# A Profile

# of

# Older Americans: 2004 

![](media/image1.png){width="1.78125in" height="1.7638888888888888in"}

# Administration on Aging

# U.S. Department of Health and Human Services 

# Table of Contents

**Highlights**....................................................................................................
1

**The Older
Population**.....................................................................................
2

**Future
Growth**.............................................................................................
3

Figure 1: Number of Persons 65+, 1900 - 2030 (numbers in millions)

**Marital
Status**..............................................................................................
4

Figure 2: Marital Status of Persons 65+ - 2003

**Living
Arrangements**.....................................................................................
5

Figure 3:  Living Arrangements of Persons 65+: 2002

**Racial and Ethnic
Composition**..........................................................................
6

**Geographic
Distribution**..................................................................................
6

> Figure 4: Persons 65+ as Percentage of Total Population by State: 2003
> (US Map)
>
> Figure 5: Percentage Increase in Population 65+ by State: 2003 (US
> Map)
>
> Figure 6: The 65+ Population by State: 2003 (table)

**Income**
.....................................................................................................
10

Figure 7: Percent Distribution by Income: 2003

**Poverty**
................................\.....................................................................
11

**Housing**
...................................................................................................
11

**Employment**
..............................................................................................
12

**Education**
.................................................................................................
12

**Health and Health Care**
.................................................................................
12

**Disability** **and Activity Limitations**
.................................................................... 13

Figure 8: Percent with Disabilities, By Age: 1997

**Caregiving**
....................................................................................................
14

**Special Topic: Health Insurance Coverage**
...................................................... 15

Figure 9: Sources of Health Insurance Coverage: 2003

**Notes**
.......................................................................................................
16

**Highlights \***

-   The older population (65+) numbered 35.9 million in 2003, an
    increase of 3.1 million or 9.5% since 1993.

-   The number of Americans aged 45-64 -- who will reach 65 over the
    next two decades -- increased by 39% during this decade.

-   About one in every eight, or 12.4 percent, of the population is an
    older American.

-   Over 2.0 million persons celebrated their 65th birthday in 2003.

-   Persons reaching age 65 have an average life expectancy of an
    additional 18.2 years (19.5 years for females and 16.6 years for
    males).

-   Older women outnumber older men at 21.0 million older women to 14.9
    million older men.

-   In 2003, 17.6% of persons 65+ were minorities\--8.2% were
    African-Americans,\*\* 2.8% were Asian or Pacific Islander,\*\* and
    less than 1% were American Indian or Native Alaskan.\*\* Persons of
    Hispanic origin (who may be of any race) represented 5.7% of the
    older population. In addition, 0.5% of persons 65+ identified
    themselves as being of two or more races.

-   Older men were much more likely to be married than older women\--71%
    of men vs. 41% of women (Figure 2). Almost half of all older women
    in 2003 were widows (43%).

-   About 31 percent (10.5 million) of noninstitutionalized older
    persons live alone (7.8 million women, 2.7 million men).

-   Half of older women age 75+ live alone.

-   About 416,000 grandparents aged 65 or more had the primary
    responsibility for their grandchildren who lived with them.

-   By the year 2030, the older population will more than double to 71.5
    million.

-   The 85+ population is projected to increase from 4.7 million in 2003
    to 9.6 million in 2030.

-   Members of minority groups are projected to represent 26.4 percent
    of the older population in 2030, up from 16.4 percent in 2000.

-   The median income of older persons in 2003 was \$20,363 for males
    and \$11,845 for females. Median money income of all households
    headed by older people (after adjusting for inflation) rose by 0.4%
    from 2002 to 2003; however, this difference was not statistically
    significant.

-   For one-third of Americans over 65, Social Security benefits
    constitute 90% of their income.

-   About 3.6 million elderly persons (10.2%) were below the poverty
    level in 2003. This poverty rate was not statistically different
    from the poverty rate in 2002. Another 2.3 million or 6.7% of the
    elderly were classified as \"near-poor\" (income between the poverty
    level and 125% of this level).

-   About 11% (3.7 million) of older Medicare enrollees received
    personal care from a paid or unpaid source in 1999.

######### 

\*Principal sources of data for the Profile are the U.S. Bureau of the
Census, the National Center on Health Statistics, and the Bureau of
Labor Statistics. The Profile incorporates the latest data available but
not all items are updated on an annual basis.

### The Older Population

The older population\--persons 65 years or older\--numbered 35.9 million
in 2003 (the most recent year for which data are available). They
represented 12.4% of the U.S. population, about one in every eight
Americans. The number of older Americans increased by 3.1 million or
9.5% since 1993, compared to an increase of 13.3% for the under-65
population. However, the number of Americans aged 45-64 -- who will
reach 65 over the next two decades -- increased by 39% during this
period.

In 2003, there were 21.0 million older women and 14.9 million older men,
or a sex ratio of 140 women for every 100 men. The female to male sex
ratio increases with age, ranging from 115 for the 65-69 age group to a
high of 226 for persons 85 and over.

Since 1900, the percentage of Americans 65+ has tripled (from 4.1% in
1900 to 12.4% in 2004), and the number has increased eleven times (from
3.1 million to 35.9 million). The older population itself is getting
older. In 2003, the 65-74 age group (18.3 million) was eight times
larger than in 1900, but the 75-84 group (12.9 million) was 17 times
larger and the 85+ group (4.7 million) was 38.5 times larger.

In 2002, persons reaching age 65 had an average life expectancy of an
additional 18.2 years (19.5 years for females and 16.6 years for males).

A child born in 2002 could expect to live 77.3 years, about 30 years
longer than a child born in 1900. Much of this increase occurred because
of reduced death rates for children and young adults. However, the
period of 1980-2002 also has seen reduced death rates for the population
aged 65-84, especially for men -- by 30.4% for men aged 65-74 and by
23.3% for men aged 75-84. Life expectancy at age 65 increased by only
2.5 years between 1900 and 1960, but has increased by 3.9 years from
1960 to 2002.

Over 2.0 million persons celebrated their 65th birthday in 2003. In the
same year, about 1.8 million persons 65 or older died. Census estimates
showed an annual net increase of over 317,000 in the number of persons
65 and over.

There were 50,639 persons aged 100 or more in 2003 (0.17% of the total
population). This is a 36% increase from the 1990 figure of 37,306.

***(Data for this section were compiled primarily from Internet releases
of the U.S. Bureau of the Census and the National Center for Health
Statistics).***

\- 2-

### Future Growth

The older population will continue to grow significantly in the future
([see Figure 1]{.underline}). This growth  slowed somewhat during the
1990\'s because of the relatively small number of babies born during the
Great Depression of the 1930\'s. But the older population will burgeon
between the years 2010 and 2030 when the \"baby boom\" generation
reaches age 65.

By 2030, there will be about 71.5 million older persons, more than twice
their number in 2000. People 65+ represented 12.4% of the population in
the year 2000 but are expected to grow to be 20% of the population by
2030. The 85+ population is projected to increase from 4.6 million in
2002 to 9.6 million in 2030.

Minority populations are projected to represent 26.4% of the elderly
population in 2030, up from 17.6% in 2003. Between 2000 and 2030, the
white\*\* population 65+ is projected to increase by 77% compared with
223% for older minorities, including Hispanics (342%),
African-Americans\*\* (164%), American Indians, Eskimos, and Aleuts\*\*
(207%), and Asians and Pacific Islanders\*\* (302%).

![](media/image2.wmf){width="5.104166666666667in"
height="3.9791666666666665in"}

***Note: Increments in years are uneven.***

***(Sources: Projections of the Population by Age are taken from the
January 2004 Census Internet Release. Historical data are taken from
\"65+ in the United States,\" Current Population Reports, Special
Studies, P23-190 Data for 2000 are from the 2000 Census and 2003 data
are taken from the Census estimates for 2003.)***

\- 3-

### Marital Status

In 2003, older men were much more likely to be married than older
women\--71% of men, 41% of women (Figure 2). Almost half of all older
women in 2003 were widows (43%). There were over four times as many
widows (8.2 million) as widowers (2.0 million).

Divorced and separated (including married/spouse absent) older persons
represented only 10.7% of all older persons in 2003. However, this
percentage has increased since 1980, when approximately 5.3% of the
older population were divorced or separated/spouse absent.

![](media/image3.wmf){width="4.447916666666667in"
height="2.7708333333333335in"}

***(Based on Internet releases of data from the 2003 Current Population
Survey of the U.S. Bureau of the Census)***

\- 4 -

### Living Arrangements

Over half (53.9%) the older noninstitutionalized persons lived with
their spouse in 2003. Approximately 10.3 million or 71.2% of older men,
and 8.1 million or 41.1% of older women, lived with their spouse
(Figure 3). The proportion living with their spouse decreased with age,
especially for women. Only 28.7% of women 75+ years old lived with a
spouse.

About 30.8% (10.5 million) of all noninstitutionalized older persons in
2003 lived alone (7.8 million women, 2.7 million men). They represented
39.7 of older women and 18.8% of older men. The proportion living alone
increases with advanced age. Among women aged 75 and over, for example,
half (49.8%) lived alone.

About 643,000 grandparents aged 65 or over maintained households in
which grandchildren were present in 2003. (Another 215,000 elderly were
spouses of such people.) In addition, 453,000 grandparents over 65 years
lived in parent- maintained households in which their grandchildren were
present. About 416,000 grandparents over 65 years old were the persons
with primary responsibility for their grandchildren who lived with them.

While a relatively small number (1.56 million) and percentage (4.5%) of
the 65+ population lived in nursing homes in 2000, the percentage
increases dramatically with age, ranging from 1.1% for persons 65-74
years to 4.7% for persons 75-84 years and 18.2% for persons 85+. In
addition, approximately 5% of the elderly lived in self-described senior
housing of various types, many of which have supportive services
available to their residents.

###### Figure 3:  Living Arrangements of Persons 65+: 2003

![](media/image4.wmf){width="2.8020833333333335in"
height="2.2604166666666665in"} ![](media/image5.wmf){width="2.8125in"
height="2.2291666666666665in"}

***(Based on data from U.S. Bureau of the Census including the 2003
Current Population Survey and the 2003 American Community Survey.  See:
March 2003 Current Population Survey Internet releases. See also:
\"America's Families and Living Arrangements; Population
Characteristics: June, 2001, Current Population Reports, P20-537" and**
**"The 65 Years and Over Population: 2000, Census 2000 Brief, October,
2001" as well as other Census 2000 data and unpublished data from the
Centers for Medicare and Medicaid Services.)***

\- 5 -

### Racial and Ethnic Composition

In 2003, 17.6% of persons 65+ were minorities\--8.2% were
African-Americans,\*\* 2.8% were Asian or Pacific Islander,\*\* and less
than 1% were American Indian or Native Alaskan.\*\* Persons of Hispanic
origin (who may be of any race) represented 5.7% of the older
population. In addition, 0.5% of persons 65+ identified themselves as
being of two or more races.

Only 6.8% of minority race and Hispanic populations were 65+ in 2003
(8.3% of African-Americans,\*\* 8.4% of Asians and Pacific
Islanders,\*\* 6.9% of American Indians and Native Alaskans,\*\* 5.2% of
Hispanics), compared with 15.1% of whites.\*\*

***(Data for this section were compiled from Internet releases of the
Census 2003 Estimates).***

### Geographic Distribution

The proportion of the older persons in the population varies
considerably by state with some states experiencing much greater growth
in their older populations (Figures 4 and 5). In 2003, about half (52%)
of persons 65+ lived in nine states. California had over 3.8 million;
Florida 2.9 million; New York 2.5 million; Texas 2.2 million; and
Pennsylvania 1.9 million.  Ohio, Illinois, Michigan, and New Jersey each
had well over 1 million (Figure 6).

Person 65+ constituted approximately 14% or more of the total population
in 9 states in 2003 (Figure 6): Florida (17.0%); Pennsylvania (15.4%);
West Virginia (15.3%); North Dakota (14.8%); Iowa (14.7%); Maine (14.4);
South Dakota (14.3); Rhode Island (14.0%); and Arkansas (13.9%). In nine
states, the 65+ population increased by 20% or more between 1993 and
2003 (Figure 6): Nevada (60.5%); Alaska (50.3%); Arizona (32.4%); New
Mexico (27.1%); Colorado (22.8%); Utah (22.5%); Delaware (22.4%); Hawaii
(20.9%); and Idaho (20.6%). The ten jurisdictions with the highest
poverty rates for elderly over the period 2001-2003 were Mississippi
(17.1%); the District of Columbia (16.0%); Arkansas (15.7%); Texas
(15.1%); South Carolina (14.6%); North Carolina (13.7%); Massachusetts
(13.0%); Tennessee (12.8%); Alabama (12.6%); and New York (12.6%).

Most persons 65+ lived in metropolitan areas in 2003 (77.4%). About 50%
of older persons lived in the suburbs, 27.2% lived in central cities,
and 22.6% lived in nonmetropolitan areas.

The elderly are less likely to change residence than other age groups.
In the five year period from 1995 to 2000, 22.8% of older persons had
moved (compared to 47.7% of persons under 65). Most older movers (59.7%)
stayed in the same county while only 18.8% (of the movers) moved to
another state. The 85+ segment of the older population had a much high
rate of moving. During this period, 32.3% of the 85+ population moved,
61.1% of them within the same county.

***(Data for this section and for Figure 4 were compiled primarily from
the Census Population Estimates for 2003 as well as other Internet
releases of the U.S. Bureau of the Census including tables from the
March 2003 Current Population Survey and "Internal Migration of the
Older Population: 1995 to 2000," Census 2000 Special Report, CENSR-10,
August 2003).***

\- 6 -

**Figure 4: Persons 65+ as a Percentage of Total Population  - 2003**

![](media/image6.wmf)

***Based on Census 2003 Population Estimates from the U.S. Bureau of the
Census\
***

\- 7 -

###### 

###### ![](media/image7.wmf)Figure 5:  Percentage Increase in Population 65+ \-- 1993 to 2003

***Based on Census 1993 and 2003 Population Estimates from the U.S.
Bureau of the Census*\
**

\- 8 -

  ------------------- ------------ ----------- ------------- ----------------
  **Figure 6: The 65+                                        
  Population by State                                        
  2003**                                                     

  **Numbers**         **Number of  **Percent   **Increase    **Percent Below
                      Persons**    of All      from 1993 to  Poverty
                                   Ages**      2003**        2001-2003**

  **US Total (50      35,919,174   12.4%       9.5%          10.3%
  States + DC)**                                             

  **Alabama**         592,181      13.2%       8.6%          12.6%

  **Alaska**          40,598       6.3%        50.3%         7.9%

  **Arizona**         714,467      12.8%       32.4%         6.5%

  **Arkansas**        377,682      13.9%       5.4%          15.7%

  **California**      3,764,870    10.6%       12.8%         8.6%

  **Colorado**        441,371      9.7%        22.8%         9.0%

  **Connecticut**     470,689      13.5%       2.2%          6.2%

  **Delaware**        106,896      13.1%       22.4%         5.6%

  **District of       67,845       12.0%       -11.9%        16.0%
  Columbia**                                                 

  **Florida**         2,897,383    17.0%       14.3%         10.2%

  **Georgia**         826,506      9.5%        18.7%         12.4%

  **Hawaii**          169,346      13.5%       20.9%         8.8%

  **Idaho**           155,652      11.4%       20.6%         5.4%

  **Illinois**        1,507,377    11.9%       1.8%          8.2%

  **Indiana**         763,059      12.3%       5.3%          8.0%

  **Iowa**            433,618      14.7%       0.1%          8.7%

  **Kansas**          353,585      13.0%       0.5%          8.6%

  **Kentucky**        512,381      12.4%       6.4%          10.3%

  **Louisiana**       524,348      11.7%       7.8%          12.4%

  **Maine**           188,385      14.4%       10.6%         10.5%

  **Maryland**        624,980      11.3%       13.2%         9.9%

  **Massachusetts**   856,982      13.3%       0.9%          13.0%

  **Michigan**        1,236,501    12.3%       5.4%          9.0%

  **Minnesota**       609,396      12.0%       7.6%          9.1%

  **Mississippi**     349,407      12.1%       6.1%          17.1%

  **Missouri**        759,980      13.3%       3.0%          8.0%

  **Montana**         125,160      13.6%       12.2%         10.8%

  **Nebraska**        232,387      13.4%       2.3%          10.0%

  **Nevada**          250,787      11.2%       60.5%         8.2%

  **New Hampshire**   154,174      12.0%       15.9%         7.0%

  **New Jersey**      1,123,842    13.0%       4.8%          9.3%

  **New Mexico**      225,266      12.0%       27.1%         12.2%

  **New York**        2,488,959    13.0%       3.9%          12.6%

  **North Carolina**  1,016,214    12.1%       17.0%         13.7%

  **North Dakota**    93,837       14.8%       0.8%          10.5%

  **Ohio**            1,516,771    13.3%       3.0%          7.7%

  **Oklahoma**        461,133      13.1%       5.3%          11.8%

  **Oregon**          453,568      12.7%       9.0%          6.4%

  **Pennsylvania**    1,901,764    15.4%       0.4%          9.0%

  **Rhode Island**    150,797      14.0%       -2.3%         11.4%

  **South Carolina**  511,732      12.3%       19.9%         14.6%

  **South Dakota**    109,040      14.3%       4.3%          10.9%

  **Tennessee**       726,683      12.4%       12.3%         12.8%

  **Texas**           2,175,256    9.8%        18.3%         15.1%

  **Utah**            203,007      8.6%        22.5%         8.4%

  **Vermont**         80,132       12.9%       16.1%         8.9%

  **Virginia**        833,427      11.3%       17.2%         10.0%

  **Washington**      690,583      11.3%       13.3%         8.3%

  **West Virginia**   277,220      15.3%       0.4%          10.1%

  **Wisconsin**       711,987      13.0%       5.5%          7.8%

  **Wyoming**         59,963       12.0%       17.7%         7.7%
  ------------------- ------------ ----------- ------------- ----------------

**Population data is from the Census Bureau Population Estimates and
poverty data is from the Current Population Survey, 2001, 2002, and 2003
Annual Social and Economic Supplements.\
**

\- 9 -

**Income**

The median income of older persons in 2003 was \$20,363 for males and
\$11,845 for females. Median money income of all households headed by
older people rose by 0.4% from 2002 to 2003; however, this difference
was not statistically significant. Households containing families headed
by persons 65+ reported a median income in 2003 of \$35,310 (\$36,797
for non-Hispanic Whites, \$28,407 for African-Americans, \$34,872 for
Asians, and \$25,355 for Hispanics). About one of every ten (9.9%)
family households with an elderly householder had incomes less than
\$15,000 and 50.4% had incomes of \$35,000 or more (Figure 7).

###### Figure 7: Percent Distribution by Income: 2003\*

![](media/image8.wmf){width="4.395833333333333in"
height="3.4895833333333335in"}

***\$35,310 median for 12.0 million family households 65+  ***

![](media/image9.wmf){width="4.364583333333333in"
height="2.9791666666666665in"}

***\$14,664 median for 33.8 million persons 65+ reporting income***

\- 10 -

For all older persons reporting income in 2002 (33.8 million), 29.3%
reported less than \$10,000. Only 26.8% reported \$25,000 or more. The
median income reported was \$14,664.

For one-third of Americans over 65, Social Security benefits constitute
90% of their income. The major other sources of income as reported by
the Social Security Administration for older persons in 2002 were income
from assets (reported by 55%), private pensions (reported by 29%),
government employee pensions (reported by 14%), and earnings (reported
by 22%).

***(Based on data from Current Population Survey, Annual Social and
Economic Supplement, \"Income, Poverty, and health Insurance Coverage in
the United States: 2003,\" P60‑226, issued August, 2003,  by the U.S.
Bureau of the Census, related Census detailed tables on the Census
Bureau web site, and from Fast Facts and Figures About Social Security,
2004, Social Security Administration)***

### Poverty

About 3.6 million elderly persons (10.2%) were below the poverty level
in 2003. This poverty rate was not statistically different from the
poverty rate in 2002. The historic lowest level of 9.7% was reached in
1999. Another 2.3 million or 6.7% of the elderly were classified as
\"near-poor\" (income between the poverty level and 125% of this level).

One of every twelve (8.8%) elderly Whites\*\* was poor in 2003, compared
to 23.7% of elderly African-Americans,\*\* 14.3% of Asians,\*\* and
19.5% of elderly Hispanics. Higher than average poverty rates for older
persons were found among those who lived in central cities (13.1%),
outside metropolitan areas (i.e. rural areas) (11.0%), and in the South
(11.9%).

Older women had a higher poverty rate (12.5%) than older men (7.3%) in
2003. Older persons living alone were much more likely to be poor
(18.6%) than were older persons living with families (5.8%). The highest
poverty rates (40.8%) were experienced by older Hispanic women who lived
alone.

### *Based on data from Current Population Survey, Annual Social and Economic Supplement, \"Income, Poverty, and Health Insurance Coverage in the United States: 2003,\" P60‑226, issued August, 2004,  by the U.S. Bureau of the Census and related Census detailed tables on the Census Bureau web site*

### Housing

Of the 21.6 million households headed by older persons in 2003, 80% were
owners and 20% were renters. The median family income of older
homeowners was \$25,353. The median family income of older renters was
\$13,540. In 2003, 42% of older householders spent more than one-fourth
of their income on housing costs - 35% for owners and 76% for renters -
.as compared to 41% of all householders.

For homes occupied by older householders in 2003, the median year of
construction was 1965 (it was 1971 for all householders) and 5.2% had
physical problems. In 2003, the median value of homes owned by older
persons was \$122,790 (with a median purchase price of \$32,905)
compared to a median home value of \$140,201 for all homeowners. About
72% of older homeowners in 2003 owned their homes free and clear.

***(Source: \"American Housing Survey for the United States in 2003,
Current Housing Reports\" H150/03)***

\- 11 -

### Employment

In 2003, 5.0 million (14.4 %) Americans age 65 and over were in the
labor force (working or actively seeking work), including 3.3 million
men (18.3%) and 2.1 million women (10.7%). They constituted 3.4% of the
U.S. labor force. About 3.6% were unemployed. Labor force participation
of men 65+ decreased steadily from 2 of 3 in 1900 to 15.8% in 1985, and
has stayed at 16%-18% since then. The participation rate for women 65+
rose slightly from 1 of 12 in 1900 to 10.8% in 1956, fell to 7.3% in
1985, and has been around 8%-10% since 1988.

***(Source: Bureau of Labor Statistics web-site:
http://www.bls.gov/cps/home.htm)***

### Education

The educational level of the older population is increasing. Between
1970 and 2003, the percentage who had completed high school rose from
28% to 71%. Over 17% in 2003 had a bachelor\'s degree or more. The
percentage who had completed high school varied considerably by race and
ethnic origin in 2003: 76% of Whites\*\*, 70% of Asians and Pacific
Islanders, 52% of African-Americans, and 36% of Hispanics. The increase
in educational levels is also evident within these groups. In 1970, only
30% of older Whites and 9% of older African-Americans were high school
graduates.

***(Source: Current Population Survey, Annual Social and Economic
Supplement, 2003 and related tables on the Census Bureau web site)***

### Health and Health Care

In 2004 (January-June), 37.4% of noninstitutionalized older persons
assessed their heath as excellent or very good (compared to 65.8% for
persons aged 18-64). There was little difference between the sexes on
this measure, but older African-Americans (57.7%)\*\* and older
Hispanics (60.1%) were less likely to rate their health as excellent or
good than were older Whites (76.9%).\*\*\*\*\* Most older persons have
at least one chronic condition and many have multiple conditions. Among
the most frequently occurring conditions of elderly in 2000-2001 were:
hypertension (49.2%), arthritic symptoms (36.1%), all types of heart
disease (31.1%), any cancer (20.0), sinusitis (15.1%), and diabetes
(15.0).

Almost 70% reported in 2004that they received an influenza vaccination
during the past 12 months and 57% reported that they had ever received a
pneumococcal vaccination. About 24% (of persons 60+) report
height/weight combinations that place them among the obese. Over 26% of
persons aged 65-74 and 16% of persons 75+ report that they engage in
regular leisure-time physical activity. Only 8% reported that they are
current smokers and only 4% reported excessive alcohol consumption. Only
2.4% reported that they had experienced psychological distress during
the past 30 days.

In 2002, over 12.7 million persons aged 65 and older were discharged
from short stay hospitals. This is a rate of 3,575 for every 10,000
persons aged 65+ which is more than three times the comparable rate for
persons aged 45-64 (which was 1,159 per 10,000). The average length of
stay for persons aged 65+ was 5.8 days; the comparable rate for persons
aged 45-64 was 5.0 days. The average length of stay for older people has
decreased almost 5 days since 1980. Older persons averaged more office
visits with doctors in 2002 -- 6.6 for those aged 65-74 and 7.2 for
persons over 75 while persons aged 45-65 averaged only 3.7 office visits
during that year. Almost 96% of older persons reported that they did
have a usual place to go

\- 12 -

for medical care and only 2.5% said that they failed to obtain needed
medical care during the previous 12 months due to financial barriers.

In 2002, older consumers averaged \$3,741 in out-of-pocket health care
expenditures, an increase of 45% since 1992. In contrast, the total
population spent considerably less, averaging \$2,416 in out-of-pocket
costs. Older Americans spent 12.7%of their total expenditures on health,
more than twice the proportion spent by all consumers (5.9%). Health
costs incurred on average by older consumers in 2002 consisted of
\$2,002 (53%) for insurance, \$905 (24%) for drugs, \$688 (18%) for
medical services, and \$146 (4%) for medical supplies.

***(Sources: Advanced Data From Vital and Health Statistics and other
data releases from the National Center for Health Statistics web site;
and the Bureau of Labor Statistics web site)***

**Disability and Activity Limitations**

In 1997, more than half of the older population (54.5%) reported having
at least one disability of some type (physical or nonphysical). Some of
these disabilities may be relatively minor but others cause people to
require assistance to meet important personal needs. Over a third
(37.7%) reported at least one severe disability. The percentages with
disabilities increase sharply with age (Figure 8). Disability takes a
much heavier toll on the very old. Almost three-fourths (73.6%) of those
aged 80+ report at least one disability. Over half (57.6%) of those aged
80+ had one or more severe disabilities and 34.9% of the 80+ population
reported needing assistance as a result of disability. There is a strong
relationship between disability status and reported health status. Among
those 65+ with a severe disability, 68.0% reported their health as fair
or poor. Among the 65+ persons who reported no disability, only 10.5%
reported their health as fair or poor. Presence of a severe disability
is also associated with lower income levels and educational attainment.

###### Figure 8: Percent With Disabilities, By Age: 1997

![](media/image10.wmf)

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In another study which focused on the ability to perform specific
activities of daily living (ADLs), over 27.3% of community-resident
Medicare beneficiaries over age 65 in 1999 had difficulty in performing
one or more ADLs and an additional 13.0% reported difficulties with
instrumental activities of daily living (IADLs). By contrast, 93.3% of
institutionalized Medicare beneficiaries had difficulties with one or
more ADLs and 76.3% of them had difficulty with three or more ADLS.
\[ADLs include bathing, dressing, eating, and getting around the house.
IADLs include preparing meals, shopping, managing money, using the
telephone, doing housework, and taking medication\]. Limitations on
activities because of chronic conditions increase with age. Among those
65-74 years old, 19.9 percent had difficulties with ADLs. In contrast,
over half (52.5%) of these 85 years and older had difficulties with
ADLs.

It should be noted that (except where noted) the figures above are taken
from surveys of the noninstitutionalized elderly. Although nursing homes
are being increasingly used for short-stay post-acute care, about 1.6
million elderly are in nursing homes (about half are age 85 and over).
These individuals often have high needs for care with their ADLs and/or
have severe cognitive impairment, due to Alzheimer\'s disease or other
dementias.

***(Sources: Current Population Reports, \"Americans with Disabilities,
1997\" P70-73, February 2001 and related Internet data; Internet
releases of the Census Bureau and the National Center on Health
Statistics)***

**Caregiving**

About 11% (3.7 million) of older Medicare enrollees received personal
care from a paid or unpaid source in 1999. Almost all community resident
older persons with chronic disabilities receive either informal care
(from family or friends) or formal care (from service provider
agencies). Over 90% of all these older persons with chronic disabilities
received informal care and/or formal care; and about two thirds received
only informal care. About 9 % of this chronically disabled group
received only formal services.

***(Source: National Long Term Care Survey)***

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**Special Topic: Health Insurance Coverage**

In 2003, almost all (96%) non-institutionalized persons 65+ were covered
by Medicare. Medicare covers mostly acute care services and requires
beneficiaries to pay part of the cost, leaving about half of health
spending to be covered by other sources. About 61% had some type of
private health insurance. Over 6.4% had military-based health insurance
and 9% of the non-institutionalized elderly were covered by Medicaid.
Less than 1% did not have coverage of some kind. Over 87% of
non-institutionalized Medicare beneficiaries in 2002 had some type of
supplementary coverage. However, among Medicare beneficiaries residing
in nursing homes, almost 58% were covered by Medicaid in 2001.

**Figure 9:**

![](media/image11.wmf){width="5.125in" height="3.4479166666666665in"}

Note: Figure 9 data is for the non-institutionalized elderly. A person
can be represented in more than one category.

***(Source: \"Income, Poverty, and health Insurance Coverage in the
United States: 2003,\" P60‑226, issued August, 2003, based on data from
Current Population Survey, Annual Social and Economic Supplement, Bureau
of the Census. Medicare beneficiary data is from the Medicare Current
Beneficiary Survey)***

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**Notes:**

\*Principal sources of data for the Profile are the U.S. Bureau of the
Census, the National Center on Health Statistics, and the Bureau of
Labor Statistics. The Profile incorporates the latest data available but
not all items are updated on an annual basis.

\*\*Excludes persons of Hispanic origin.

\*\*\*Calculated on the basis of the official poverty definitions for
the years 2000-2002

\*\*\*\* Census 2000 figure

\*\*\*\*\* 2001 figure

*A Profile of Older Americans: 2004* was prepared by the Administration
on Aging (AoA), U.S. Department of Health and Human Services. The annual
Profile of Older Americans was originally developed and researched by
Donald G. Fowles, AoA. Saadia Greenberg, AoA, developed the 2004
edition.

AoA serves as an advocate for the elderly within the federal government
and is working to encourage and coordinate a responsive system of family
and community based services throughout the nation. AoA helps states
develop comprehensive service systems which are administer by 56 State
and Territorial Units on Aging, 655 Area Agencies on Aging, 226 Native
American and Hawaiian organizations, and more than 29,000 local service
providers.

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