As Number of Elderly With ‘Chronic Disabilities’ Declines ‘Sharply,’ Medicare Spending Growth May Slow, Study Finds

The rate of chronic disability among elderly Americans is declining, which could translate into "dramatically lower costs" for Medicare, a new study in the Proceedings of the National Academy of Sciences reveals. The Washington Post reports that the study tracked chronic disability rates and nursing home statistics from 1982 to 1999, the last year for which statistics were available. Researchers found that chronic disability, defined in the study as "impairments for three months or longer that impede daily activities," has been declining gradually among Americans over 65 since 1982, and that rate of decline sped up during the 1990s because of factors such as advancements in medical technology and healthier lifestyles (Connolly, Washington Post, 5/8). Other findings from the study are included below:

• In 1982, about 26.2% of Americans over 65 were chronically disabled, compared to 19.7% in 1999 (USA Today, 5/8);
• Declines in disability rates were "particularly striking" among African Americans. Between 1982 and 1999, chronic disability rates among blacks fell nearly 11%;
• Fewer Americans over age 65 are living in nursing homes. In 1999, 3.4% of older Americans were living in nursing homes, compared to 6.2% in 1982 -- a total decline of 400,000 individuals (Washington Post, 5/8);
• Life expectancy is increasing. Life expectancy for Americans at age 65 increased from about 81.5 years in 1982 to 82.8 years in 1999 (USA Today, 5/8).

Better Health Spurred by Technology, Good Habits
Researchers say that the lower rates of disability result from a combination of technological, economic and lifestyle factors. Physical modifications, such as better diet and lower rates of smoking, have helped lower disease and disability rates, while "increasing evidence" shows that more education and increased brain activity reduce the risk of Alzheimer's disease. In addition, "widely available treatments" for conditions such as arthritis and cataracts and a rise in the use of preventive medicine for illnesses such as heart disease also helped boost Americans' health. Economically, higher-paying jobs have also led to "better access to care," according to David Cutler, a health economist at Harvard University (Washington Post, 5/8). Physicians and health officials said the findings reflect the leaps in scientific progress made in recent years. Dr. Richard Suzman, an associate director of the National Institute on Aging at the NIH, said, "The lesson is that we have increasing control over how we age, replacing the fatalism of 15 years ago when there was no vision of cures or even prevention" of chronic illnesses and disabilities.

Good Sign for Medicare
Some physicians and lawmakers have pointed to the findings as a hopeful sign for Medicare's financial solvency, stating that better health among older Americans will lead to reduced Medicare spending for medical care. Dr. Kenneth Manton, director of the Center for Demographic Studies at Duke University, said, "The government's projections of Medicare costs are too high because there is no adequate adjustment for changes in the statistical distribution of health status and disability." He added that if disability rates continue to decline at 2.6% per year, as they have for the past five years, Medicare expenditures would decrease. Moreover, Manton said that even if disability rates decreased at the lower rate of 1.6% per year, "the demand for Medicare services would be fairly static," despite the "surging numbers of aging baby boomers." Robert Reischauer, former director of the Congressional Budget Office and current president of Urban Institute, called the study findings "good news for the individuals and good news for the Medicare trust fund and other sources of support for long term care and health care." Sen. Edward Kennedy (D-Mass.) added, "Healthier senior citizens need less medical services and that's good for the elderly and good for Medicare. ... The new study emphasizes the importance of focusing on improving the health of the elderly rather than enacting destructive cuts in the Medicare program."

But Will it Last?
But some economists "questioned" whether the falling disability rates would translate into savings for Medicare, since the findings might only indicate that the onset of disability is "postponed" until people reach their 70s or 80s. Reischauer noted that it remains "unclear" whether the improved health status of the elderly "would lead to a permanent slowdown in health care costs or whether the slowdown would be only temporary." He added that it is not known whether "the people who don't have chronic disabilities at 75 will be alive and at age 85 will have the disabilities at that point, or maybe a different set of problems that will be equally, or more, expensive to treat." Manton said that recent research has indicated that costs in the final two years of life were lower for individuals who lived longer (Freudenheim, New York Times, 5/8). But Cutler warned that the "ever-growing" elderly population and more expensive medical treatments will likely continue to boost Medicare spending (Washington Post, 5/8). The study's "implications for Medicare planning" will be discussed on May 10 at a Senate Health, Labor, Education and Pensions Committee concerning medical advances and their cost implications for Medicare planning (New York Times, 5/8).