# Presentation: 477703

## Slide 1

**Notes:**
Image of cover page of “Older Americans 2008:  Key Indicators of Well Being.”

## Slide 2

**Notes:**
Population Section divider page

## Indicator 1 – Number of Older Americans

**Indicator 1**** ****– Number of Older Americans**

**Notes:**
This chart for Indicator 1 - Number of Older Americans shows the large growth of the population 65 and older from 1900 to 2006 and the even greater projected growth from 2006 to 2050.  It also shows the growing numbers of persons 85	 and older and their large projected growth to 2050. 

## Indicator 1 – Number of Older Americans

**Indicator 1**** ****– Number of Older Americans**

**Notes:**
This map chart for indicator 1 - Number of Older Americans – shows the percentage of persons 65 and older by county.  The highest percentages are in rural areas of the central and western part of the country, some areas of the eastern states, and Florida. 

## Indicator 2 – Racial and Ethnic Composition

**Notes:**
This chart of Indicator 2 - Racial and Ethnic Composition – shows the strong projected growth of the minority older population which will reach 39 percent of the 65 and over population in 2050.  Black elderly are project to grow to 12 percent in 2050 and Hispanic elderly are projected to grow to 18 percent. 

## Indicator 3 – Marital Status

**Notes:**
This chart of Indicator 3 - Marital Status – shows that most older men are married but a lower percent of older women are married.  These percentages of married elderly decline with aging, especially among women.  Over half of older women aged 75 to 85 are widows and 76 percent of those over 85. 

## Indicator 4 – Educational Attainment

**Notes:**
This chart for Indicator 4 - Educational Attainment – shows the growing increase in the number of persons over 65 who are high school graduates – about 76 percent in 2007.  The percent of college graduates is also increasing although it is much lower. 

## Indicator 4 – Educational Attainment

**Notes:**
This chart for Indicator 4 - Educational Attainment – shows the substantial gaps between the percent of high school graduates among different racial and ethnic categories. 

## Indicator 5 – Living Arrangement

**Notes:**
This chart for Indicator 5 - Living Arrangements – shows that most men over 65 live with spouses (76 percent), although there are racial and ethnic variations.  Only 19 percent of older men live alone.  However, only 42 percent of women 65 and over live with spouses and 39 percent live alone.  There are also racial and ethnic differences among older women. 

## Indicator 6 – Older Veterans

**Notes:**
This chart for Indicator 6 - Older Veterans – shows that most older men are veterans.  This percentage is highest among younger elderly but older elderly categories will show increase percentages of veterans in 2010. 

## Slide 11

**Notes:**
Economics Section divider page

## Indicator 7 – Poverty

**Notes:**
This chart for Indicator 7 – Poverty – shows that the percentages of persons 65 and over who are below poverty has decrease from about 40 percent in 1959 to about 9 percent in 2006.  In recent years this percentage has been around 10 percent. 

## Indicator 8 – Income

**Notes:**
This chart for Indicator 8 – Income – shows the decline from 1974 to 2006 in the percentage of persons 65 and over who are in poverty or are low income and the increase in the high and middle income groups. 

## Indicator 9 – Sources of Income

**Notes:**
This chart for Indicator 9 - Sources of Income - shows trend in sources of sources of income from 1976 to 2006.  It shows some decline in proportion of income come from assets while the proportion of income from social security and other pensions has increased. 

## Indicator 9 – Sources of Income

**Notes:**
This chart for Indicator 9 - Sources of Income –shows that the lower income groups derive most of the income from social security while the higher income groups have more of their incomes from earnings, pensions, and assets. 

## Indicator 10 – Net Worth

**Notes:**
This chart for Indicator 10 - Net Worth – shows the increase in median household net worth for white and Black older person from 1984 to 2005.  However, the net worth of white elderly remains substantially higher. 

## Indicator 10 – Net Worth

**Notes:**
This chart for Indicator 10 - Net Worth –shows that older persons with higher levels of educational attainment show higher levels of median household net worth. 

## Indicator 11 – Participation in the Labor Force

**Notes:**
This chart for Indicator 11 - Participation in the Labor Force – shows declining rates of labor force participation for men in older age categories.  It also shows increased labor force participation in the past decade. 

## Indicator 11 – Participation in the Labor Force

**Notes:**
This chart for Indicator 11 - Participation in the Labor Force - shows declining rates of labor force participation for women in older age categories.  It also shows increasing rates over the years, especially in recent years. 

## Indicator 12 – Total Expenditures

**Notes:**
This chart for Indicator 12 - Total Household Annual Expenditures – shows the percent of household expenditures by age for different age groups.  Differences are modest but the oldest group spends a higher percent on health care and housing. 

## Indicator 13 – Housing Problems

**Notes:**
This chart for Indicator 13 - Housing Problems – shows the percentage of older persons with physical or cost burden housing problems fro 1986 to 2005.  Only 5 percent had physical problems with their housing in 2005.  However, from 1985 to 2006, the percent reporting cost burden issues increased from 26 percent to 33 percent. 

## Slide 22

**Notes:**
Health Status Section divider page

## Indicator 14 – Life Expectancy

**Notes:**
This chart for Indicator 14 - Life Expectancy – shows the steady increase in life expectancy at ages 65 and 85 for men and women from 1900 to 2004. 

## Indicator 14 – Life Expectancy

**Notes:**
This chart for Indicator 14 - Life Expectancy – shows the steady increase in life expectancy at ages 65 from 1980 to 2003 for women in the United States, Canada, England and Wales, Japan and France.  All show gains but the United States has lower life expectancy than all these countries except for England and Wales.

## Indicator 14 – Life Expectancy

**Notes:**
This chart for Indicator 14 - Life Expectancy – shows the steady increase in life expectancy at ages 65 from 1980 to 2003 for men in the United States, Canada, England and Wales, Japan and France.  All show gains but the United States has lower life expectancy than all these countries except for England and Wales. 

## Indicator 15 – Mortality

**Notes:**
This chart for Indicator 15 – Mortality – shows a steep in deaths from heart disease from 1981 to 2004 but much less or no decreases for other major causes of death. 

## Indicator 16 – Chronic Health Conditions

**Notes:**
This chart for Indicator 16 - Chronic Health Conditions – shows the percent of men and women reporting selected chronic conditions.  Over half of men and women reported hypertension with arthritis and heart disease as the next most common conditions. 

## Indicator 17 – Sensory Impairments and Oral Health

**Notes:**
This chart for Indicator 17 - Sensory Impairments and Oral Health – shows that in 2006 48 percent of men and 35 percent of women reported any trouble seeing; 16 and 18 percent respectively reported any trouble seeing, and 27 and 25 percent respectively report that they had no natural teeth.

## Indicator 18 – Respondent-Assessed Health Status

**Notes:**
This chart for Indicator 18 - Respondent-Assessed Health Status – shows that the percent of persons over 65 who report good to excellent health declines with age and that non-Hispanic whites report higher levels than non-Hispanic Blacks and Hispanics. 

## Indicator 19 – Depressive Symptoms

**Notes:**
This chart for Indicator 19 - Depressive Symptoms – shows that from 1998 to 2004 11 to 12 percent of men over 65 had clinically relevant depressive symptoms as did 17 to 19 percent of women. 

## Indicator 19 – Depressive Symptoms

**Notes:**
This chart for Indicator 19 - Depressive Symptoms – shows a modest increase in clinically relevant depressive symptoms for older age categories.  Also shows lower levels for men except at the 85 and over group where the levels are similar. 

## Indicator 20 – Functional Limitations

**Notes:**
This chart for Indicator 20 – Functional Limitations – shows the percent of Medicare enrollees age 65 and over who have limitations in activities of daily living (ADLs) and instrumental activities of daily living (IADLs) from 1992 to 2005.  The chart shows a decrease in the level of ADL and IADL limitations during these years. 

## Indicator 20 – Functional Limitations

**Notes:**
This chart for Indicator 20 – Functional Limitations - shows the percent of men and women who are Medicare enrollees age 65 and over and who are unable to perform certain physical functions in 1991 and 2005.  The chart shows that women report more such physical problems than men. 

## Slide 34

**Notes:**
Health Risks and Behaviors Section divider page

## Indicator 21 – Vaccinations

**Notes:**
This chart for Indicator 21 – Vaccinations – the percentage of people over 65 from 1989 to 2006 who reported having been vaccinated against influenza and pneumoccoccal disease by race and Hispanic origin.  The percentage vaccinated has risen – although with some fluctuation – while Blacks and Hispanics report lower rates of vaccinations. 

## Indicator 22 – Mammography

**Notes:**
This chart for Indicator 22 – Mammography – shows that the percent of women over 65 who have had a mammography in the previous two years more almost tripled from 1987 to 2005. 

## Indicator 23 – Diet Quality

**Notes:**
This chart for Indicator 23 - Dietary Quality – shows that the healthy eating index 2005 score for persons 65 and older was 68 out of the maximum of 100 points.  There were no significant differences between adults aged 55 to 64, 65 to 74, or 75 and older. 

## Indicator 24 – Physical Activity

**Notes:**
This chart for Indicator 24 - Physical Activity – shows that in 2005–2006, 22 percent of people age 65 and over reported engaging in regular leisure time physical activity. The percentage of older people engaging in regular physical activity was lower at older ages, ranging from 26 percent among people age 65–74 to 10 percent among people age 85 and over. There was no significant change in the percentage reporting physical activity between 1997 and 2006. 

## Indicator 25 – Obesity

**Notes:**
This chart for Indicator 25 – Obesity – shows that As with other age groups, the percentage of people age 65 and over who are obese has increased since 1988–1994. In 2005–2006, 37 percent of noninstitutionalized women age 65–74 and 24 percent of women age 75 and over were obese. This is an increase from 1988–1994, when 27 percent of women age 65–74 and 19 percent of women age 75 and over were obese. Older men follow similar trends; 24 percent of men age 65–74 and 13 percent of men age 75 and over were obese in 1988–1994, compared with 33 percent of men age 65–74 and 25 percent of men age 75 and over in 2005–2006. 

## Indicator 26 – Cigarette Smoking

**Notes:**
This chart for Indicator 26 - Cigarette Smoking – shows that the percentage of older Americans who are current cigarette smokers declined dramatically in the four decades between 1965 and 2005. Most of the decrease during this period is the result of the declining prevalence of cigarette smoking among men (from 29 percent in 1965 to 9 percent in 2005). For the same period, the percentage of women who smoke cigarettes has remained relatively constant, increasing slightly from 10 percent in 1965 before declining to 8 percent in 2005. 

## Indicator 27 – Air Quality

**Notes:**
This first chart for Indicator 27 - Air Quality – shows that in 2006, 24 percent of people age 65 and over lived in counties with poor air quality for ozone compared with 31 percent in 2000. Since the year 2000, ground level ozone pollution peaked in 2002 when the United States experienced a hot, dry summer climate that was particularly conducive to the formation of ground-level ozone. A comparison of 2000 and 2006 shows a reduction in PM 2.5. In 2000, 44 percent of people age 65 and over lived in a county where PM 2.5 concentrations were at times above the EPA standards compared with 21 percent of people age 65 and over in 2006. 

## Indicator 27 – Air Quality

**Notes:**
This second chart for Indicator 27 - Air Quality – shows that the counties with poor air quality in 2006.  In 2006 nearly 38 percent of the population lived in a county where measured air pollutants reached concentrations above EPA standards. This percentage was fairly consistent across all age groups, including people age 65 and over. Overall, approximately 113 million people lived in counties where monitored air in 2006 was unhealthy at times because of high levels of at least one of the six principal air pollutants: ozone, particulate matter (PM), nitrogen dioxide, sulfur dioxide, carbon monoxide, and lead. 

## Indicator 28 – Use of Time

**Notes:**
This first chart for Indicator 28 - Use of Time – shows that in 2006, older Americans spent on average more than one-quarter of their time in leisure (6.5 hours per day). This proportion increased with age: Americans age 75 and over spent 33 percent of their time in leisure compared with 23 percent for those age 55–64.  On an average day, people age 55–64 spent 16 percent of their time (almost 4 hours) working or doing work-related activities compared with 4 percent (less than one hour) for people age 65–74 and 1 percent (less than 30 minutes) for people age 75 and over. 

## Indicator 28 – Use of Time

**Notes:**
This second chart for Indicator 28 - Use of Time – shows that in 2006 watching TV was the activity that occupied the most leisure time—about one-half the total—for Americans age 55 and over. Americans age 75 and over spent a higher percentage of their leisure time reading (14 percent versus 10 percent) and relaxing and thinking (11 percent versus 7 percent) than did Americans age 55–64. The proportion of leisure time that older Americans spent socializing and communicating—such as visiting friends or attending or hosting social events—declined with age. For Americans age 55–64, 13 percent of leisure time was spent socializing and communicating compared to 10 percent for those age 75 and over. 

## Slide 45

**Notes:**
Health Care Section divider page

## Indicator 29 – Use of Health Care Services

**Notes:**
This first chart for Indicator 29 - Use of Health Care Services – shows that between 1992 and 1999, the hospitalization rate increased from 306 hospital stays per 1,000 Medicare enrollees to 365 per 1,000. The rate then decreased to 350 per 1,000 enrollees in 2005. The average length of a hospital stay decreased from 8.4 days in 1992 to 5.7 days in 2005. Skilled nursing facility stays increased significantly from 28 per 1,000 Medicare enrollees in 1992 to 79 per 1,000 in 2005. Much of the increase occurred from 1992 to 1997. 

## Indicator 29 – Use of Health Care Services

**Notes:**
This second chart for Indicator 29 - Use of Health Care Services – shows that Between 1992 and 2005, the number of physician visits and consultations increased. There were 11,359 visits and consultations per 1,000 Medicare enrollees in 1992, compared with 13,914 in 2005. The number of home health care visits per 1,000 Medicare enrollees increased rapidly from 3,822 in 1992 to 8,227 in 1997. Home health care use increased during this period in part because of an expansion in the coverage criteria for the Medicare home health care benefit.40 Home health care visits declined after 1997 to 2,295 per 1,000 enrollees in 2001. The decline coincided with changes in Medicare payment policies for home health care resulting from implementation of the Balanced Budget Act of 1997. The visit rate increased thereafter to 2,770 per 1,000 enrollees in 2005. 

## Indicator 30 – Health Care Expenditures

**Notes:**
This first chart for Indicator 30 - Health Care Expenditures - shows that after adjusting for inflation, health care costs increased significantly among older Americans from 1992 to 2004. Average costs were substantially higher at older ages. 

## Indicator 30 – Health Care Expenditures

**Notes:**
This second chart for Indicator 30 - Health Care Expenditures - shows that hospital and physician services are the largest components of health care costs of the elderly. Long-term care facilities accounted for 14 percent of total costs in 2004. Prescription drugs accounted for 15 percent of health care costs. The mix of health care services changed between 1992 and 2004. Inpatient hospital care accounted for a lower share of costs in 2004 (25 percent compared to 32 percent in 1992). Prescription drugs increased in importance from 8 percent of costs in 1992 to 15 percent in 2004. “Other” costs (short term institutions, hospice and dental care) also increased as a percentage of all costs (4 percent to 8 percent). 

## Indicator 31 – Prescription Drugs

**Notes:**
This first chart for Indicator 31 - Prescriptions Drugs - shows that average prescription drug costs for older Americans have increased rapidly in recent years. Average costs per person were $2,107 in 2004. Average out-of-pocket costs also increased, though not as rapidly as total costs because private and public insurance covered more of the cost over time. Older Americans paid 60 percent of prescription drug costs out of pocket in 1992, compared with 36 percent in 2004. Private insurance covered 38 percent of prescription drug costs in 2004; public programs covered 25 percent.

## Indicator 31 – Prescription Drugs

**Notes:**
This second chart for Indicator 31 - Prescriptions Drugs - shows that the number of Medicare beneficiaries enrolled in Part D prescription drug plans increased from 18.2 million in June 2006 to 19.7 million in September 2007. In September 2007, two thirds of enrollees were in stand-alone plans and one-third were in Medicare Advantage plans. In addition, approximately 6.5 million beneficiaries were covered by the Retiree Drug Subsidy in both years. Beneficiaries who were not in Part D plans and not covered by the Retiree Drug Subsidy either had drug coverage through another source (e.g., Tricare, Federal Employees Health Benefits plan, Department of Veterans Affairs, or current employer) or did not have drug coverage. In September 2007, 5.9 million Part D enrollees were receiving low income subsidies. Many of these beneficiaries had drug coverage through the Medicaid program prior to enrollment in Part D. 

## Indicator 32 – Sources of Health Insurance

**Notes:**
This chart for Indicator 32 - Sources of Health Insurance – shows that Most Medicare enrollees have a private insurance supplement, approximately equally split between employer sponsored and Medigap policies. The percentage with Medicaid coverage has increased slightly over the last several years to about 12 percent in 2005. Enrollment in Medicare HMOs and similar health plans, which are usually equivalent to Medicare supplements because they offer extra benefits, varied between 6 percent and 21 percent. About 12 percent of Medicare enrollees report having no health insurance supplement. Enrollment in HMOs and similar health plans increased rapidly throughout the 1990s, then decreased beginning in 2000 as many HMOs withdrew from the Medicare program. The percent with Medigap policies decreased in the late 1990s as HMO enrollment increased. There was a slight increase in the percentage of Medicare enrollees without a supplement in 2002. 

## Indicator 33 – Out-of-Pocket Health Care Expenditures

**Notes:**
This chart for Indicator 33 - Out-of-Pocket Health Care Expenditures – shows that from 1977 to 2004, the percentage of household income that people age 65 and over allocated to out-of-pocket spending for health care services increased among those in the poor/near poor income category (from 12 percent to 29 percent).   The percentage of household income that people age 65 and over allocated to out-of-pocket spending among those in the other income category increased from 5 to 8 percent. 

## Indicator 34 – Sources of Payment for Health Care Services

**Notes:**
This chart for Indicator 34 - Sources of Payment for Health Care Services – shows that Medicare paid for slightly more than one half (53 percent) of the health care costs of Medicare enrollees age 65 and over in 2004. Medicare finances most of their hospital and physician costs, as well as a majority of short term institutional, home health, and hospice costs. Medicaid covered 9 percent of health care costs of Medicare enrollees age 65 and over, and other payers (primarily private insurers) covered another 19 percent. Medicare enrollees age 65 and over paid 19 percent of their health care costs out-of-pocket, not including insurance premiums. In 2004, 48 percent of long-term care facility costs for Medicare enrollees age 65 and over were covered by Medicaid; another 45 percent of these costs were paid out-of-pocket. Fifty five percent of prescription drug costs were covered by third party payers other than Medicare and Medicaid, consisting mostly of private insurers. Thirty-two percent of prescription drug costs were paid out-of pocket. Seventy-six percent of dental care received by older Americans was paid out-of pocket. 

## Indicator 35 – Veterans’ Health Care

**Notes:**
This chart for Indicator 35 - Veterans' Health Care – shows that In 2006, approximately 2.4 million veterans age 65 and over received health care from VHA. An additional 1.1 million older veterans were enrolled to receive health care from VHA but did not use its services in 2006. 

## Indicator 36 – Nursing Home Utilization

**Notes:**
This first chart for Indicator 36 - Nursing Home Utilization – shows that In 2004, 9 people per 1,000 age 65–74 resided in nursing homes, compared with 36 people per 1,000 age 75–84 and 139 people per 1,000 age 85 and over. The total rate of nursing home residence among the older population declined between 1985 and 2004. In 1985, the age adjusted nursing home residence rate was 54 people per 1,000 age 65 and over. By 2004 this rate had declined to 35 people per 1,000. Among people age 65– 74, rates declined by 24 percent, compared with a 37 percent decline among people age 75–84 and age 85 and over. 

## Indicator 36 – Nursing Home Utilization

**Notes:**
This second chart for Indicator 36 - Nursing Home Utilization – shows that In 2004, the majority of nursing home residents age 65 and over received assistance with at least one activity of daily living (ADL). Levels of assistance provided for individual ADLs were high, from 94 percent for bathing to 73 percent for transferring. The only ADL for which the majority of residents received no assistance (65 percent) was eating. 

## Indicator 37 – Residential Services

**Notes:**
This first chart for Indicator 37 - Residential Services – shows that In 2005, 2 percent of the Medicare population aged 65 and over resided in community housing with at least one service available. Approximately 5 percent resided in long term care facilities. The percentage of people residing in community housing with services and in long-term care facilities was higher for the older age groups; among individuals age 85 and over, 7 percent resided in community housing with services, and 17 percent resided in long-term care facilities. Among individuals age 65–74, 98 percent resided in traditional community settings. 

## Indicator 37 – Residential Services

**Notes:**
This second chart for Indicator 37 - Residential Services – shows that People living in community housing with services had more functional limitations than traditional community residents, but not as many as those living in long term care facilities. Forty-six percent of individuals living in community housing with services had at least one activity of daily living (ADL) limitation compared with 26 percent of traditional community residents. Among long-term care facility residents, 82 percent had at least one ADL limitation. Forty percent of individuals living in community housing with services had no ADL or instrumental activities of daily living (IADL) limitations. 

## Indicator 38 – Personal Assistance and Equipment

**Notes:**
This first chart for Indicator 38 - Personal Assistance and Equipment – shows that Between 1992 and 2005, the age adjusted proportion of people age 65 and over who had difficulty with one or more ADLs and who did not receive personal assistance or use special equipment with these activities decreased from 42 percent to 35 percent. More people are using equipment only—the percentage increased from 28 percent to 36 percent. The percentage of people who used personal assistance only decreased from 9 percent to 7 percent. In 2005, nearly two-thirds (65 percent) of people who had difficulty with one or more ADLs received personal assistance or used special equipment: 7 percent received personal assistance only, 36 percent used equipment only, and 22 percent used both personal assistance and equipment. 

## Indicator 38 – Personal Assistance and Equipment

**Notes:**
This second chart for Indicator 38 - Personal Assistance and Equipment – shows that In 2005, more than three-fifths of people age 65 and over who had difficulty with one or more IADLs received personal assistance. The percentage of people receiving personal assistance was higher for people age 85 and over (74 percent) than it was for people age 75–84 (67 percent) or people age 65–74 (63 percent). There was no significant change between 1992 and 2005 in the percentage of people (in any age group) who had difficulty with one or more IADLs and who received personal assistance. Men and women were equally to receive assistance. 

## SPECIAL FEATURE - Literacy

**Notes:**
This special feature chart on Literacy shows that the majority of older Americans face literacy challenges. In 2003, 60 percent of people age 65 and over had below basic or basic document and prose literacy, and 71 percent had below basic or basic quantitative literacy. Only 3 percent to 5 percent of older Americans had proficient literacy in any component. Between 1992 and 2003, the percentage of older Americans that had below basic prose, document, and quantitative literacy decreased significantly, from 33 percent to 23 percent for prose, from 38 percent to 27 percent for document, and from 49 percent to 34 percent for quantitative.

## SPECIAL FEATURE – Health Literacy

**Notes:**
This special feature chart on Health Literacy shows that Older adults are proportionately more likely to have below basic health literacy than any other age group. Almost two-fifths (39 percent) of people age 75 and over have a health literacy level of below basic compared with 23 percent of people age 65–74 and 13 percent of people age 50–64. 

## Slide 64

**Notes:**
This chart is titled The Historical Experience of Three Cohorts of Older Americans: A Timeline of Selected Events 1923-2008.  The timeline lists the 1923, 1933, and 1943 cohorts.  Selected events include the year, historical events, and legislative events.