Well-Being Improves For Most Older People, But Not For All, New Federal Report Says

The global population is aging at a rate unprecedented in history. In the U.S., the population age 65 and older is expected to double by 2030. The Forum developed the report, "Older Americans 2000: Key Indicators of Well-Being," to regularly track trends as society and individuals look for ways to address the aging boom. Today's report, which brings together information from more than a dozen national data sources for the first time, will serve as a baseline for future updates.

"Americans age 65 and older are an important and growing segment of our population. While many federal agencies provide data on this diverse population, it is sometimes difficult to understand how this group is faring. For the first time, the federal statistical system has come together to provide a unified picture of the overall health and well-being of older Americans," says Katherine K. Wallman, Chief Statistician, U.S. Office of Management and Budget.

The 128-page report covers 31 key indicators carefully selected by the Forum to portray aspects of the lives of older Americans and their families. The report is divided into five subject areas: population, economics, health status, health risks and behaviors, and health care. Highlights include:

Population -- The number and proportion of older people in the U.S. population have grown and generally will continue to grow at a very rapid pace. Aging in the 21st century will be characterized by a steep rise in the population age 85 and older and increased racial and ethnic diversity.

* The number of older people in the U.S. has increased ten-fold since 1900. Today, an estimated 35 million people, 13 percent of the population, are age 65 and older. By 2030, 20 percent of Americans, about 70 million, will have passed their 65th birthday. The population age 85 and above is currently the fastest growing segment of the older population; its growth is particularly important for anticipating health care and assistance needs, because these individuals tend to be in poorer health and require more services than people below age 85.

* The racial and ethnic makeup of the U.S. is changing, and the older population is no exception. In 2000, an estimated 84 percent of the population age 65 and older is non-Hispanic white, 8 percent non-Hispanic black, 6 percent Hispanic, 2 percent non-Hispanic Asian and Pacific Islander, and less than 1 percent non-Hispanic American Indian and Alaska Native. By 2050, those proportions are projected to be substantially different: 64 percent of the older population is expected to be non-Hispanic white, 16 percent Hispanic, 12 percent non-Hispanic black, and 7 percent non-Hispanic Asian and Pacific Islander, with the non-Hispanic American Indian and Alaska Native populations remaining at less than 1 percent.

* Today's older Americans are better educated than their counterparts 50 years ago, a factor that can positively influence socioeconomic status and health. In 1998, a high school diploma was held by some 67 percent of older Americans, compared with just 18 percent in 1950. About 15 percent of older Americans had earned at least a bachelor's degree in 1998, increasing from 4 percent in 1950.

Economics -- The economic picture for most older Americans is improving. But there are also significant disparities in income and wealth. Poverty has dropped dramatically, but rates are still very high for some groups. Social Security benefits and pensions have taken on greater importance. Overall, the net worth of older Americans also has increased over time.

In 1998, 11 percent of older Americans had incomes below the poverty threshold, compared to 35 percent in 1959. The proportions of the older population in poverty vary, however, by age, gender, and race and ethnicity. For example, the poverty rate is highest at older ages -- 14 percent for people age 85 and older, compared with 9 percent for people ages 65 through 74. It is higher among older women (13 percent) than older men (7 percent). And it is higher for minorities than non-Hispanic whites; for example, divorced black women ages 65 through 74 had a poverty rate of 47 percent in 1998, among the highest for any subset of older people. On the other end of the income spectrum, almost two-thirds of the older population experienced medium and high incomes in 1998, compared with about half in 1974.

* The importance of Social Security to the lowest-income elderly cannot be overestimated. It accounts for some 80 percent of income for people in the lowest two-fifths of the income spectrum.

* Net worth (the value of real estate, stocks, bonds, and other assets minus outstanding debts), an important measure of economic security, has increased in recent years. Estimates of the amount of the increase vary, but in one survey, median net worth among households headed by older people jumped 69 percent between 1984 and 1999. However, there is a large disparity in net worth between older black and white households.

Health Status -- Older Americans are living longer and feeling better. An overwhelming majority rate their health as good or excellent. Men and women report comparable levels of well-being. Disability rates are declining as well. But large numbers of older people find their health threatened by memory impairments, depression, chronic conditions, and disability, especially at very advanced ages, which can substantially diminish quality of life.

* Americans born at the beginning of the 21st century are expected to live almost 30 years longer than those born at the turn of the 20th century. In 1997, a newborn baby girl could expect to live 79 years and a boy 74 years, compared to 51 years for a girl and 48 years for a boy born in 1900. Life expectancy varies by race, however. The average life expectancy for a white baby born in 1997 was 6 years higher than for a black baby born in the same year.

* Chronic disease, memory impairment, and depressive symptoms affect large numbers of older people, and the risk of such problems often increases with age. In 1995, almost 60 percent of people age 70 and older report having arthritis, up slightly from the proportion reporting arthritis in 1984. The prevalence of arthritis and other chronic diseases, such as hypertension, heart disease, cancer, diabetes, and stroke are also reported, and vary by race and ethnicity. Increases in memory impairment and depressive symptoms occur with advancing age: one-third or more of men and women age 85 and older have moderate or severe memory impairment and 23 percent of this group experience severe depressive symptoms.

* Despite the prevalence of illness or chronic conditions, the proportion of Medicare beneficiaries age 65 and older with a chronic disability was 21 percent in 1994, down from 24 percent in 1982. During this time period, the older population grew significantly, and the number of older people estimated to have functional limitations increased by 600,000. This was considerably fewer, however, than the 1.5 million increase projected had disability rates not declined.

Health Risks and Behaviors -- Social and behavioral aspects of life can make a difference in health and well-being. Most older people describe themselves as socially active, which may enhance their physical and emotional health. But others report choices and behaviors, such as the failure to engage in physical activity or to keep up with vaccinations, that could interfere with health and independence.

* A large majority of older people report social contacts with friends, neighbors, and relatives or engaging in activities, such as going out to restaurants. The proportion of older Americans engaged in physical activity is increasing: between 1985 and 1995 the percentage who were sedentary decreased from 34 percent to 28 percent for men and 44 percent to 39 percent for women.

* From 1989 through 1995, the proportion of older people who were vaccinated against influenza and pneumonia increased, but reached the 60 percent coverage target set by Healthy People 2000 for only one group, non-Hispanic whites vaccinated against influenza. An increasing trend also holds true for older women getting mammograms; 55 percent of older women in 1994 reported having had a mammogram in the previous two years, compared with 23 percent in 1987.

Health Care -- Older people report being generally satisfied with health care quality and access. Average costs have not risen steeply during the 1990s. The cost of health care and use of services is closely associated with age and institutional status, with higher expenditures incurred by the oldest Americans and those living in long-term care facilities.

* Between 1992 and 1996, there was a slight increase in average inflation-adjusted annual health care expenditures (both public and private) for older Americans. In 1996, the average annual expenditure was $5,864 for people age 65 through 69, rising to $16,465 at age 85 and older. In 1996, 69 percent of noninstitutionalized Medicare beneficiaries had some type of private or public coverage for prescription drugs, while 31 percent did not. Out-of-pocket expenditures for prescription drugs were 83 percent higher for those not covered than for those with coverage.

* People age 85 and older are the most likely Americans to live in nursing homes. In 1997, only 11 people per 1,000 age 65 through 74 lived in a nursing home, compared with 192 people per 1,000 among those age 85 and older. About three-fourths of nursing home residents are women, roughly equal to their representation in the population age 85 and older. People in nursing homes today are more functionally impaired than their counterparts in previous years. The percentage of nursing home residents who were incontinent, who needed help with eating, or who were dependent on others for mobility increased slightly between 1985 and 1997.

* For those who receive home care, the nature of assistance may be changing. Most home care is provided informally by family, friends, and the community, as it has been for quite some time. But since the 1980s, the use of informal support as an exclusive means of help appears to be declining. The percentage of older people receiving only informal care dropped from 74 percent in 1982 to 64 percent in 1994, while the use of combined formal and informal care increased from 21 percent to 28 percent during the same time period.

Beyond the specific indicators, the Forum's report also examines areas where research and data efforts need to be improved. Among the recommendations are extending age reporting categories to more specifically incorporate upper age ranges in federal data collection efforts, improving the way data are collected to measure income and wealth, strengthening measures of disability, and gathering information to understand the reasons for improvements in life expectancy and function.

The Federal Forum on Aging-Related Statistics was established in 1986 to foster collaboration among federal agencies that produce or use data on the older population. The Forum is made up of nine federal agencies -- the Administration on Aging, the Bureau of Labor Statistics, the Census Bureau, the Health Care Financing Administration, the National Center for Health Statistics of the Centers for Disease Control and Prevention, the National Institute on Aging at the National Institutes of Health, the Office of the Assistant Secretary for Planning and Evaluation (Department of Health and Human Services), the Office of Management and Budget, and the Social Security Administration. Other agencies contributing to "Older Americans 2000" are the Bureau of Justice Statistics (Department of Justice), the National Highway Safety Traffic Administration (Department of Transportation), and the Center for Nutrition Policy and Promotion (Department of Agriculture).

The public may view copies of the report on the web site www.agingstats.gov. Single printed copies of "Older Americans 2000: Key Indicators of Well-Being" are available from the National Center for Health Statistics, at (301) 458-4636 or by sending an e-mail request to nchsquery@cdc.gov. Anyone wishing multiple printed copies of the report should contact Forum Staff Director Kristen Robinson at (301) 458-4460 or send an e-mail request to kgr4@cdc.gov.