissemination of Age-detailed Substate Data
- Timely Substate Data
- Social Service Statistics
- Private Data Bases
- Hospital Data
- Nursing Home Data
- Health Maintenance Organization Data
- Hospice Data
- Commercial Health Insurance Data
- Professional Association Data
- Summary
- 11 Statistical Methodology for Health Policy Analysis
- INTRODUCTION
- LONGITUDINAL INFORMATION
- The Rationale for Longitudinal Studies
- Designing Longitudinal Studies
- Designs and Their Implications for Longitudinal Data Analysis
- Analytical Strategies
- RECORD LINKAGE
- The Rationale for Record Linkages
- Obstacles to the Use of Record Linkage Techniques
- Obstacles to Performance of Record Linkages
- Obstacles to Dissemination and Use of Record Linkage Results
- PROJECTIONS FOR AN AGING POPULATION
- QUANTIFYING UNCERTAINTY
- References
- Appendix A Background Papers
- HEALTH AND RELATED ISSUES
- STATISTICAL METHODOLOGY FOR POLICY ANALYSIS
- IMPROVEMENT OF DATA RESOURCES FOR POLICY ANALYSIS ON AGING
- Appendix B Effects of Budgetary Constraints on Federal Statistical Programs
- BUREAU OF THE CENSUS
- NATIONAL CENTER FOR HEALTH STATISTICS
- NATIONAL CENTER FOR HEALTH SERVICES RESEARCH
- HEALTH CARE FINANCING ADMINISTRATION
- NATIONAL INSTITUTE OF MENTAL HEALTH
- SOURCES OF INFORMATION
- Appendix C Descriptions of Data Bases Mentioned in the Panel's Recommendations
- Appendix D Long-term Health Care Minimum Data Set
- Appendix E Acronyms
- Appendix F Biographical Sketches
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