Vital and

Health Statistics

Long-Term Care

for the Functionally

Dependent Elderly

Series13:

Data From the National Health Survey

No, 104

This report presents the prevalence of functional dependency among the

elderly population both inside and outside of institutions in 1984-85, as well as

the prevalence of long-term care use (nursing homes, formal home care, and

informal home care) by the functionally dependent elderly population.

Estimates are based on data collected in the Supplement on Aging to the

1984 National Health Interview Survey and in the 1985 National Nursing Home

Survey,

US. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service

Centers for Disease Control

Ndlona[ Center for Health Statistics

Hyattsville, Maryland

September 1990

DHHS Publication No. (PHS) 90-1765
Copyright information

All material appearing mthks report IS mthepubhcdomaln and may be

reproduced or copied without permlsslon, citation as to source. however, IS

appreciated.

Suggeatad citation

Hmg E, Blcmm B. Long-term care forthefunct}onally dependent elderly.

National Center for Health Statlstlcs. Vttal Health Stat 13(1 O4). 1990.

Library of Congress Cataloging-in-Publiition Data

Hmg, Esther.

Long-term care forthefunctlonally dependent elderly by Esther Hlng and

Barbara Bloom.

p. cm —(Vital and health stattstlcs. Series 13, Data from the national

health survey ;no. 104) (DHHSpubl{catlon ;no (PHS)9G1765)

“Basedo ndatacollected mthe Supplement onagtng to the 1984 National

Health interview Suwey and In the 1985 Natlonai Nursing Home Survey”

Includes btbl[ographlcal references

ISBN &840&43435-1

1. Aged. Physically handlcapped—Long term care 2. Aged, Physically

handicapped-Long lermcar&Unlted States-Statlstlcs.3 Aged—Unted

States—Functlonal assessment 4 Aged—United States—Functional

assessment—Statlstlcs. I Bloom. Barbara. Il. Fktl, Joseph E.

Supplement onagmg to the 1984 National Health interview Survey Ill National

Center for Health Statlstlcs(U.S.)lV National Nursing Home Survey (U S.)V

Tile VI Series Vll Senes:VNal and health statistics Series 13, data from the

national health survey : no. 104.

[DNLM 1. Actlvltles of Dally Llwng-in old ag*Unted States—statistics

2 Health Sewices for Aged—utMlzatlon-Unlted States. 3 Long Term Cars+

United States—statlsi( cs.4 Nursing Serwces—utilization—UnitedStates. W2A

N148vm no. 104]

RA407.3.A349no 104

[RA564.8]

362.1’0973’02t s+c20

[362. 1‘6’0846]

DNLMIDLC

for L/brary of Congress 9G5888

CIP
National Center for Health Statistics

Manning Feirdeib, M.D., Dr.P.H., Director

Robert A. Israel, Deputy Director

Jacob J. Feldman, Ph.D., Associate Director for AruzZysis

and Epidemiology

Gail F. Fisher, Ph.D., Associate Director for Planning and

Extramural Programs

Peter L. Hurley, Associate Director for VW and Health

Statistics Systems

Stephen E. Nieberding, Associate Director for Management

Charles J. Rothwell, Associate Director for Data Processing

and Services

Monroe G. Sirken, Ph.D., Associae Director for Research

and Methodology

David L. Larson, Assistant Directo~ Atlanta

Division of Health Care Statistics

W. Edward Bacon, Ph.D., Director

Thomas McLemore, Deputy Director

Evelyn S. Mathis, Chiej Long-Temn Care Statistics Branch

Manoochehr K. Nozary, Chiej Technical Services Branch

Division of Health Interview Statistics

Owen T. Thornberv, Jr., Ph.D., Director

Deborah M. Winn, Ph.D., Deputy Director

Gerry E. Hendershot, Ph.D., Chie~ Illness and Disability

Statistics Branch

Cooperation of the U.S. Bureau of the Census

Under the Iegklation establishing the National Health Interview Survey, the

Public Health Service is authorized to use, insofar as possible, the services or

facilities of other Federa~ State, or privnte agencies.

In accordance with specifications est.nbfished by the Division of Health

Interview Statistics, the U.S. Bureau of the Census, under n contmctwd

m’rmrgement, part icipnted in pkroirrg the survey and collecting the dfitri.
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Highlights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sourcesandlimitationsofthedata . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Functional dependencyamongthe elderly . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Definitionoffunctional dependency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Prevalence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Impactonlivingarrangement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Impactonhealth status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Useoflong-terrn care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Homecare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nursinghome andhomecareuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Useofhealthcareandcommunity services inthepastyear . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . .

Listofdetailedtables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Appendwes

I. Technical notesonmethods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

II. Definitionsofcertaintemnsusedin thisreport . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

111. Selectedquestionsonfunctional dependency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

IV. Noteson standarderrorsandstatistical tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

List of text tables

A. Percent of noninstitutionalized persons 65 years of age and over dependent in selected activities of daily living

andinstrumental activities ofdaily living: United States, 1984 and 1986 . . . . . . . . . , . . . . . . . . . . . .

B. Number and percent distributionof functionally dependent persons65 years of age and over, by living arrangements,

according to dependency level: United States, 1984-85 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

C. Number and percent distribution of noninstitutionalized persons 65 years of age and overdependent in home care

activities, by living arrangement of caregivers, according to relationship of caregivers: United States, 1984 . . . . .

D. Number and percent of functionally dependent persons 65 years of age and over, bytypeof long-term care received

anddependency level: United States, 1984-85 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

E. Number and percent distribution of noninstitutionalized functionally dependent persons 65 years of age and over

receiving home care by source of assistance, according to selected characteristics: United States, 1984 . . . . . . .

F. Number of persons 65 years of age and over receiving long-term care and prevalence rate of selected chronic

condhions per 100 persons, by type of Iong-term care: United States, 1984-85 . . . . . . . . . . . . . . . . . . .

List of text figures

1. Percent of persons 65 years of age and over residing in nursing homes and percent of functionally dependent

persons 65yewsof ageandover residing innursing homes, byage: United States, 1984-85 . . . . . . . . . . . .

1

2

3

5

5

5

6

8

11

11

12

15

16

17

19

34

37

39

47

4

8

11

12

13

14

7

...

Ill
2. Percent of functionally dependent persons 65 years of age and over residing in nursing homes, by level of

dependency :United States, 198&85. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...9

3. Percent of functionally dependent persons 65 years of age and over residing in nursing homes, by selected

chronic conditions: United States, 1984-85, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...14

Symbols

..- Data not available

. . . Category not applicable

Quantity zero

0.0 Quantity more than zero but less than

0.05

z Quantity more than zero but less than

500 where numbers are rounded to

thousands

*

Figure does not meet standard of

reliability or precision (more than 30-percent relative standard error)

# Figure suppressed to comply with

confidentiality requirements
Long=term care for the

functionally dependent

elderly

by Esther Hing, Division of Health Care Statistics, and

Barbara Bloom, Division of Health Interview Statistics

Introduction

The population in need of long-term care has been defined

as those requiring assistance either in the activities of daily

living or in the instrumental activities of daily living ( 1–5).

The activities of daily living (ADL’s) reflect an individual’s

capacity for self care in such basic functions as bathing,

dressing, eating, or using the toilet (6); whereas the instrumental activities of daily living (IADL’s) are common everyday

tasks such as preparing meals, shopping, or doing housework,

which enable an individual to live independently in the community (7). For example, the National Long-Term Care Demonstration, initiated in 1980 by the Department of Health and

Human Services to evaluate comprehensive case management

of community care, used functional disability in ADL’s and

IADL’s as eligibility criteria for inclusion in the study (5).

In addition, the 1982 National Long-Term Care Survey defined

the Medicare population at risk of needing long-term care

as those functionally impaired in ADL’s and IADL’s for at

least 3 months (4). The link between functional dependency

and increased use of long-term care services has been cited

in many previous studies (1,2,8–1 1). Weissert estimated that

of 4.9 million persons dependent in ADL’s or in mobility

in 1977, 26 percent were in nursing homes and 52 percent

of those dependent in toileting or eating resided in nursing

homes (2). Branch and others found that dependency in ADL’s

was predictive of both nursing home placement and home

care utilization in prospective studies of community-dwelling

elderly persons in Massachusetts (8–9). Other than the studies

by Weissert and Scanlon (3), most of these studies have

examined factors associated with either nursing home institutionalization or home care utilization, but not both. This

report will examine the prevalence of ADL and IADL dependency among the elderly population both inside and outside

of nursing homes in 1984-85, and the use of nursing homes

and home care services by those dependent in either ADL’s

or IADL’s. Data used in this report are from the Supplement

on Aging (SOA) to the 1984 National Health Interview Survey

(NHIS) and the 1985 National Nursing Home Survey (NNHS).

It should be pointed out that in order to link data on

the elderly in the community (NHIS) and in nursing homes

(NNHS), some modification of the definitions of functional

dependency from each survey was necessary. The definitions

of functional dependency used in this report are unique to

this report. A recent study has found that differences in which

ADL items are being measured, and how they are measured,

accounts for much of the variation in size of the elderly

population with ADL disabilities as estimated from recent

national surveys (12). Estimates of functional disability may

also vary from survey to survey because of differences in

sample design, sample size, survey methodology, and age

structure of the population at the time the surveys were conducted (12). Therefore, caution must be exercised when comparing results from this study with other studies.
Highlights

● In 1984-85, 29 percent of the institutionalized and noninstitutionalized elderly population (or about 8 million persons) were in need of long-term care services.

● Seventy-nine percent of the functionally dependent elderly

received some type of long-term care in 1984-85. Informal

home care services provided by friends or family members

were the most frequent type of long-term care received

by the functionally dependent elderly (42 percent), followed by formal home care services (21 percent) and

nursing home care (16 percent).

● Use of nursing homes increased as the number of limitations in activities of daily living (ADL’s) increased; nursing home use was greatest (59 percent) among those

dependent in five to seven ADL’s.

● Home care use was greater for those with four or fewer

ADL limitations or for those with limitations only in

instrumental activities of daily living (IADL’s).

● Among the functionally dependent elderly, use of nursing

homes increased with age and was greater for females,

for white persons, for unmarried persons, and for persons

with incomes below the poverty threshold.

● Among the functionally dependent elderly, use of formal

home-care services was greater for females, for persons

living alone, for unmarried persons, and for persons with

incomes above the poverty threshold.

● Among the functionally dependent elderly, use of informal

home-care services was greater for males, for black persons or persons of other races, for married persons, and

for persons living with a spouse or others.

● Among the noninstitutionalized elderly population, use

of health care services in the past year was greater among

the functionally dependent elderly than among the functionally independent. Severely dependent elderly persons

with five to seven ADL limitations had more physician

contacts in the past year, were more likely to be hospitalized at least once in the past year, and were more

likely to use home health services in the past year than

were those with fewer ADL limitations.
Sources and limitations of the

data

Data presented in this report are for the noninstitutionalized and institutionalized elderly population in

1984-85. The data presented on the civilian noninstitutionalized population 65 years of age and over were derived

from responses to the Supplement on Aging (SOA) to the

1984 National Health Interview Survey (NHIS). The NHIS

is a large, continuing survey of the civilian noninstitutionalized

population of the United States conducted by the National

Center for Health Statistics. Each year people in about 50,000

households are selected through a multistage area probability

sampling process. The sample is divided into weekly subsampies. People in the households are interviewed once during

the year by U.S. Bureau of the Census interviewers to obtain

information about their health and use of health care.

In 1984, a special Supplement on Aging was added to

the NHIS to obtain information about older people who were

living in the community. A publication by Fitti and Kovar

describes the SOA’s background, sample design, questionnaire

planning and development, survey operations, and analysis

(13). Selected results from the SOA have already been published innumerous NCHS publications (14-22).

All members of households in the NHIS 65 years of

age and over and a half sample of those 55-64 years of

age were selected for the SOA sample. Where possible, information was obtained from the sample person. Of the 16,148

people for whom information was obtained, 92 percent

answered the questions for themselves; for the remaining completed interviews, a proxy respondent provided the information

on the sample person. This report is based on interviews

for sample persons 65 years of age and over who numbered

11,497 and represented 26,433,000 persons in the population.

The response rate was 97 percent. The supplement was also

designed to be the basis of a family of longitudinal studies

that are known collectively as the Longitudinal Study of Aging

(LSOA). Data from the 1984 SOA and the 1986 LSOA have

already been published (23).

Data on functional dependency of the civilian noninstitutionalized population 65 years of age and over in 1984

substantially underrepresent functional dependency of the total

population 65 years of age and over in 1984, because many

of the most dependent members of this age group were institutionalized in nursing homes, and were not represented

in the SOA sample. Data on the functional limitations of

nursing home residents, therefore, were included in this study

for a more complete picture of functional dependency among

the elderly.

Data on nursing home residents are from the 1985 National

Nursing Home Survey (NNHS), a nationwide sample survey

of nursing homes, their residents, discharges, and staff, conducted periodically by the National Center for Health Statistics.

Preliminary statistics from the 1985 NNHS about facilities,

residents, discharges, and registered nurses have been published (24-27). Final statistics on a variety of topics (28-31)

have also been published.

Estimates in this report are based on the sample of 4,650

residents 65 years of age and over from the 1,079 nursing

homes participating in the survey. A sample of five or fewer

residents per sample facility was selected. Residents included

in the sample were those on the nursing home’s roster the

night before data collection began. Data were collected by

interviewing knowledgeable nursing home staff members, who

referred to the residents’ medical records when necessary.

The response rate for the resident sample was 97 percent.

More details on the survey methodology of the NHIS and

the NNHS are presented in appendix I.

By combining data from the NNHS and the SOA of

the 1984 NHIS, a more complete picture of functional dependency and use of Iong-term care is obtained. However, certain

caveats should be noted in combining 1985 NNHS and 1984

SOA data. First, nursing homes do not completely represent

the institutionalized elderly population. Thus, the data analyzed

in this report do not include all elderly persons in “board

and care homes” or “residential care homes,” mental hospitals,

chronic disease, rehabilitation, or other long-term care hospitals. The 1984 SOA, however, includes independent group

residences for the elderly, handicapped, and functionally disabled, which includes “board and care homes. ” Residences

which provided any nursing or medical care were excluded

from the SOA.

Second, it was assumed that the functionally dependent

noninstitutionalized population in 1984 was similar to that

in 1985. Table A shows the basis for this assumption. Between

1984 and 1986, the percent of noninstitutionalized elderly

persons dependent in each of the personal care activities of

bathing, dressing, using the toilet, transferring, and eating

were similar. Table A also shows that there was no change

in the percent of noninstitutionalized elderly persons dependent

in preparing meals, shopping, managing money, using the

telephone, and doing light and heavy housework during the

same time period. In this report, the percent of functionally

dependent elderly in the community in 1984 was used as

a surrogate for the functionally dependent elderly in the community in 1985, and use of nursing homes in 1985 was assumed

to be the same in 1984. Thus, it is assumed that the combined

3
Table A. Percent of noninatitutionaliied persona 65 years of age and

over dependent in selected activities of daily living and instrumental

activities of daily living United States, 1964 and 1986

Selected activities of daily living and

instrumental actwitfes of daily Iivin.q 1984 1986

Activmes of dally living

Bathing, . . . . . . . . . . . . . . .

Dressing, . . . . . . . . . . . . . . . . . . . . .

Using thetodet, . . . . . . . . . . . . . . . . . .

Transferring . . . . . . . . . . . . . . . . . . . .

Eatin g . . . . . . . . . . . . . . . . . . . . . . .

Instrumental activities of daily living

Preparing meals.....,,. . . . . . . . . . .

Shopping . . . . . . . . . . . . . .

Managing money . . . . . . . . . . . . . .

Usingthetelephone . . . . . . . . . . . . . . . .

Light housework . . . . . . . . . . . . . . . . .

Percent

6.26 621

4.34 4.38

2.27 2.43

2.88 3.24

1.06 1.09

3.64 3.86

7.31 7,45

3.44 3.26

1.94 1.91

4.40 4.87

SOURCE: Hendershot, G. Theaglng ivingln thecommuni~: Data from ~hel986andl984

National Health interview Sutveys, Paper presented attheennual meeting of the

Gerontological Society of Amerm, Washington, D.C 1987.

data represent cross-sectional estimates for the midpoint of

the 1984-85 survey period.

Third, although it was assumed that the nursing home

resident population in 1985 was independent of the noninstitutionalized elderly population sampled in 1984, some percent of the 1985 NNHS sample was in the community in

1984 and thus was eligible for inclusion in the 1984 SOA.

The magnitude of this potential double counting, however,

is probably small because on any given day the nursing home

resident population is more representative of long-stay than

short-stay patients (28).

And finally, there may be reporting differences due to

the different methodologies employed by the two surveys.

In the SOA, information about functional dependency, disability, medical care, and other health-related items was reported

primarily by elderly respondents in personal interviews. In

the NNHS, the comparable information was reportedly nursinghome staff respondents whoreferred to the patients’ medical records when necessary. Differences in response to the

same question may occur because of the different respondents.

Responses mayalso differ because ofdifferences in question

wording in the two surveys. Appendix II presents clefinitions

of terms used in this report. Reference to the definitions

in appendix 11 is essential to interpret the data in this report.

Facsimiles of selected questions on functional dependency

used in the NHIS and NNHS are shown in appendix 111.

Because the data in this report are national estimates

based on two sample surveys and are subject to sampling

errors, standard error charts are provided for each survey

in appendix IV. The method used to estimate sampling errors

for combined estimates from the NHIS and NNHS is also

discussed in appendix IV.

Terms used in this report such as “similar” and “the

same” indicate that no statistical significance exists, between

the statistics being compared. Terms that relate to differences

(such as “greater” or “less”) indicate that differences are statistically significant. The t-test with a critical value of 1.96

(0.05 level of significance) was used to test all comparisons

that are discussed. Lack of comment regarding the cIifference

between any two statistics does not mean that the clifference

was tested and found to be not significant.
Functional dependency among

the elderly

Definition of functional dependency

In this report functional dependency refers to persons

dependent in at least one activity of daily living (ADL) or

instrumental activity of daily living (IADL). In this report,

the ADL’s are bathing, dressing, eating, getting in or out

of bed or chair (transferring), mobility, using the toilet, and

continence. The IADL’s included were preparing meals, shopping, managing money, using the telephone, doing light housework, doing heavy housework, and getting outside. These

IADL’s are similar to those used in the Older American Resources and Services program (OARS) Multidimensional Functional Assessment Questionnaire (7).

The criteria for dependence in each of the individual

activities for the noninstitutionalized elderly population were

those used in a previous report on physical functioning of

the aged (21). In that report, persons were considered dependent in ADL’s if they (1) had difficulty performing the activity

because of a health or physical problem and received the

help of another person in performing the activity or (2) were

unable to perform the activity without special equipment and

did not have that equipment. Persons were considered dependent in IADL’s if they had difficulty or were unable to perform

the activity by themselves because of a health or physical

problem.

The criteria for dependence for nursing home residents

differed from those for the noninstitutionalized population.

Nursing home residents were considered dependent in ADL’s

if at the time of the survey they ( 1) required the assistance

of another person or special equipment to perform the activity

or (2) did not perform the activity at all (because they were

intravenously fed, chairfast, or for some other similar reason).

Nursing home residents were considered dependent in IADL’s

if they received personal help or supervision to perform the

activity at the time of the survey. It should be noted that

although the NNHS question wording for ADL’s employs

the phrase “requires any assistance” (rather than “receives”

assistance, as in the SOA), the data are probably comparable

because residents in an institutional environment are more

likely to receive assistance if they need it.

These criteria for the noninstitutionalized and institutionalized populations roughly conform to categories of

physical function defined by Katz and others (6) for ADL’s,

and by the OARS Multidimensional Functional Assessment

Questionnaire (7) for mobility and the IADL’s. Because there

are unavoidable differences between definitions in this report

and definitions used elsewhere, the reader should consult appendix 11of this report, which presents operational definitions

of dependence based on Supplement on Aging (SOA) questions

and based on the National Nursing Home Survey (NNHS)

current resident questions.

It should be noted that the definition of mobility used

in this report differs from that used in the previously mentioned

report on physical functioning of the aged. This was necessary

because the NNHS questionnaire for nursing home residents

differentiates between residents unable to walk (that is, chairfast or bedfast) and residents who walked with assistance.

In the previously mentioned report, mobility was defined only

by whether an individual walked with assistance or not. In

this report, dependence in mobility is defined as: walks with

assistance, is chairfast, or is bedfast.

Differences also exist between NNHS and SOA definitions

of selected instrumental activities of daily living (IADL’s).

For nursing home residents, information on IADL’s was modified for the nursing environment. The modified IADL’s for

nursing home residents include items on the need for assistance

in caring for personal possessions, handling money, securing

personal items such as newspapers, toilet articles, or

snackfood, and using the telephone. For the purposes of this

report, dependency in securing personal items was considered

to be equivalent to shopping for noninstitutionalized persons,

and care of personal possessions was considered to be equivalent to doing light housework. The two IADL’s not appropriate

for nursing home residents (preparing meals and doing heavy

housework) were assumed to be activities in which the residents

were dependent. This approach is also consistent with that

used in the OARS Multidimensional Functional Assessment

Instrument for institutionalized individuals (7). It should be

noted, however, that although this report assumed that all

nursing home residents received help in preparing meals and

doing heavy housework, not all residents were dependent

in these activities.

Prevalence

Table 1 presents the functional status in individual ADL’s

and IADL’s for the noninstitutionalized population and for

nursing home residents. The activities of daily living (ADL’s)

reflect an individual’s capacity for self care. The instrumental

activities of daily living (IADL’s), on the other hand, are

more complex tasks that enable an individual to live independently in the community. For example, the IADL of managing

money involves cognitive functioning, whereas continence,

an ADL, involves only physical functioning. In addition, some

of the IADL’s can only be performed if the individual is

5
able to perform some ADL’s. For example, an individual

needs assistance in shopping if they are chairkdst or bedfast.

In general, elderly nursing home residents were more

dependent in all ADL’s and lADL’s than their noninstitutionalized counterparts. Ninety-four percent of nursing

home residents were dependent in at least one ADL and all

nursing home residents were dependent in at least one IADL.

In contrast, the comparable proportion among the noninstitutionalized population was 18 percent each for ADL’s and

IADL’s. Among the noninstitutionalized elderly population,

4.8 million were dependent in at least one ADL and 4.7

were dependent in at least one IADL. Of the 6.7 millicn

noninstitutionalized elderly who were dependent in either

ADL’s and IADL’s, 41 percent were dependent in both ADL’s

and IADL’s. The comparable proportion among nursing home

residents was 94 percent.

For the remainder of this report, functional status will

be reported by a summary measure of ADL and IADL dependence with five levels of impairment: independent, dependent

in IADL’s only, dependent in one to two ADL’s. dependent

in three to four ADL’s, and dependent in five to seven ADL’s.

Persons dependent in both ADL’s and IADL’s were classified

by the number of ADL dependencies. These categories reflect

the range of functional limitations from complete independence

to severe dependence (five to seven ADL dependencies).

Using the summary measure of functional dependence,

table 2 shows that 25 percent or 6.7 million of the

26.4 million noninstitutionalized elderly were functionally dependent in ADL’s and IADL’s in 1984. Although defined

differently, this estimate of functionally impaired elderly persons is similar in range to the 6 million noninstitutionalized

elderly persons reporting difficulty with personal care activities

and 7.1 million reporting difficulty with home management

activities, reported in an earlier study using the 1984 SOA

(19). In 1985, all 1.3 million elderly nursing home residents

were functionally dependent in at least one ADL or IADL

(table 3). Overall, 8.1 million elderly persons (both institutionalized and noninstitutionalized) were functionally dependent in at least one ADL or IADL in 1984-85.

Table 4 shows that overall, 29 percent of the elderly

population were functionally dependent in at least one ADL

or IADL, whereas 7 I percent were independent in all activities.

The most frequent category of functional dependence among

the elderly was dependence in one to two ADL’s (14 percent),

followed by dependence in only IADL’s (7 percent). Five

percent of the elderly were in the most dependent category

(five to seven ADL dependencies) and 3 percent were dependent in three to four ADL’s.

Functional dependency increased with increasing age;

from 20 percent among those 65–74 years of age to 66 percent

among those 85 years of age and over. Dependency in each

category of ADL or IADL dependency also increased with

age. The percent increase by age among dependency categories

was greatest for those severely dependent in five to seven

ADL’s; 5 percent of those 65–74 years of age were dependent

in five to seven ADL’s compared with 22 percent of those

85 years of age and over.

Overall, elderly females were 50 percent more likely to

be functionally dependent (34 percent) than were elderly males

(2z percent), Elderly females were more likely to be functionally dependent regardless of age group. The level of functional

dependence for elderly females, however, varied by age group.

From 65–84 years of age, females were more likely than

males of the same age to be dependent in only IADL’s or

in one to two ADL’s. After 75 years, females were more

likely to be dependent in five to seven ADL’s than males

of the same age. These findings may reflect the selective

effect of mortal ity on the functional status of elderly males.

According to Moore, men appear to have higher health

care utilization (hospitals, in particular) and mortality rates

for fatal diseases (32), which may account for the tendency

of elderly males living in the community or in nursing homes

to be more functionally independent than their female counterparts. Elderly females, on the other hand, have more chronic

conditions which are self-limiting, but usually not fatal (for

example, arthritis or hypertension). Because women live

longer, they also live with these chronic conditions longer

(32).

Functional dependence also varied by race. Elderly black

persons were more likely (36 percent) than elderly white persons (28 percent) to be functionally dependent in at least

one ADL or IADL. The higher percentage of functionally

dependent black persons was due to their greater representation

in the mildly impaired categories. Eighteen percent of elderly

black persons were dependent in one or two ADL’s and 10

percent were dependent in only IADL’s. The comparable proportions among elderly white persons were 14 ancl 7 percent,

respectively. The proportions of elderly black and white persons severely impaired (five to seven ADL dependencies and

three to four ADL dependencies) were statistically similar.

There was no difference in prevalence of functional dependency by Hispanic origin.

Elderly persons who were not currently married (widowed,

divorced, separated, or never married) were significantly more

likely to be functionally dependent regardless of ADL or

IADL dependency category. Overall, 38 percent of unmarried

elderly were functionally dependent compared with 22 percent

of married elderly persons.

Poverty status as defined by the U.S. Bureau of the Census

depends on family size and annual income. In 1984, the

poverty threshold for a single individual was $4,980, and

that for a two-person household was $6,720 (33). Because

information on income was not available for nursing home

residents, use of Medicaid, State-funded indigent care, or

other government assistance or welfare for payment last month

was used as an indicator of poverty for the purposes of this

report. See appendix II for more details on definitions of

poverty from the SOA and NNHS. Table 4 shows that elderly

persons with incomes below the poverty level were twice

as likely (50 percent) as those with incomes above the poverty

level (25 percent) to be functionally dependent.

Impact on living arrangement

Table 5 shows that the most likely living arrangement

for the 8.1 million functionally dependent elderly was living

with a spouse (36 percent), foIlowed by living alone (29

percent), living with persons other than a spouse (19 percent),

6
and living in a nursing home (16 percent). Among functionally

dependent elderly persons, the percent living with a spouse

declined with increasing age; from 51 percent among those

65–74 years of age to 11 percent among those 85 years of

age and over. In contrast, the proportion of persons living

with others or in a nursing home increased with age. The

percent of functionally dependent elderly persons living with

others doubled from 15 percent of those 65–74 years of age

to 28 percent among those 85 years of age and over. On

the other hand, the comparable percentages of those living

in nursing homes increased more than fivefold; from 6 percent

among those 65–74 years of age to 36 percent among those

85 years of age and over. The increased risk of nursing home

use by the functionally dependent elderly over the elderly

population in general is shown in figure 1. Overall, functionally

dependent elderly persons were over 3.5 times as likely to

live in a nursing home than the general population, with

the greatest differential in the 65–74 years age group.

The pattern of living arrangements for the functionally

dependent elderly, however, varied by sex. Functionally dependent elderly males were more likely to live with a spouse

than their female counterparts both overall (61 percent compared with 24 percent of females), and in each age group.

This finding, in part, reflects the tendency of married men,

who are usually older than their wives, to die before their

wives do. The sex differential in percent living with a spouse

increased with age, with functionally dependent males 85

years of age and over nearly 10 times more likely (36 percent)

Although functionally dependent males were most likely

to live with a spouse, their female counteqarts were most

likely to live alone (35 percent compared with 14 percent

of functionally dependent males). The pattern of living arrangements for functionally dependent females varied by age.

Females 65–84 years of age were most likely to live alone.

At 85 years of age and over, however, they were more likely

to either live with persons other than a spouse (30 percent)

or in a nursing home (38 percent) than any other arrangement.

Cross-sectional surveys of nursing home residents have

found that at 65 years of age and over, females use nursing

homes twice as often as males. In 1985, 6 percent of females

65 years of age and over resided in nursing homes compared

with 3 percent of males of the same age (28). Among the

functionally dependent elderly population, the sex differential

in nursing home use still favors females but is much narrower

than that found among the general elderly population. At

65 years of age and over, functionally dependent females

were only 30 percent more likely to reside in a nursing home

(18 percent) than their male counterparts (14percent).

Functionally dependent black elderly persons were more

likely than elderly white persons to live with persons other

than a spouse. Thirty percent of black elderly persons lived

with persons other than a spouse compared with 18 percent

of elder]y white persons. Functionally dependent white persons, in contrast, were more likely than functionally dependent

persons of black or other races to reside in a nursing home

(17 percent compared with 10 percent each of elderly persons

to live with a spouse than their female counterparts (4 percent). of black or other races, respectively).

40

30

10

0

65 years and over 65-74 years 75-84 years 85 years and over

Age

F~ure 1. Percent of persons 65 yesrs of sge and over residing in nursing homes snd percent of functionally dependent persons 65 years of age and

over residing in nursing homes, by sge United Ststes, 19S4-S5

7
Table 5 also shows that functionally dependent elderly

persons who were married rarely resided in nursing homes

(5 percent compared with 24 percent of the functionally dependent elderly who were not married). Although 91 percent

of the functionally dependent married elderly lived with their

spouse, their unmarried counterparts were most likely to live

alone (46 percent) or with persons other than a spouse

(31 percent). The strong effect of unmarried status on nursing

home use is shown in table 6. Unmarried functionally dependent elderly persons used nursing homes more often than their

married counterparts regardless of age, sex, race, Hispanic

origin, or poverty status. Previous studies have found that

persons living alone are at increased risk of nursing home

placement. Table 6 shows that marital status may be viewed

as a substitute measure for living alone because the functionally

dependent elderly who were married rarely lived alone.

Poverty status also had an effect on living arrangements

of the functionally dependent elderly. Table 5 shows that

persons with income levels below the poverty line were more

likely to either live alone (40 percent) or in a nursing home

(37 percent) than the functionally dependent with incomes

above the poverty line (25 and 10 percent, respectively).

As Kovar (23) noted, there is evidence of a progression

of living arrangements among the elderly; from living alone,

then with other people if available, to nursing homes.

Table B shows that the common thread in this progression

is the level of functional impairment. The elderly dependent

in only IADL’s or in one to two ADL’s were most likely

to live alone or with a spouse; 77 percent of the elderly

dependent in only IADL’s lived alone or with a spouse, and

76 percent of the elderly dependent in one to two ADL’s

lived alone or with a spouse. On the other hand, elderly

dependent in three to four ADL’s were most likely to live

with a spouse (34 percent) or with others (29 percent). Elderly

persons dependent in three to four ADL’s were also four

to six times more likely to be in a nursing home (26 percent)

than mildly impaired elderly persons (6 percent for those

with one to two ADL dependencies and 4 percent of those

dependent in only IADL’s). The elderly in the most dependent

category (five to seven ADL’s) were primarily in nursing

homes (59 percent) and rarely lived alone (5 percent). In

fact. figure 2 shows a nearly linear relationship between the

percent of elderly residing in nursing homes and the number

of ADL dependencies. About 76 percent of the elderly dependent in all ADL’s were nursing home residents compared with

only 4 percent of the elderly dependent in only one ADL.

The percent of elderly persons residing in nursing homes

among those dependent in only IADL’s and in only one ADL

was the same (4 percent).

Impact on health status

In this section, health status is examined by level of

functional dependency. Health status includes morbidity in

terms of number of chronic conditions and prevalence of

chronic conditions, as well as selected health measures available only for the noninstitutionalized population (bed days

in the past 12 months and respondent-assessed health status).

In this report, prevalence refers to the number of persons

with a specific condition at a given point in time. For both

the noninstitutionalized and institutionalized elderly, prevalence estimates of specific conditions were obtained by aggregating the number of persons reported to have these conditions at the time of the survey. For nursing home residents,

these conditions were reported by the nursing home staff

respondents, who referred to the residents’ medical records.

For the noninstitutionalized elderly, these conditions were

self-reported by the elderly respondent in the majority of

cases through the interview process. For example, conditions

causing trouble in performing ADL’s and IADL’s were elicited

in the interview (see appendix III). The presence of specific

conditions such as osteoporosis, hypertension, and coronary

heart disease was also determined during the interview, as

well as conditions causing any limitation of activities (see

Ries for facsimile of entire National Health Interview Survey

Questionnaire, including the Supplement on Aging Questionnaire). For the purposes of this report, only the first eight

reported conditions were used to obtain prevalence estimates.

Because of the difference in respondents and methods of obtaining medical conditions for the noninstitutionalized elderly,

differences may occur in reporting of condhions.

Caution also needs to be exercised in comparing the person-based prevalence estimates of chronic conditions presented

in this report, and estimates of the number of chronic conditions

typically presented in reports based on the National Health

Interview Survey (NHIS). The major difference is that the

latter estimates of prevalence area count of conditicms existing

at the time of the interview, and the prevalence estimates

presented in this report reflect the number of persons with

Table B. Number and percent distribution of functionally dependent persons 65 years of age and over by Iiiing arrangement according to dependency

level: United States, 1984-65

Living arrangement

Lwing arrangements Living Living

Lwmg with Lwmg with with with Nursvng

Dependency level Total Alone spouse others Nursing home Total Alone spouse others home

Number Percent distribution

Total dependent m ADLs or IADLs 8,051,100 2,314,500 2,872,400 1,545,900 1,318,300 100.0 28.7 35.7 19.2 16.4

5–7 ADL dependencies 1,373,800 65,100 257,000 239,700 812,000 100.0 4.7 18.7 17.4 59.1

3-4 ADL dependencies 728,000 85,700 243,800 210,400 188,200 100,0 11.8 33.5 289 25.9

1–2 ADL dependencies 3,968,600 1,374,800 1,633,300 721,700 238,600 100,0 34.6 41.2 18.2 6.0

Dependent In IADLs only 1,980,700 789,000 738,300 374,200 79,300 100,0 39,8 37.3 18,9 4.0

NOTE AOL’S are actw!ties of daily Ihvmg, IAOL’S are instrumental actwk!es of daily lhwng

8
‘“r 75.9

IADL only 1 ADL 2 ADL’s 3 ADLs 4 ADL’s 5 ADL% 6 ADL’s 7 ADL’s

Level of dependency in ADL’s and IADL’s

Note: ADLs are activities of daily Pwing;lADL’a are instrumental actwitles of daily hving.

Fgure 2. Percent of functionallydependent persons 65 years of age and over residing in nursing homes, by level of dependency: United States, 1964-65

thecondkion. Because aperson might have several conditions

within a catego~, such as heart dkease, the average number

of conditions usually presented in NHIS reports is generally

higher than the person-based prevalence estimate of the same

condition. For example, the average annual estimate of hypertension among noninstitutionalized elderly persons in 1984

was 10,740 thousand (34), whereas table 7 shows the personbased prevalence for the same condition was 10,283 thousand.

Differences in the same direction were also found for heart

disease, ischemic heart disease, diabetes, cataracts, and deafness. The difference was greatest, however, for heart disease

and ischemic heart disease. The average annual rate of heart

disease per 1,000 persons 65 years of age and over was

320 (34), whereas the person-based prevalence rate was 183.6.

For ischemic heart disease, the average annual rate per 1,000

persons was 157.4 (34), whereas the person-based prevalence

rate was 110. The difference in these rates resulted from

the greater likelihood of persons with heart disease to have

multiple heart conditions (35). Table 8 presents the prevalence

of selected chronic conditions among the elderly in nursing

homes by level of functional dependency.

Table 9 shows the prevalence of selected chronic conditions for both the institutionalized and noninstitutionalized

elderly population by level of functional dependency. In 1984-

85, the chronic conditions most prevalent among the functionally dependent elderly were arthritis or rheumatism (49 percent), followed by hypertension (38 percent) and heart disease

(31 percent). A simihir pattern was also found among the

mildly impaired elderly (one to two ADL dependencies and

IADL dependencies only). Among the most severely impaired

elderly (five to seven ADL dependencies), heart d]sease was

the most prevalent chronic condition (37 percent), followed

by arthritis or rheumatism (31 percent), mental disorders (25

percent), hypertension (24 percent), and cerebrovascular disease (23 percent). Among the elderly dependent in three to

four ADL dependencies, arthritis or rheumatism was the most

prevalent chronic condition (47 percent), followed by heart

disease (37 percent), hypertension (30 percent), and cerebrovascular disease ( 19 percent).

In general, functionally dependent elderly persons had

a higher prevalence of most of the chronic conditions shown

in table 9. Functionally dependent elderly persons had higher

prevalence rates per 100 persons than functionally independent

elderly persons for the following conditions: diabetes mellitus,

mental disorders, glaucoma, cataract, heart disease, ischemic

heart disease, cerebrovascular disease, atherosclerosis, chronic

obstructive pulmona~ disease, and senility without mention

of psychosis. The difference in prevalence rates for these

two groups was particularly striking for mental disorders (8

per 100 functionally dependent elderly persons compared with

less than 1 per 100 functionally independent elderly persons),

heart disease (31 per 100 functionally dependent elderly

9
persons compared with 15 per 100 functionally independent

elderly persons), and cerebrovascular disease (12 per 100

functionally dependent elderly persons compared with 3 per

100 functionally independent persons).

Among the functionally dependent elderly, prevalence

of mental disorders increased as functional status worsened;

from 3 percent among the elderly dependent in only IADL

activities to 25 percent among those dependent in five to

seven ADL’s. In contrast, prevalence of hypertension was

lower for functionally dependent elderly persons in the two

most dependent categories (24 and 30 percent for elderly

persons with five to seven and three to four ADL dependencies,

respectively) than for those mildly impaired with one to two

ADL dependencies (43 percent) or only with IADL dependencies (41 percent). This surprising finding may be related to

a tendency to underreport less serious conditions when reporting other conditions of a more serious nature. Further research

is needed to investigate this conjecture. Cerebrovascular disease was least prevalent among those with only IADL

dependencies.

The average number of chronic conditions among elderly

persons with five to seven ADL dependencies was 3.7 and

among elderly persons with three to four ADL dependencies

it was 3.8. Among those less functionally impaired with one

to two ADL dependencies or only IADL dependencies, the

average number of chronic conditions was 3.5 and 3.6,

respectively.

Table 10 shows that among the noninstitutionalized elderly, use of bed days last year was higher for the functionally

dependent elderly; 56 percent of the functionally dependent

elderly had one or more bed days last year compared with

28 percent among the functionally independent elderly.

Functional status also affected the noninstitutionalized elderly’s assessment of their health status. The percent of elderly

assessing their health as fair or poor was greatest among

those in the two most dependent categories. Only 22 percent

of functionally independent elderly persons assessed their

health as fair or poor, whereas 78 and 75 percent of the

elderly in the two most dependent categories (five to seven

ADL dependencies and three to four ADL dependencies, respectively) assessed their health as fair or poor.

10
Use of long-term care

Home care

In this report, home care recipients were those who received the help of another person for the following activities:

bathing, dressing, eating, transfernng, walking, using the

toilet, preparing meals, shopping, managing money, doing

heavy housework, doing light housework, and getting outside.

Home care recipients are the subset of persons “dependent”

in these activities (as defined in the previous section) who

received the help of another person. For example, not all

persons classified as dependent in bathing received help from

another person. Noninstitutionalized persons who were dependent in bathing included both persons who received help

from another person as well as persons who were unable

to bathe without special equipment and dld not have that

equipment. Noninstitutionalized persons dependent in IADL’s,

on the other hand, were those who had difficulty or were

unable to perform the IADL by themselves because of a

health or physical problem. Thus, for example, home care

recipients who received help preparing meals are a subset

of the persons dependent in preparing meals.

Although these home care activities are basically the same

ADL’s and IADL’s previously examined in this report, there

are some differences which warrant comment. First, continence

is excluded because personal help in performing this activity

is not applicable except for the small percentage of incontinent

elderly who receive help taking care of a colostomy, urinary

catheter, or other device to control bowels or urination (4

percent of the 3.2 million incontinent noninstitutionalized elderly). Second, personal help in walking was used as a criteria

for home care, because information on personal help for the

549,000 bedfast and chairfast elderly was not obtained in

the 1984 SOA. Thus, help from another person for the 1.2

million elderly dependent in walking may underestimate personal help received by all mobility dependent elderly in the

community.

For each activity for which personal help was received,

three types of information about the caregiver were obtained:

who the caregiver was (relative or nonrelative), where the

caregiver lived (household member or nonhousehold member),

and whether the caregiver was paid or not. Table 11 presents

information about the relationship of the caregiver for these

activities. Overall, 60 percent of the 5.1 million community

dwelling elderly dependent in the home care activities received

help from only family members, 16 percent received help

on]y from nonrelatives, 19 percent received help from both

family and nonrelatives, and 5 percent received no help. These

findings are consistent with previous studies that found that

the bulk of Iong-term care is provided by family (36-39).

For example, Callahan and others (40), in a review of the

literature, found that between 60 and 85 percent of all impaired

persons received help from family members. Table 11 shows

that 79 percent of elderly persons dependent in home care

activities received help from family members (either solely

or in combination with nonrelatives).

Caregivers were more likely to live with the dependent

elderly than not. Table 12 shows that 44 percent of the noninstitutionalized elderly dependent in home care activities received care from a household member, compared with 33

percent receiving care from nonhousehold members and 18

percent receiving care from persons living both inside and

outside of the household. OveraIl, 65 percent of elderly persons

receiving help in home care activities received care from

relatives who were also household members (table C). Seventy

percent of elderly persons relying solely on care from family

members received care from relatives who lived in the same

household. Elderly persons relying only on nonrelatives for

Table C. Number and percent d=tribution of noninstitutionaliied persons 65 yesrs of age and over dependent in home care activities, by Iiiing

arrangement of ceregivere, according to relationship of caregiver= United States, 1984

Living arrangement of caregivers Living arrangement of caregivers

Both household Both household

and and

Household Nonhousehold nonhousehold Household Nonhousehold nonhousehold

Relationship of caregivers Total members members members Total members members members

Number Percent distribution

Total . . . . . . . . . . . . . . . . . . . 4,801,800 2,227,600 1,660,500 913,700 100.0 46.4 34.6 19.0

Only relatives . . . . . . . . 3,048,200 2,142,500 613,600 292,100 100.0 70.3 20.1 9.6

Only nonrelativss . . . . . . . 799,300 54,600 711,300 ‘33,400 100.0 6.6 69.0 ‘4.2

Both relatives and

nonrelative . . . . . . . . . . . . . . 954,300 ‘30,500 335,600 588,200 100.0 ‘3.2 35.2 61.6

11
care received care primarily from nonhousehold members

(89 percent).

In the remainder of this report, formal home care services

will be defined as those that were paid for. In the literature,

formal home care services usually refer to those rendered

by nurses, nurses’ aides, personal companions, and other types

of community helpers who are paid for their services. In

the absence of information on type of helpers (only information

on whether the helper was a relative or nonrelative was obtained

in the 1984 SOA), paid status will be used in this report

to represent formal home care services. Unpaid help will

be referred to as informal home care in this report. Informal

services are usually provided by relatives, friends, or neighbors

and are not compensated.

Table 13 shows that, overall, 63 percent of the noninstitutionalized elderly dependent in home care activities relied

solely on informal networks of caregivers, whereas 13 percent

relied solely on formal ‘caregivers. Eighteen percent relied

on a mix of both formal and informal caregivers. The percent

of noninstitutionalized elderly persons dependent solely on

formal caregivers is slightly higher than that reported by Soldo

from the 1979 National Health Interview Survey. Although

the question wording for ADL’s and IADL’s from the 1979

NHIS differed from those in the 1984 SOA (the 1979 question

was: “Because of a disability or health problem, did anyone

in the family receive or need help from another person.. .“),

the data showed change. In 1979, approximately 9 percent

of the elderly needing home care received care only from

formal helpers from the community. The percent of elderly

persons classified as needing home care who received services

from the formal and informal support networks (16 percent),

however, was similar (41 ).

The finding that use of formal home care services has

increased since 1979 may be due to the increasing availability

of formal home care services since the 1970’s. Between 1973

and 1985, the number of home health visits per 1,000 Medicare

beneficiaries increased fivefold (30). The introduction of Medicare’s prospective payment system (PPS) for hospitals also

had an effect on home health care utilization. Under this

payment system, hospitals are reimbursed a preestablished

amount based on the Medicare patients’ condition as classified

by the diagnosis-related group. Because the prospective payment system gives hospitals strong incentives to limit costs

incurred by Medicare patients, hospitals are discharging

patients after shorter stays (29). A recent study h.rnd that

after PPS was introduced, there was an increase in hospital

episodes resulting in use of home health services (13 to 16

percent) and also an increase in home health us(e without

prior hospital stays (from 14 to 22 percent) (42).

Tables 1l–l 3 show that 95 percent or 4.8 million of

the 5.1 million noninstitutionalized elderly persons dependent

in any of the 13 home care activities received help from

another person. However, as mentioned earlier, this figure

may underestimate the total number of functionally dependent

noninstitutionalized elderly persons receiving home care because information was not obtained about assistance received

by incontinent, bedfast, and chairfast elderly. Table 14 shows

that when incontinent, bedfast, and chairfast elderly are included, about 241,100 of these persons received help in at

least one of the 13 home care activities, increasing the number

of home care recipients to 5 million. TLus, 63 percent of

the 8 million functionally dependent elderly received home

care services in 1984-85. As expected, the percent of functionally dependent elderly receiving home care services is higher

than that received by the elderly population in general

(18 percent).

In the next section, use of home care services (any formal

or only informal) is compared with nursing home use by

the functionally dependent elderly.

Nursing home and home care use

Overall, 6.4 million or 79 percent of functionally dependent elderly persons received long-term care services in 1984-85

(table 15). The most frequent type of long-term care received

was informal home care services (42 percent), whereas 21

percent received at least some formal home care services.

Sixteen percent received nursing home care.

Table D shows that all persons in the two most functionally

dependent categories (five to seven ADL dependencies and

three to four ADL dependencies) received some type of longterm care, whereas 62 and 90 percent of those mildly impaired

in one to two ADL’s or in only IADL’s, respectively, received

long-term care services. Use of nursing homes was far greater

among persons dependent in five to seven ADL’s (59 percent),

but use of nursing homes did increase as level of dependency

increased. Use of any formal home care service was greatest

among the elderly dependent in only IADL’s (33 percent

Table D. Number and percent of functionally dependent persons 65 years of age and over, by type of long-term care received and dependency Ievek

United States, 1964-65

Type of long-term care Type of long-term care

All types of Nursing Formal informal All types of Nucsing Formal Informal

Dependency level Total long-term care home care home care’ home care long-term care home care home care’ home care

Number Percent distribution

Total dependent in ADL’s

orlADL’s. 8,051,100 6,361,300 1,318,300 1,662,500 3,380,400 79.0 16.4 20,6 42.0

5-7 ADL dependencies 1,373,800 1,373,800 812,100 225,500 336,200 100.0 59.1 16.4 24.5

3-4 ADL dependencies 728,000 726,000 168,200 166,300 373,500 100.0 25,9 22.8 51.3

1–2 ADL dependencies . . 3,968,600 2,477,000 238,800 627,100 1,811,200 62.4 , 6.0 15.8 40.6

Dependent in IADL’s only 1,980,700 1,782,400 79,300 643,600 1,059,600 90.0 4.0 32.5 53.5

‘Includes persons receivingboth formal and informal home care serwces

NOTE. ADL’s are actwit!es of darly fivmg; IAOL’S are instrumental actwmea of dally Ihvmg

12
compared with 16-22 percent of elderly in the more dependent

categories). Informal home care services were most likely

to be received by persons dependent in three to four ADL’s

(51 percent) and persons dependent in only IADL’s

(54 percent).

The greater use of formal and informal home care services

by the elderly dependent in only IADL’s is surprising because

recent research and the preceding analysis have suggested

a hierarchical relationship between IADL’s and ADL’s, with

IADL dependencies representing less severe disability (43).

However, according to a previous study of home care expenses

among the disabled elderly, “payment for home-based care

has a diversity of roles among the disabled elderly” (44).

Among the highly disabled elderly, the high proportion receiving both formal and informal help indicates that “paid help

may be a necessary complement for unpaid help in the case

of the severely disabled elderly. Paid help also appears to

serve as a source of assistance for people with mild limitations

but who need assistance with chores such as shopping or

laundry” (44). Table E shows that a similar pattern occurred

among the noninstitutionalized functionally dependent elderly

in 1984. Thirty-two percent of the severely dependent group

(five to seven ADL dependencies) received help from both

formal and informal helpers, in contrast to only 13 percent

of those with only IADL dependencies. On the other hand,

25 percent of persons dependent in only IADL’s relied solely

on formal care providers, whereas 8 percent of their counterparts with five to seven ADL dependencies relied solely on

formal care providers.

Among the functionally dependent elderly population,

overall use of long-term care and use of nursing homes increased with age (table 15). Use of any formal home care

services did not vary by age. Although it appears that use

of informal home care services decreased with increasing age,

the differences were not statistically significant. Functionally

dependent nursing home residents were older, on the averge

83 years, than their counterparts using formal (78 years) or

informal home care services (77 years).

Overall, functionally dependent females received Iongterm care services more often than their male counterparts

(82 percent of females compared with 73 percent of males).

Males, however, received informal home care services (46

percent) more often than females (40 percent). Females used

formal home care services more often than males both overall

and through ages 65–84 years. Although females used nursing

homes more often than males overall (18 percent compared

with 14 percent for elderly males), use of nursing homes

for females exceeded that for males only in the age group

85 years and over.

Functionally dependent white elderly persons were more

likely to reside in nursing homes (17 percent) than their counterparts of black or other races (1O percent). Functionally

dependent elderly persons of black and other races, in contrast,

were more likely to use informal home care services (49

percent compared with 41 percent by their white counteqmrts).

These findings are consistent with the greater likelihood of

ii.mctionally dependent elderly persons of black or other races

to live with potential caregivers (table 5). There were no

differences in use of long-term care services by Hispanic

origin.

Overall, the unmarried functionally dependent elderly used

long-term care (82 percent) more often than their married

counterparts (74 percent); particularly nursing home and formal

home care services. Twenty-four percent of unmarried functionally dependent elderly persons were in nursing homes

and 23 percent used some type of formal home care service.

The comparable percentages for their married counterparts

were 5 and 17 percent, respectively. Functionally dependent

elderly persons who were married, on the other hand, used

informal home care (52 percent) more often than their unmarried counterparts (36 percent). Thus, it appears that greater

use of formal home care services by unmarried functionally

dependent elderly persons may be necessitated by lack of

access to informal care helpers. Table E supports this conjecture, because it shows that noninstitutionalized functionally

dependent elderly persons who used formal home care services

were primarily those living alone (30 percent compared with

7 and 6 percent of those living with a spouse or with others,

Table E. Number and percent dmtnbutionof noninatitutiinaliied functionally dependent persons 65 years of age and over reoeiving home care by source

of assistance, acoording to selected characteristics United StateS 19S4

Source of assistance Source of assistance

Both formal Both fomra/

Only formal Only informal and informal Only formal Only informal and informal

Selected characteristics Total home care home care home care Total home care home care home care

Number Percent distriiiution

Total . . . . . . . . . . . . . . . . . . . . . . 5,042,900 712,400 3,380,400 950,100 100.0 14.1 67.0 18.8

Dependency level in ADL’s or IADL’s

5-7 ADL dependencies . . . . . . . . . . . 561,700 46,900 336,200 178,600 100.0 8.4 59.8 31.8

3-4 ADLdependencies . . . . . . . . . . . . 539,800 18,800 373,500 147,500 100.0 3.5 69.2 27.3

1-2 ADL dependencies . . . . . . . 2,238,300 226,700 1,611,200 400,400 100.0 10.1 72.0

Dependent in IADL’s only . . . . . . .

17.9

1,703,100 419,900 1,059,600 223,600 100.0 24.7 62.2 13.1

Living arrangements

Alone . . . . . . . . . . . . . . . . . . . . . 1,564,000 473,500 737,600 352,900 100.0 30.3 47.2 22.6

Whspouse. . . . . . . . . . . . . . . . . . 2,095,700 155,000 1,587,900 352,900

Wilh others . . . . . . . . . . . . . . . . . .

100.0 7.4 75.8 16.8

1,383,200 83,800 1,055,000 244,400 100.0 6.1 76.3 17.7

NOTE ADL’s are activities of dai~ Mng: IADL’s are instrumental activities of daily hving. Figures may not add to totals b?causs of rounding.

13
respectively). In contrast, informal home care was solely used

by 76 percent of functionally dependent elderly living with

a spouse or with others.

Finally, poverty status was associated with greater longterm care use primarily because of the greater use of nursing

homes (37 percent among those with incomes below the poverty threshold compared with 10 percent of those with incomes

above the poverty threshold). Nonpoor functionally dependent

elderly persons were more likely to use formal (23 percent)

and informal home care services (45 percent) than were poor

functionally dependent elderly persons (14 and 32 percent,

respectively). Thus, it appears that having higher income levels

allows the functionally dependent elderly to remain in the

community longer by purchasing formal home care services.

Table F shows how the prevalence of chronic conditions

vaned among long-term care users. Although there were no

differences in prevalence of conditions among persons receiving any formal home care services and persons receiving

only informal home care services, prevalence of the less serious

chronic conditions of glaucoma, cataracts, hypertension,

atherosclerosis, and arthritis or rheumatism was higher among

home care patients (formal or informal) than among nursing

home residents. In contrast, nursing home residents had higher

prevalence of mental disorders, heart disease, ischemic heart

disease, and cerebrovascular disease. The disparity in prevalence of these conditions among the functionally dependent

using nursing home and home care services in the community

suggests that these conditions may be associated with an increased chance of institutionalization among the functionally

dependent elderly. Figure 3 tends to confirm this association,

Table F. Number of persona 65 yeare of age and over receiving longterm care and prevalence rate of selected chronic conditions per 100

persons, by type of long-term care United States, 1964-65

Type of long-term care

Nursing Formal Informal

Selected chrome conditions home care home carel home care

Number of persons . 1,318,300 1,662,500 3,380,400

Rate per 100 persons

Total . . . . . . . . . . . . . . . . . . 100.0 100.0 100.0

Malignant neoplasm 5.1 11.1 10.2

Diabetes mellitus 12,5 10.3 11,1

Mental disorders 38.2 1.8 2.8

Glaucoma . . . . . . . . . . . . . . . 2,6 10.5 9.5

Cataract . . . . . . . . 3.3 16.9 19.0

Deafness . . . . . . . . . . . . 2.2 33 5.5

Hypertension . .,, . . . . . . . 17.5 41,8 41.7

Heart disease.. 40.0 30,4 31.9

Ischemic heart disease 26.4 15.5 16.1

Cerebrovascular disease 19.3 12,4 12.4

Atherosclerosis . 8.3 15.8 16.9

Chronic obstructive pulmonary

disease . . . . . . . . . . . . . . . 7.2 4,9 4.9

Arthritis or rheumatism 19.6 56.8 53.0

Senility without mention of

psychosis . . . . . . . . . . . . . 4.2 50 4.9

‘Includes persons recewmg both formal and informal home care

Mental disorders 79.1

Cerebrovascular

disease ~ 26.2

Chronic obstructwe

pulmonary disease ~ 24.0

Heart disease \~ 21.0

Diabetes melhtus ~ 19.5

Senility without

mention of psychosis = 17,6

Atherosclerosis H 9.8

Deafness ~ 8.7

Malignant neoplasm m 8.6

Hypertension ~ 7.6

Arthritla or rheumatism m 6.6

Glaucoma B 5.5

Cataract N 3.4

I I I I I

o 20 40 60 80 100

Percent

Figure 3. Percent of functionally dependent persons 65 years of age and

over residing in nursing homes, by selected chronic condtiorw

United States. 1984-65

because functionally dependent elderly with mental disorders,

cerebrovascular disease, chronic obstructive pulmonary disease, heart disease, diabetes mellitus, and senility (without

mention of psychosis) resided in nursing homes significantly

more often than functionally dependent elderly with other

chronic conditions (3–1 O percent). By far, the presence of

mental disorders was the one condition most often associated

with nursing home residency; 79 percent of functionally dependent elderly persons reported to have mental disorders

resided in nursing homes. Similar findings have also been

reported in the literature (3, 8, 11, 45-46),

It is of interest that the prevalence rate of malignant

neoplasm among persons receiving either formal or informal

home care services (11. 1 and 10.2 per 100 persons, respectively) was twice that for nursing home residents (5. 1 per

100 persons). Thus, more cancer patients are receiving care

in their own homes than in nursing homes. This is particularly

true of Medicare beneficiaries using the new hospice benefit

enacted as part of the Tax Equity and Fiscal Responsibility

Act (TEFRA) of 1982. In 1984-85, 89 percent of Medicare

beneficiaries using the hospice benefit received routine home

care services (47).

14
Use of health care and

community services in the past

year

In this section, health care and community services utilization of noninstitutionalized persons are presented by the level

of functional dependency and by the type of home care received. Health care utilization includes average number of

physician contacts per year, number of short-stay hospital

episodes in the past year, average number of hospital days

per person hospitalized, and nursing home admission in the

past year. Community services include use of senior center,

senior center meals, special transportation for the elderly,

home-delivered meals, homemaker services, and home health

services.

Table 16 presents health care and community services

utilization data of the noninstitutionalized elderly by varying

degree of functional dependency. In 1984, the severely impaired elderly with five to seven ADL dependencies had twice

as many physician contacts (37 per person per year) as the

moderate]y impaired with three to four ADL dependencies

(19 per person per year); three times as many contacts as

the mildly impaired with one to two ADL dependencies (12

per person per year); and six times as many as the independent

elderly (6 per person per year).

Examination of hospital utilization shows the same pattern.

A far greater percentage of the severely dependent elderly

(60 percent) had at least one hospital episode in the past

year compared with the moderately dependent elderly (43

percent), the mildly dependent elderly (31 percent), and the

independent elderly (14 percent). In addition, the proportion

of severely dependent elderly persons with three or more

hospital episodes in the past year (15 percent) was at least

triple that of any other group.

Admission to a nursing home in the past year was more

likely for the elderly who were dependent in ADL’s or IADL’s

(2 percent) than for the independent elderly (O.1 percent). However, there were no significant dhlferences between the percent

of severely, moderately, or mildly dependent elderly persons

who were admitted to a nursing home in the past year.

Overall, the elderly with some dependency in ADL’s

or IADL’s used community services (30 percent) more than

the independent elderly (20 percent). However, there was

variation in the kinds of services used by the different dependency groups. As expected, as dependency level increased,

use of home health services which included visiting nurses

and home health aides increased from 8 percent of the moderately dependent elderly to 38 percent of the severely dependent

elderly.

Senior centers and senior center meals were used more

by the mobile, mildly dependent elderly (16 and 10 percent,

respectively) than the moderately dependent elderly (5 and

4 percent, respectively) or the severely dependent elderly (5

and 4 percent, respectively). No statistically significant differences were found between the mildly, moderately, and severely

dependent elderly who used special transportation for the elderly, home-delivered meals, and homemaker services.

In Table 17, health care and community service utilization

are examined by the type of home care received—formal,

informal, or no home care received. The data presented is

consistent with the overall picture that persons with greater

dependency utilized more health care services than those who

were less dependent.

Among the noninstitutionalized elderly, persons who received at least some formal or paid home care averaged more

physician contacts per year (20 contacts) than persons who

received only informal home care (14 contacts) or persons

who did not receive any home care (8 contacts).

Hospitalizations followed the same pattern-the more dependent elderly who received formal home care had higher

rates of hospitalization than the less dependent elderly who

received informal home care. Forty-four percent of the elderly

who received formal home care were hospitalized at least

once in the past year compared with 37 percent of the elderly

who received informal home care. The independent elderly

who received no home care had the lowest rate with 21 percent

of that group hospitalized atleast once in the past year.

Although a greater percentage of the more dependent

elderly were hospitalized at least once in the past year, there

were no significant differences found between the home care

categories for the average number of hospital days per person

hospitalized or for admission to a nursing home in the past

year.

Overall, the elderly who received formal home care used

community services (46 percent) more than those who received

informal home care (25 percent) or no home care (25 percent).

Again, there was variation in the kinds of services used by

the different dependency levels.

As expected, the elderly who received formal home care

were the greatest consumers of home health services (23 percent) compared with the informal care recipients (9 percent)

or the independent elderly (3 percent). The more dependent

group also used special transportation for the elderly, homedelivered meals, and homemaker services more than the other

groups.

Senior centers and senior meals were used by the independent (no home care received) elderly (18 and 12 percent,

respectively) more than by the formal care recipients (13

and 9 percent, respectively) or the informal care recipients

(11 and 7 percent, respectively).

15
Discussion

The findings in this report have shown joint associations

between functional status and other characteristics (for example, age) and long-term care use. Thus, controlling for functional dependency, use of nursing homes still increased more

than fivefold between the age groups 65–74 years and 85

years and over. The presence of mental disorders and functional

dependency was also highly associated (79 percent) with nursing home use. Because many of the associations found in

this report may be correlated with each other, multivariate

techniques are necessary to evaluate the relative influences

of each characteristic.

Another qualification for the results of this study is that

they are highly dependent on the ADL and IADL items included in the definition of the functionally dependent elderly

and the criteria used to differentiate dependence and independence in the ADL and IADL items (12). For example, the

results of this study are not comparable with those of a previous

study using the 1984 SOA (19) on the functional limitations

of the noninstitutionalized elderly, because the criteria for

dependencies in the ADL’s and IADL’s were different. And

although this study found that 6.7 million non institutionalized

elderly persons were functionally dependent in at least one

ADL or IADL, a different estimate can be derived by simply

excluding one of the ADL’s or IADL’s. If this study hdd

excluded doing heavy housework as an IADL, for example,

the estimated number of functionally dependent elderly would

have been 5.5 million.

Despite the “fluid” nature of these estimates, the results

of this study are consistent with many previous studies (1-4,

7–1 1). For example, Weissert and ScanIon found that persons

with a higher risk of nursing home use were those who were

dependent in five to six ADL functions, unmarried, over

75 years of age, and had low incomes (3). The percent of

elderly persons using formal home care services (6 percent)

is similar to the proportion of aged Medicare beneficiaries

using Medicare home health agency services (5 percent) (48).

Branch and others found that receiving help with at least

one activity of daily living was predictive of incident use

of comprehensive medical home care among communitydwelling elders in Massachusetts (9). Liu and Manton found

that dependency in ADL’s was predictive of hospital use

(42). The consistency of these results is reassuring because

they occurred despite differences in populations, year of data

collection, and survey methodology (sample frame., use of

proxy respondents, and survey instrument design).
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List of detailed tables

1. Number and percent of noninstitutionalized persons and

nursing home residents 65 years of age and over, by

functional status in ADL’s and IADL’s: United States,

1984and 85 . . . . . . . . . . . . . . . . . . . . . . .

2. Number of noninstitutionalized persons 65 years of age

and over, by level of functional dependency in ADL’s

and IADL’s and selected demographic characteristics:

United States, 1984 . . . . . . . . . . . . . . . . . . .

3. Number of nursing home residents 65 years of age and

over, by level of functional dependency in ADL’s and

IADL’s and selected demographic characteristics: United

States, 1985 . . . . . . . . . . . . . . . . . . . . . . .

4. Number and percent distribution of persons 65 years of

age and over by level of functional dependency in ADL’s

and IADL’s, according to selected demographic

characteristics: United States, 1984-85 . . . . . . . . . .

5. Number and percent distribution of functionally dependent

persons 65 years of age and over by living arrangements,

accordhg to selected demographic characteristics: United

States, 198+85 . . . . . . . . . . . . . . . . . . . . .

6. Number and percent distribution of functionally dependent

persons 65 years of age and over by living arrangements,

according to current marital status and selected

demographic characteristics: United States, 1984-85 . . .

7. Number of selected chronic conditions among

noninstitutionalized persons 65 years of age and over, by

level of functional dependency in ADL’s and IADL’s:

United States, 1984 . . . . . . . . . . . . . . . . . . .

8. Number of selected chronic conditions among nursing

home residents 65 years of age and over, by level of

functional dependency in ADL’s and IADL’s: United

States, 1985 . . . . . . . . . . . . . . . . . . . . . . .

9. Number of selected chronic conditions among persons 65

years of age and over and rate per 100 persons, by level

of functional dependency in ADL’s and IADL’s: United

States, 1984-85 . . . . . . . . . . . . . . . . . . . . .

10. Number of noninstitutionalizcd persons 65 years of age

and over by level of functional dependency; and percent

distribution by bed days in the past 12 months and

respondent-assessed health status, according to level of

functional dependency: United States, 1984 . . . . .

20

21

22

22

24

25

26

26

27

27

11. Number and percent distribution of noninstitutionalized

persons 65 years of age and over dependent in home care

activities by relationship of caregivers, according to home

care activities: United States, 1984 . . . . . . . . . . . 28

12. Number and percent dkribution of noninstitutionalized

persons 65 years of age and over dependent in home care

activities by living arrangement of caregivers, according

to home care activities: United States, 1984 . . . . . . . 28

13. Number and percent distribution of noninstitutionalized

persons 65 years of age and over dependent in home care

activities by source of help, according to home care

activities: United States, 1984 . . . . . . . . . . . . . . 29

14. Number and percent distribution of functionally dependent

noninstitutionalized persons 65 years of age and over

receiving home care by type of home care, according to

selected demographic charactenstic~ United States,

1984-85 . . . . . . . . . . . . . . . . . . . . . . ...29

15. Number and percent distribution of functionally dependent

persons 65 years of age and over by type of long-term

care used, according to selected demographic

characteristics United States, 1984-85 . . . . . . . . . . 30

16. Number of noninstitutionalized persons 65 years of age

and over, by level of functional dependency in ADL’s

and IADL’s and selected measures of health care and

community service utilization last yew, percent

distribution of persons by number of short-stay hospital

episodes and whether in a nursing home last year,

according to level of functional dependency; and percent

of persons using community services last year, by level

of functional dependency: United States, 1984 . . . . . . 31

17. Number of functionally dependent noninstitutionalized

persons 65 years of age and over, by type of home care

received and selected measures of health care and

community service utilization last yeaq percent

distribution of persons by number of short-stay hospital

episodes and whether in a nursing home last year,

accordhrg to type of home care received, and percent of

persons using community services last year, by type of

home care received United States, 1984 . . . . . . . . . 32

19
Table 1. Number and percent of noninatitutionaliied persona and nursing home residents 65 yeara of age and over, by functional status in ADL’s and

IADL’s United State$ 1964 and 1985

Nonmstitut/ona/tzed population, 1984 Nursing home residents, 7985

Functions/ status Number Percent Number Percent

Total . . . . . . . . . . . . . . . . . . . .

Type of ADL dependency

Bathing . . . . . . . . . . . . . . .

Dressing . . . . . . . . . . . . . . .

Usingtoilet room . . . . . . . . . . . . . . . . . . . . .

Transferring . . . . . . . . . . .

Continenc+ifficulty with bowel and/or bladder control

Eating. . . . . . . . . . . . . . . . . . . .

Mobility . . . . . . . . . . . . .

Type of IADL dependency

Preparing meads . . . . . . . . . .

Shopping forpersonalitemsz. . . . .

Managing money . . . . . . . . . . . . . . . . . . . . . . .

Using thetelephone . . . . . . . . . . . . . . . . . . . . .

Going outside........,,. . . . . . . . . . . . . . .

Doing light housework@ . . . . . . . . . . . . .

Doing heavyhousework . . . . .

. . . . . .

,,...

.,,.. . . . . . .

.

.,,,. . . . .

. . . . .

. . . .

..,,. .

. . . . . . .

. . . . . . . . .

. . . . . . . . .

. . .

. . . . . . . . .

. ..., . . .

. . . . .

Number of ADL dependencies

None . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1 . . . . . . . . . . . . . . . . . .

2 . . . . . . . . . . . . . . . . . . . : :::::::::::::::::.. ::::::::::

3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number of IADL dependencies

None . . . . . . .

l..........::::::::: :::::......,,:::::: ::::::::::::

2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4 . . . . . . . . . . . . . . . . . . . . . . . .

5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6 . . . . . . . . . . . . . . . . . . . . . . .

7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ::::::

Overall dependency in ADI-% and IADL’s

Dependentin ADL’sandlADL’s. . . . . . . . . . . . . . .

Dependent inADL’sonly . . . . . . . . . . . . . . . . . . .

Dependent inlADLaonly . . . . . . . . . . . . . . . . . .

independent inADLsandlADL’s . . . . . . .

26,433,000

1,653,600

1,146,600

600,800

761,800

3,255,600

281,200

1,795,000

1,014,900

1,930,700

910,200

513,700

1,499,200

1,162,300

4,035,400

21,601,600

3,063,200

666,600

347,000

192,900

207,900

230,500

123,400

21,766,100

2,340,100

791,200

452,400

264,800

331,800

277,400

169,100

2,765,400

2,065,900

1,901,500

19,700,200

100.0

6.3

4.3

2.3

2.9

12.3

1,1

6.8

3.8

7.3

3.4

1.9

5.7

4.4

15.3

81.7

11.6

2.5

1.3

0.7

0.8

0.9

0.5

82.3

8.9

3.0

1.7

1.1

1.3

1.0

0.7

10.5

7.6

7.2

74.5

1,318,300

1,200,200

1,022,700

833,300

824,900

718,500

531,600

969,800

1,318,300

1,029,400

1,008,600

652,700

611,600

991,300

1,318,300

79,300

117,600

121,100

98,200

90,000

174,200

249,400

368,400

53,800

155,800

107,300

157,800

568,300

275,300

1,239,100

79,300

100.0

91.0

77.6

63.2

82.6

54.5

40.3

73.6

100.0

78.1

76.5

64.7

46.4

75.2

100.0

6.0

8.9

9.2

7,4

6.8

13.2

18.9

29.5

4.1

11.8

8.1

12.0

43.1

20.9

94.0

6.0

~Transferring refensto getting in Orout Ofa bad m chair,

‘Refers to securing personal items for nursing home residents.

3Refers to care of personal possessions for nursing home residents.

NOTE: ADL’s are activities of daily Wng; IADL’s are instrumental act!wtres of daily tivtng. Figures may not add to totals because of rounding

20
Table 2. Number of noninstitutionaiiied persons 65 yeare of age and over, by tevel of functional dependency in ADL’s and IADL’s and selected

demogrsphc characteristic= United States, 19S4

Level of functional dependency in ADL’s and IADL’s

Dependent in ADL 3 or IADL 3

Not dependent in

All Ail 5=7 ADL 34 ADL 1-2 ADL Dependent in either ADL’s

Demographic characteristics persons dependencies dependencies dependencies dependencies IADL k only or IADL’s

Sex by age Number

Both sexes:

Tota165years and over . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . .

75-64 years . . . . . . . . . . . . . . . . . . . .

85years And over . . . . . . . . . . . . . . . . .

Male:

Tota165years and over . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . .

75-64 years . . . . . . . . . . . . . . . . . . . .

85 years And over . . . . . . . . . . . . . . . . .

Female:

Tota165 years and over . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . .

75-64 years . . . . . . . . . . . . . . . . . . . .

85years And over . . . . . . . . . . . . . . . . .

26,433,000

16,287,800

8,246,700

1,896,500

6,732,800

3,116,500

2,563,900

1,052,400

2,139,300

1,120,000

764,300

255,000

4,593,500

1,996,500

1,799,500

797,500

561,700

191,900

218,600

151,200

178,700

83,600

64,400

‘30,500

363,000

108,100

154,200

120,700

539,800

190,900

215,100

133,900

205,500

87,700

78,200

‘39,600

334,300

103,100

136,900

94,300

3,729,600

1,602,400

1,425,000

502,400

1,268,900

682,500

461,700

124,700

2,460,900

1,119,900

963,300

377,600

3,295,900

402,000

●31,600

112,800

3,617,000

1,703,100

2,026,700

756,600

2,973,000

1,901,500

931,300

705,200

265,000

486,200

266,000

160,100

60,200

1,415,300

665,300

545,100

204,800

1,664,800

215,300

“21,400

44,600

1,856,900

760,900

1,140,600

359,700

1,541,600

19,700,200

13,171,300

5,684,800

644,100

8,646,100

5,955,200

2,363,400

329,600

11,052,000

7,216,100

3,321,400

514,500

18,019,700

1,439,200

241,300

568,200

19,132,000

11,537,800

8,162,400

2,067,000

17,613,100

10,787,500

7,075,200

3,127,600

584,500

15,645,500

9,212,600

5,120,900

1,312,000

Race

White . . . . . . . . . . . . . . . . . . . . . . . . .

Black . . . . . . . . . . . . . . . . . . . . . . . . .

Ofher . . . . . . . . . . . . . . . . . . . . . . . . .

23,932,100

2,182,500

316.400

5,912,500

743,300

77.100

485,400

63,700

●12,700

466,300

62,300

*11,200

Hispanic origin

Hispanic . . . . . . . . . . . . . . . . . . . . . . . .

Not Hispanic . . . . . . . . . . . . . . . . . . . . .

779,700

25,653,300

211,500

6,521,300

‘25,600

536,100

‘28,400

511,400

Current marital status

Married . . . . . . . . . . . . . . . . . . . . . . . .

Notmarried . . . . . . . . . . . . . . . . . . . . . .

14,522,100

11,910,900

2,984,300

3,748,500

271,800

289,900

243,5CXI

291,3C41

Poverty status

Belowpovertythreshold . . . . . . . . . . . . . . .

Abovepcvertythreshold . . . . . . . . . . . . . . .

3,382,100

23,050,900

1,295,000

5,437,600

91,700

470,000

66,900

452,900

NOTE: ADLsare ativties ofda!ly rwiM:lADUs areinstmmen@l adtitim ofdtily (wing.Fguresmay MttibtoWls ~wofrmtiW,

21
Table3. Numtirof nursing home residents 65years ofageand over, bylevel of funtional dependency in ADVaand lADUsand selected demogmptic

characteristics United States, 1965

Level of functional dependency in ADL ‘a and IADL ‘a

Dependent in ADL k or IADL ‘a

Not deRendent in

All All 5-7 ADL 3-4 ADL 1–2 ADL Dependent in either ADLk

Demographic characteristics residents dependencies dependencies dependencies dependencies IADL !sonly or IADL’s

Sex by age

Both sexes:

Total 65 years and over

65-74 years ...,.... . . . . . .

75-64 years . . . . . . . . . . . . . .

85 years And over . . . . . . . . . . . . . .

Male:

Tota165 years and over . . . . . . . .

65-74 years . . . . . . . . . . . . .

75-84 years . . . . . . . . . . . . . . . . . . .

85 years Andover.......,,, . . . . . . .

Female:

Tota165 years and over . . . . . . . . . . . . . .

65-74 years..........,,. . . . . . . .

75-84years . . . . . . . . . . . . . . . . . . .

65yearsand over . . . . . . . . . . . . . . .

Race

White . . . . . . . . . . . . . . . . . . . . . . . .

Black . . . . . .

Other.......,::;::::: j:::’::::

Hispanic origin

Hispanic . . . . . . . . . . . . . . . . . . . .

Not Hispanic.......,,.. . . . . . . .

Current marital status

Married . . . . . . . . . . . . . . . . . . . . . .

Not married . . . . . . . . . . . . . . . . . . ...1

Poverty status

Below poverfythreshold . . .

Above poverty threshold . . . .

1,318,300

212,100

509,000

597,300

334,400

80,600

141,300

112,600

963,900

131,500

367,700

484,700

1,227,400

82,000

6,900

35,300

1,283,000

168,400

I ,150,000

749,400

566,900

1,316,300

212,100

509,000

597,300

334,400

80,600

141,300

112,600

983,900

131,500

367,700

484,700

1,227,400

62,000

8,900

35,300

1,283,000

168,400

1,150,000

749,400

568,900

612,100

110,700

299,900

401,500

181,600

37,800

75,200

68,900

630,300

73,000

224,700

332,600

751,800

54,800

“5,500

23,400

788.700

120,900

691,100

474,900

337,100

Number

166,200

26,800

73,600

87,600

51,300

9,300

22,100

19,900

136,900

17,500

51,600

67,700

173,200

14,100

●1,000

“4,900

163,300

20,400

167,800

109,500

78,700

238,800

50,400

102,000

86,400

68,500

19,100

32,200

17,200

170,300

31,300

69,600

69,300

226,700

10,400

*I ,700

5,600

233,200

20,000

218,800

129,500

79,300

24,200

33,400

21,700

32,900

14,400

11,800

6,700

46,400

9,800

21,600

15,000

75,700

“2,800

“800

‘1 ,300

77,900

7,100

72,200

—

—

35,500

43,800

NOTE: ADCsare activities ofdaily Lv!ng; lADLsare instrumental actlvtbes ofdaily l!v!ng, figures maynotadd tototals because ofrounting

Table4. Numkrand percent dstribution ofpersons fiyeamti ageandover bylevel of functbnal dependency in ADUsandlADL's, according to

selected demographic charactenstica: United States, 1984-65

Level of functional dependency in ADL ‘e and IADL k

Dependent in ADL !sor IADL b

All All

Not dependent in

5=7 ADL 3-4 ADL 1-2 ADL Dependent in eitherADL>

Demographic characteristics persons dependencies dependencies dependencies dependencies lADLkorrly or IADL Is

Sex by age

Both sexes:

Tota165years Andover.. . . . . . . . .

65-74years . . . . . . . . . . . . . .

75-84years . . . . . . . . . . . . . . . . .

65yearsand over ...,,...

Male:

Tota165years andover . . . . . . . . . .

65-74years . . . . . . . . . . . . . . . . . .

73-64yeare . . . . . . . . . . . .

85yearsandover . . . . . . . . . . . . .

Female:

Tota165yearsand over . . . . . . .

65-74years . . . . . . . . . . .

75-64years . . . . . . . . . . ,.....,

85yearsandover .

See note at end of table

22

27,751,300

16,499,800

8,757,700

2,493,800

11,121,900

7,155,700

3,269,100

697,t 00

16,629,400

9.344.100

8,051,100

3,328,600

3,072,900

1,649,700

2,473,600

1,200,600

905,700

367,500

5,577,300

2,126,000

:468:600 2,167,200

,796,700 1,282,100

1,373,800

302,600

516,500

552,700

360,500

121,600

139,600

99,300

1,013,300

181,100

378,900

453,400

Number

728,000

217,600

266,900

221,500

256,800

97,000

100,300

59,500

471,200

120,600

188,600

162,000

3,968,600

1,852,800

1,527,000

588,600

1,337,400

701,600

493,600

141,900

2,631,200

1,151,200

1,033.100

446,900

1,980,700

955,500

738,600

286,700

519,100

280,400

171,900

66,800

1,461,700

675,100

566,700

219,900

19,700,200

13,171,300

5,684,600

644,100

6,646,100

5,955,200

2,363,400

329.600

11,052,000

7,216,100

3,321,400

514,500
Table 4. Number and percent distribution of persons 65 years of age and over by level of functional dependency in ADL’s and IADL’s according to

selected demographic characteristics United Stateq 19M-85-Con.

Level of functional dependency in ADL’s and lADL’s

Dependent in ADL k or IADL3

Not dependent in

All All 5-7 ADL 34 ADL 1-2 ADL Dependent in either ADL ‘a

Demographic characteristics persons dependencies dependencies dependencies dependencies IADL’s only or IADL’s

Race

White . . . . . . . . . . . . . . . . . . . . . . . . .

Black . . . . . . . . . . . . . . . . . . . . . . . .

Other . . . . . . . . . . . . . . . . . . . . . . . .

Hispanic origin

Hispanic . . . . . . . . . . . . . . . . . . . . . . . .

Not Hispanic . . . . . . . . . . . . . . . . . . . . .

Current marital status

Married . . . . . . . . . . . . . . . . . . . . . . . .

Notmarried . . . . . . . . . . . . . . . . . . . . . .

Poverty status

Belowpoverlythreshold . . . . . . . . . . . . . .

Abovepovertythreshold . . . . . . . . . . .

Sex by age

Both sexes:

Tota165yearsand over . . . . . . . . . . . . . .

65-74years . . . . . . . . . . . . . . . . . . . .

75-84years . . . . . . . . . . . . . . . . . . . .

85yearsandover . . . . . . . . . . . . . . . . .

Male:

Tota165yearsand over . . . . . . . . . . . . . .

65-74years . . . . . . . . . . . . . . . . . . . .

75-84years . . . . . . . . . . . . . . . . . . . .

85yearsandover . . . . . . . . . . . . . . . . .

Female

Tota165yearsand over . . . . . . . . . . . . . .

65-74years . . . . . . . . . . . . . . . . . . . .

75-84years . . . . . . . . . . . . . . . . . . . .

85years Andover . . . . . . . . . . . . . . . . .

Race

White . . . . . . . . . . . . . . . . . . . . . . . . .

Black . . . . . . . . . . . . . . . . . . . . . . . . .

Other . . . . . . . . . . . . . . . . . . . . . . . . .

Hispanic origin

Hispanic . . . . . . . . . . . . . . . . . . . . . . . .

Not Hispanic . . . . . . . . . . . . . . . . . . . . .

Current marital status

Married . . . . . . . . . . . . . . . . . . . . . . .

Notmarried . . . . . . . . . . . . . . . . . . . . .

Poverty status

Below poverty threshold . . . . . . . . . . .

Above poverty threshold . . . . . . . . .

Number<on.

639,500 3,522,600

76,300 412,400

‘1 2,200 %?.,500

33,400 118,400

694,600 3,850,100

288,900 1,723,100

459,200 2,245,400

196,400 886,200

531,600 3,082,300

Percent distribution

25,159,500

2,264,500

327,300

7,139,800

825,300

86,000

1,237,300

116,400

“18,1OO

49,000

1,324,800

392,800

981,000

566,600

807,200

5.0

1.8

5.9

22.2

3.2

1.7

4.3

14.3

6.1

1.9

6.9

25.2

4.9

5.2

“5.5

6.0

4.9

2.7

7.5

13.7

3.4

1,740,400

216,100

‘22,200

18,019,700

1,439,200

241,300

815,000

26,936,300

246,800

7,804,300

46,000

1,934,800

568,200

19,132,000

14,690,400

13,060,900

3,152,700

4,898,500

767,900

1,212,600

11,537,600

8,162,400

4,131,500

23,619,800

2,044,500

6,006,700

395,200

1,585,500

2,087,000

17,613,100

100.0

100.0

100.0

100.0

29.0

20.2

35.1

66.2

2.6

1.3

3.3

8.9

2.3

1.4

3.1

8.5

2.8

1.3

3.4

9.0

14.3

11.2

17.4

23.6

12.0

9.8

15.1

20.4

15.8

12.3

18.8

24.9

7.1

5.8

8.4

11.5

71.0

79.8

64.9

33.8

100.0

100.0

100.0

100.0

22.2

16.8

27.7

52.7

4.7

3.9

5.3

9.6

77.8

83.2

72.3

47.3

100.0

100.0

100.0

100.0

33.5

22.8

39.5

71.4

8.8

7.2

10.3

12.2

88.5

77.2

60.5

28.6

100.0

100.0

100.0

26.4

36.4

26.3

2.5

3.4

‘3.7

14.0

18.2

●1O.2

6.9

9.6

‘6.8

71.6

83.6

73.7

100.0

100.0

30.3

29.0

4.1

2.6

14.5

14.3

5.6

7.2

69.7

71.0

100.0

100.0

21.5

37.5

1.8

3.5

11.7

17.2

5.2

9.3

78.5

62.5

100.0

100.0

49.5

25.4

4.8

2.3

21.5

13.0

9.6

6.7

50.5

74.6

NOTE: ADUssre activities ofdaily fiving; lADUsare instrumental activities ofdailyrwing,

23
Table5. Numkrand percent @atnbtin of fintiona~dependent ~mons65years ofageand over byhving arrangement, according to selected

demography characteristics: United Stste.% 1984-65

Living arrangements Living arrangements

Lwing with Livingwth Nursing Living with Living with Nursing

Demographic characteristics Total Alone spouse others home Total Alone spouse others home

Sex by age Number

--AL . . ----

oom sexes:

Tota165 years and over . 8,051,100 2,314,500

65-74 years . . . . . . . . . . . . . . . ...3.328,600 932,700

75-84 years . 3,072,900 984,900

85 years and over . . . 1,649,700 396,800

Male:

Total 65 years and over . . 2,473,800 351,800

65-74 years . . . . . . . . . . . . . . ...1.200.600 176,600

75-64 years . . . . . . . . . . 905,700 128,200

85 years and over . . . . . . . . . . . 367,500 45,000

Female:

Tota165 years and over . . . 5,577,300 1,962,800

65-74 years . . . . . . . . . . . . . . . ...2.128.000 754,100

75-84 years . . . . . . . . . . . . . . . . 2,167,200 856,700

85 years and over . . . . . . . . . . . . . . . 1,282,100 351,800

Race

White . . . . . . . . . . . . . . . . . . . . ...7.139.8002,053,600

Black . . . . . . . . . . . . . . . . . . 825,300 244,800

Other . . . . . . . . . . . . . . . . . . 86,000 ‘16,100

Hispanic origin

Hispanic, . . . . . . . . . . . . . . . . . . 246,800 57,200

NotHispanlc 7,804,300 2,257,300

Current marital status

Married . . . . . . . . . . . . . . . . ...3.152.700 63,800

Not married . 4,898,500 2,250,700

Poverty status

Below poverty threshold . . . 2,044,500 818,600

Above poverly threshold . . . 6,006,700 1,495,900

2,872,400

1,699,300

985,800

187,300

1,514,700

842,200

542,200

130,300

1,357,700

857,100

443,600

56,900

2,587,200

249,800

‘35,400

92,500

2,779,900

2,872,400

—

265,200

2,607,200

1,545,900

484,500

593,200

468,300

272,800

99,200

94,000

79,600

1,273,200

385,300

499,200

388,700

1,271,600

248,700

“25,600

61,800

1,484,200

48,100

1,497,800

211,300

1,334,700

1,318,300

212,100

509,000

597,300

334,400

80,600

141,300

112,600

983,900

131,500

367,700

484,700

1,227,400

82,000

8,900

35,300

1,283,000

168,400

1,150,000

749,400

568,900

Percent distribution

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

28.7

28.0

32.1

24.1

14.2

14.9

14.2

12.3

35.2

35.4

39.5

27.4

28.8

29.7

“18.7

23.2

28.9

2.0

45.9

40.0

24.9

35.7

51.1

32.1

11.4

61.2

70.2

59.9

35.5

24.3

40.3

20.5

4.4

36.2

30.3

’41.2

37.5

35.6

91.1

13.0

43.4

19.2

14.6

19.3

28.4

11.0

8.3

10.4

21.7

22.6

18.1

23.0

30.3

17.8

30.1

“29.8

25.0

19.0

1.5

30.8

10.3

22.2

16.4

6.4

16.6

36.2

13.5

6.7

15.6

30.6

17.6

6.2

17.0

37.8

17.2

9.9

10.4

14.3

16.4

5.3

23.5

36.7

9.5

NOTE: ADLsare actlv!t!es ofdally llvlng; lADLsare instrumental activities ofdaiiyfiving,

24
Table6. Numkrand percent tistnbuttin oftinctionally dependent ~ffions &years ofageand over byhving amangement& -tingto cumentmarfid

status andselected demographic charactenst"~: United States, 1964-65

Living arrangements Living arrangements

Current marital status and Living with Living with Nursing Living wi?h Living wifh Nursing

selected characteristics Total Alone spouse others home Total Alone spouse others home

Married Number Percent distribution

Sex by age:

Both sexes:

Total 65 years and over . . . . . . . 3,152,700

65-74 years . . . . . . . . . . . . . . ...1.791,900

75-64 years . . . . . . . . . . . . . . . ..1.113,200

85 years And over . . . . . . . . . . . . . . 247,800

Male:

Total 65 years and over . . . . . . 1,847,900

65-74 years . . . . . . . . . . . . . . . . . 882,900

75-84 years . . . . . . . . . . . . . . . . . 594,600

85 years And over . . . . . . . . . . . . . . 170,400

Female:

Total 65 years and over . . . . . . . . 1,504,800

65-74 years . . . . . . . . . . . . . . . . . 908,900

75-84 years . . . . . . . . . . . . . . . . . 518,600

85years And over . . . . . . . . . . . . . . 77,300

Race

White . . . . . . . . . . . . . . . . . . . ...2.847.800

Black . . . . . . . . . . . . . . . . . . . . . . 266,400

Other . . . . . . . . . . . . . . . . . . . . . . 38,500

Hispanic origin:

Hispanic . . . . . . . . . . . . . . . . . . . . 100,000

Not Hispanic . . . . . . . . . . . . . . . ...3.052.700

Poverty status:

Belowpovertythreshold . . . . . . . . 378,800

Abovepovertythreshold . . . . . . . . 2,773,900

63,800

“25,400

“31 ,700

‘8,700

2,872,400

1,699,300

985,800

187,300

48,100

‘24,600

‘1 7,000

“6,500

’21,900

‘13,100

‘2,300

●6,500

“26,300

“11 ,500

‘14,800

“41 ,700

‘6,400

48,100

‘6,000

“42,1 00

168,400

42,500

76,700

47,200

100.0

100.0

100.0

100.0

2.0

‘1.4

●2.8

‘2.7

‘1.0

“0.7

*1.4

‘1.4

3.1

‘2.1

‘4.5

“5.7

2.1

“0.8

“5.2

‘2.2

2.0

*7.3

“1.3

45.9

59.0

48.6

27.8

40.5

54.2

38.5

21.7

47.0

60.3

50.6

28.8

46.5

43.4

‘29.6

37.5

46.2

47.5

45.2

91.1

94.8

88.6

75.6

91.9

95.4

91.2

76.5

90.2

94.3

85.6

73.7

90.9

83.7

92.0

92.5

91.1

70.0

94.0

—

—

—

—

—

1.5

●1.4

●1.5

●2.6

‘1.3

“1.5

‘0.4

●3.8

*1.7

‘1.3

‘2.8

*1.5

‘2.4

1.6

‘1.6

‘1.5

30.6

29.9

29.4

32.9

30.4

27.1

29.5

37.1

30.6

30.7

29.4

32.3

28.7

43.4

●53.9

42.1

30.2

12.3

40.0

5.3

2.4

7.1

19.1

5.7

2.4

7.0

18.4

4.9

2.4

7.1

20.6

5.6

3.1

‘2.8

●5.3

5.3

21.1

3.2

23.5

11.0

22.0

39.2

29.1

18.7

32.0

41.2

22.3

9.0

20.1

36.9

24.9

13.2

16.5

20.4

23.6

40.2

14.9

‘1 7,200

“6,500

●8,400

‘2,300

1,514,700

842,200

542,200

130.300

94,100

21,100

41,800

31,300

100.0

100.0

100.0

100.0

46,600

“1 8,900

“23,300

“4.400

1,357,700

857,100

443,600

58.900

74,200

21,500

36,900

15,900

100.0

100.0

100.0

100.0

59,700

●2,1OO

‘2,000

2,587,200

249,800

35,400

159,100

6,200

‘1,100

100.0

100.0

100.0

‘2,200

61,600

92,500

2,779,900

“5,300

163,100

100.0

100.0

‘27,600 265,200

2,607,200

80,000

88,400

100.0

100.0

Not married

Sex by age

Both sexes:

Tota165 years and over . . . . . . . . 4,898,500 2,250,700

65-74 years . . . . . . . . . . . . . . ...1.536.700 907,400

75-84 years . . . . . . . . . . . . . . . 1,959,700 953,200

85 years and over . . . . . . . . . . . . . 1,402,000 390,100

Male:

Tota165 years And over . . . . . . . . . . . 825,900 334,600

65-74 years . . . . . . . . . . . . . . . . . 317,700 172,100

75-84 years . . . . . . . . . . . . . . . . . 311,000 119,800

85 years And over . . . . . . . . . . . . . . 197,200 42,700

Female:

Tota165 years and over . . . . . . . . . 4,072,600 1,916,100

65-74 years . . . . . . . . . . . . . . 1,219,000 735,200

75-84 years . . . . . . . . . . . . 1,648,700 833,400

85 years and over . . . . . . . . . . . 1,204,900 347,400

Race:

White . . . . . . . . . . . . . . . . . . . . . .4,292,1001,993,900

Black . . . . . . . . . . . . . . . . . . . . . . 558,900 242,700

Other . . . . . . . . . . . . . . . . . . . . . . 47,500 “14,1OO

Hispanic origin:

Hispanic . . . . . . . . . . . . . . . . . . . . 146,800 55,000

Not Hispanic . . . . . . . . 4,751,700 2,195,700

Poverty status:

Below poverty threshold . . . . . . . . 1,665,700 791,000

Above poverty threshold . . . . . . 3,232,800 1,459,700

1,497,800 1,150,000

459,800 169,500

576,100 430,400

461,900 550,100

— 100.0

— 100.0

100.0

— 100.0

250,900 240,300

86,000 59,500

91,700 99,500

73,100 81,300

100.0

100.0

100.0

100.0

1,246,900 909,600

373,800 110,000

484,400 330,800

388,700 468,800

100.0

100.0

100.0

100.0

1,229,900 1,068,200

242,300 73,900

●25,600 7,800

100.0

100.0

100.0

61 ,8(K3 30,000

1,436,000 1,120,000

100.0

100.0

205,300 889,400

1,292,500 480,500

100.0

100.0

25
Table7. Numkrof seletied chronkmntitiona among nonintititina~ued ~rsons65years ofageand over, bylevel of functional dependency in ADL's

andlADL’s United States, 1964

Level of functional dependency m ADL k and IADL ‘.s

Dependent m ADL 3 or IADL ‘a

Not dependent in

All 5-7 ADL 3-4 ADL 1-2 ADL Dependent in either ADL’a

Selected chronic conditions levels Total dependencies deDenderfcies dependencies /ADL ‘e on/y or IADL’s

Malignant neoplasm . . . . . . . . . .

Diabetes mellitus . . . . . . . . . . . . . . . . .

Mental disorders .,, ,, . . . . . . . . . . . . . .

Glaucoma . . . . . . . . . . . . . . . . . . . . .

Cataract . . . . . . . . . . . . . . . . . . . . . . .

Deafness ,

Hypertension . . .

Heartdisease . . . . . . . . . . . . . . . . . . . . .

Ischemichaartdisease. . . . .

Cerebrovasculardiseeae . . . .

Atherosclerosis . . . . . . . . . . . . . . . . . . .

Chronicobstructivepuimonarydisease . . . . .

Arthritis orrheumatlsm . . . . . . . .

Senility without mentlonofpsychoais . . .

2,594,300

2,031,500

212,500

1,428,000

3,922,300

799,700

10,263,800

4,852,300

2,908,400

1,262,000

2,162,100

666,600

12,018,000

423,600

716,500

681,300

133,100

600,300

1,259,800

306,400

2,826,100

1,981,200

1,012,500

717,000

1,004,100

301,000

3,669,500

261,300

67,000

81,800

‘25,200

66,300

86,600

‘20,600

190,300

163,600

79,800

120,100

112,800

‘14,600

256,100

“26,600

Number

56,000

66,300

●15,800

50,700

92,000

45,200

191,100

180,800

73,800

108,200

100,400

*21 ,000

305,800

43,400

407,000

347,900

70,100

307,400

716,200

154,100

1,643,900

1,001,600

516,200

342,900

496,100

160,600

2,037,300

118,800

188,500

165,300

“22,000

175,900

365,000

86,600

800,800

615,000

340,800

145,900

294,900

104,600

1,070,400

72,500

1,875,800

1,350,200

79,400

827,700

2,662,500

493,300

7,457,700

2,871,100

1,895,900

544,900

1,177,900

365,600

6,348,500

162,300

NOTE: ADLsare adivitiea ofdaily l!ving; lADLsare instrumental activities ofdally Kving.

Table8. Numkrof selected chronic mntitions among nursing home residents 65years ofage and over, bylevel of functional dependency in ADL’s and

lADLk United States, 1985

Level of functional dependency in ADL ‘e and IADL k

Dependent in ADL k or IADL k

All 5-7 ADL S4 ADL 1-2 ADL Dependent in Not dependent in

Selected chronic conditions levels Total dependencies dependencies dependencies lADL’a only either ADL’s or lADLb

Malignant neoplasm . . . . . . . . . . . . . .

Diabetes mellitus . . . . . . . . . . . . . . . . .

Mental disorders . . . . . . . . . . . . .

Glaucoma . . . . . . . . . . . . . . . . . . . .

Cataract . . . . . . . . . . . . . . . . . .

Deafness . . . . . . . . . . . . . . . ,, . . . .

Hypertension, . . . . . . . . . . . . . .

Heart disease . . . . . . . . . . . . . . . . . .

Ischemic heart disesse. . . . .

Cerebrovascular dtsease . .

Atherosclerosis . . . . . . . . . . . . . . . .

Chronic obstructive pulmonary disease .

Arthritis or rheumatism

Senility without mention of psychosis .

67,600

165,000

503,200

34,700

44,100

29,100

231,000

527,500

347,300

254,800

109,600

95,200

260,600

55,700

67,600

165,000

503,200

34,700

44,100

29,100

231,000

527,500

347,300

254,800

109,600

95,200

260,600

55,700

44,700

100,100

320,800

21,900

22,500

14,100

140,000

320,500

213,600

194,500

63,900

48,400

165,100

38,000

9,600

26,400

61,400

6,900

9,000

‘5,200

30,500

86,300

59,900

30,600

19,700

16,000

37,700

9,900

9,800

27,800

92,200

‘4,300

8,300

7,500

46,700

96,400

58,200

25,800

18,000

24,100

47,600

6,000

‘3,800

8,700

28,700

“1,700

‘4,300

“2,300

13,700

24,300

15,600

‘3,900

8,100

6,700

10,200

1,800

—

NOTE ADLsare activities ofda!ly llvlng; lADCsare instrumental activities ofdailytiving

26
Table9. Number ofaeleded chronic condtions among pemons65years ofageand over andrate perlOO~rsonq bylevel of functional dependency in

ADL’sand lADL’s United States, 1984-65

Level of functional dependency in ADLk and IADL k

Dependent in ADL’s or IADL !s

All 5-7 ADL 3-4 ADL 1–2 ADL Dependent in Not dependent in

Selected chronic conditions levels Total dependencies dependencies dependencies lADLk only either ADL k or IADL’s

All persons . . . . . . . . . . . . . . . . . . . 27,751,300 8,051,100

786,100

846,300

636,300

635,100

1,303,900

335,500

3,057,100

2,508,700

1,359,900

971,900

1,113,800

396,200

3,930,100

316,900

9.8

10.5

7.9

7.9

16.2

4.2

38.0

31.2

16.9

12.1

13.8

4.9

48.8

3.9

1,373,800

111,700

182,000

346,100

88,100

109,000

34,700

330,400

504,200

293,400

314,500

176,700

63,200

421,200

64,800

8.1

13.2

25.2

6.4

7.9

2.5

24.0

36.7

21.4

22.9

12.9

4.6

30.7

4.7

728,000 3,968,600

Number

65,600 416,800

94,700 375,700

77,200 162,300

57,600 311,700

101,000 724,600

50,400 161,600

221,700 1,690,600

267,100 1,098,100

133,700 576,400

138,800 368,700

120,100 514,000

37,000 184,700

343,500 2,084,900

53,200 124,800

Rate per 100 persons

9.0 10.5

13.0 9.5

10.6 4.1

7.9 7.9

13.9 18.3

6.9 4.1

30.4 42.6

36.7 27.7

18.4 14.5

19.1 9.3

16.5 13.0

5.1 4.7

47.2 52.5

7.3 3.1

1,980,700 19,700,200

Malignant neoplasm . . . .

Diabetes mellitus . . . . . . . .

Mental disorders . . . . . . . . . . . .

Glaucoma . . . . . . . . . . . . . .

Cataract . . . . . . . . . . . . . . . .

Deafness . . . . . . . . . . . . . . .

Hypertension . . . . . . . . . . . . . .

Heart disease . . . . . . . . . . . . . .

Ischemic heart disease. . .

Cerebrovascular disease . . .

Atherosclerosis . . . . . . . . .

Chronic obstructive pulmonary disease

Arthriis or rheumatism . . . . . . .

Senility without mention ofpsychosia .

2,661,900

2,196,500

715,700

1,462,700

3,966,400

828,800

10,514,700

5,379,800

3,255,800

1,516,800

2,291,700

761,800

12,278,600

479.300

192,000

193,900

50,800

177,600

369,300

88,900

814,500

639,300

356,400

149,800

302,900

111,300

1,080,500

74,300

1,875,800

1,350,200

79,400

827,700

2,662,500

493,300

7,457,700

2,871,100

1,695,900

544,900

1,177,900

365,600

8,346,500

162,300

. . . . .

. .

. . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . .

. . . . .

. . . . .

Malignant neoplasm . . . . . . . .

Diabetes mellitus . . . . . . . . . . .

Mental disorders . . . . . . . . . . .

Glaucoma . . . . . . . . . . . . . . . .

Cataract . . . . . . . . . . . . . . . . .

Deafness . . . . . . . . . . . . . .

Hypertension . . . . . . . . . . . . . .

Heart disease . . . . . . . . . . . . .

Ischemic heart disease. . . . . . .

Cerebrovascular disease . . . . .

Atherosclerosis . . . . . . . . .

Chronic obstructive pulmonary disease

Arthritis or rheumatism . . , . . . . .

Senility without mention of psychosis .

9.6

7.9

2.6

5.3

14.3

3.0

37.9

19.4

11.7

5.5

8.3

2.7

44.2

1.7

9.7

9.8

2.6

9.0

18.6

4.5

41.1

32.3

18.0

7.6

15.3

5.6

54.6

3.8

9.5

6.9

0.4

4.2

13.5

2.5

37.9

14.6

9.6

2.8

6.0

1.9

42.4

0.8

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

NOTE: ADL’s are activities of daily [ving; IADL’s are instrumental actiwties of daily hving,

Table 10. Number of noninstitutionafizad parsons 65 yeare of age and over by level of functional dependen~ and percent distribution by bed days in the

past 12 months and respondant-asseased health status according to level of functional dependency United Stateq 19S4

Level of functional dependency in ADL k and IADL k

Dependent in ADLk or IADL k

All 5-7 ADL 3L4 ADL 1-.2 ADL Dependent in Not dependent in

Hea/th status levels Total dependencies dependencies dependencies lADLii only either ADL’s or IADL b

Number of persons . . . . . . 26,433,000 6,732,800 561,700 539,800 3,729,800 1,901,500 19,700,200

Percent distribution

Total . . . . . . . . . . . . . . . . . . . . . . . . 100.0 100.0 100.0 100,0 100.0 100.0 100.0

Bed days in past 12 months

None or unknown . . . . . . . . . . . . . . . . .

~-7 days . . . . . . . . . . . . . . . . . . . .

8-30 days . . . . . . . . . . . . . . . . . . . . .

31–180 days . . . . . . . . . . . . . . . . . . .

181-365 days . . . . . . . . . . . . . . . .

64.9

15.6

12.5

5.0

1.9

44.1

15.8

20.1’

13.3

6.8

19.0

“5.4

17.4

22.3

35.9

39.5 47.8

16.8 17.0

19.4 16.8

15.2 12.6

9.0 3.8

45.5

16.1

23.6

11.4

3.3

72.0

15.6

9.9

2.2

0.2

Respondent-assesaed health status

Excellent . . . . . . . . . . . . . . . . . . . .

Verygood . . . . . . . . . . . . . . . . . .

Good . . . . . . . . . . . . . . . . . . . . . . .

Fair . . . . . . . . . . . . . . . . . .

Poor . . . . . . . . . . . . . . . . . . . . . . . .

15.8

20.4

31.8

20.9

11.1

“3.8 5.7

“4.3 11.5

17.3 24.2

25.7 31.3

48.9 27.3

4.7

10.4

22.9

30.8

31.1

‘1.6

‘4.7

15.5

19.9

58.3

3.9

11.5

24.3

34.6

25.6

19.6

23.8

34.6

17.5

4.3

NOTE: AD~sare activities ofdaily llvlng; lADCsare instrumental act\vltres ofdally l!v!ng. Rguresmay notaddto totilsbecause ofrounting.

27
Table Il. Number andpercent datnbutin ofnoninstitutiona~wed persons 65y~rsof ageandover dependeW inhome Mreactivties byrela~mnaMpof

csregivers according tohome care activities: United States, 1964

Relationship of caregivers Relationship of caregivers

Both relatives Both re/atives

Relatwes Nonrelative and No help Relatives Nonrelatives and No help

Home care activities Total only only nonrelative received Total only only ncmre/atives received

Numbers Percent distribution

Total dependent in home

care actwities . 5,075,800 3,048,200 799,300 954,300 274,000 100.0 80.1 15.7 18.8 5.4

Bathing . . . . . . . . . 1,653,600 1,039,300 370,500 152,900 90,900 100.0 62.8 22.4 9.2

Dressing 1,146,600

5.5

853,300 169,300 124,000 100.0 74.4 14.8 10.8

Usmgthelodet room 600,800 410,100 91,200 84,400 “15,1OO 100.0 68.3 15.2 14.0 ●2.5

Transferring 761,800 550,100 101,800 96,700 ‘1 3,200 100.0 72.2 13.4 12.7 ‘1.7

Eatin g.........,.. 281,200 192,300 “43,200 45,700 — 100,0 68.4 ‘15.4 16.3 –

Preparing meals 1,014,900 698,600 187,800 119,500 “8,900 100.0 68.8 18.5 11.8 ‘0.9

Shopping for parsonal Items 1,930,700 1,464,300 283,400 140,000 ‘42,900 100.0 75.8 14.7 7.3 “2.2

Managing money 910,200 784,300 58,000 54,800 “13,200 100.0 86.2 6.4 8.0 *1.4

Using the telephone 513,7oo 313,400 ‘43,200 ‘26,400 130,700 100.0 61.0 ‘8.4 ‘5.1 25.4

Doing light housework 1,162,300 759,600 255,500 105,900 ’41,300 100.0 65.4 22.0 9.1 ‘3.6

Doing heavy housework 4,035,400 2,349,200 1,063,100 235,800 387.400 100,0 58.2 26.3 5.8

Getting outside 1,499,200 1,015,800

9.6

196,200 191,300 95,900 100.0 67.8 13.1 12.8 6.4

Walking . . . . . . . . . . . . . . . . ,1,266,900 870,500 180,200 157,800 58,400 100.0 68.7 14.2 12.5 4.6

Table 12. Number and percent d~tnbution of noninstitutionaliied persons 65 yeaffi of age and over dependent in home care activities by living

arrangement of caregivers, according to home care activities United Statea, 1964

Living arrangement of ceregivers Living arrangement of caregivers

Both household Both household

and non- and nonHousehold Nonhousehold household No help Household Nonhousehold household No help

Home care activities Total members members members received Total members members members received

Total dependent in home

care activities . . . . 5,075,800 2,227,600 1,660,500 913,700 274,000

Bathing . . . . . . . . . . . . ...1.653.600

Dressing . . . . 1,146,600

Using the toilet room . . 800,800

Transferring 761,800

Eating . . ..281 .200 . . . ..28l.2OO

Preparing meals . . . 1,014,900

Shopping for personal items . . . 1,930,700

Managing money . . 910,200

Using the telephone . . 513,700

Doing light housework . . 1,162,300

Doing heavy housework . . 4,035,400

Gefling outside . . . . 1,499,200

Walking . . . . . . . . . . . ...1.266.900

932,900

800,900

386,400

510,700

186,100

630,200

1,089,000

817,000

302,100

695,500

1,758,100

819,100

773,100

494,700

206,800

102,100

125,000

48,400

245,400

658,100

245,900

55,400

319,800

1,665,100

394,300

260,400

135,000

138,900

97,200

112,800

47,700

130,300

140,600

‘34,200

‘25,500

t 05,700

224,800

189,900

175,000

90,900

‘15,1OO

‘13,200

“8,900

“42,900

“13,200

130,700

’41,300

387,400

95,900

58,400

Percant distribution

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

43.9

56.4

69.8

64.3

67.0

65.8

62.1

56.4

67.8

58.8

59.8

43.6

54.6

61.0

32.7

29,9

18.0

17.0

16,4

17.2

24.2

34.1

27.0

10.8

27.5

41.3

26.3

20.6

18.0 5.4

8.2 5.5

12.1

16.2 ‘2.5

14.8 ‘1.7

17.0 —

12.8 ●0.9

7.3 ‘2.2

●3.8 ‘1.4

‘5.0 25.4

9.1 ●3.6

5.6 9.6

12.7 6.4

13.8 4.6

28
Table 13. Number and percent distribution of noninstitutionaliied persons 65 years of age and over dependent in home care activities by source of help,

according to home care activitie= United States, 1964

Source of help’ Source of hefp’

Both paid Both paid

Only paid Only unpaid and No hefp Only paid Only unpaid and No help

Home care activities Total help help unpaid help received Total help help unpaid help received

Number Percent distribution

Total dependent in home

care activities . . . . . . . . . 5,075,800 659,800 3,219,000 923,000 274,000 100.0 13.0 63.4 18.2 5.4

Bathing . . . . . . . . . . . . 1,653,600 321,200 1,120,600 120,800 90,900 100.0 19.4 67.8 7.3 5.5

Dressing . . . . . . . . . . . . . . . . 1,146,600 139,200 905,000 102,300 — 100.0 12.1 78.9 8.9

Using thetoilet room . . . . . . . . . 600,800 80,700 431,200 73,800 ‘15,100 100.0 13.4 71.8 12.3 *2.5

Transferring. . . . . . . . . . 761,800 90,800 574,000 83,900 ‘13,200 100.0 11.9 75.3 11.0 ‘1.7

Eating . . . . . . . . . . . . . . . . . 281,200 “41 ,200 198,500 “43,500 100.0 “14.7 89.9 ‘1 5.5

Preparing meals . . . . . . . . . . 1,014,900

—

188,100 720,200 99,700 “8,900 100.0 18.3 71.0 9.8 ‘0.9

Shopping forpersonal items . . . . 1,930,700 238,900 1,569,600 81,200 ‘42,900 100.0 12.3 81.3 4.2 ‘2.2

Managing money . . . . . . . . . 910,200 62,000 811,500 ‘23,500 ‘13,200 100.0 6.8 89.2 ‘2.6 “1.4

Using the telephone . . . . . . . . . 513,700 45,200 318,400 ‘1 9,300 130,700 100.0 8.8 62.0 *3.8 25.4

Doing light housework . . . . . 1,162,300 244,800 785,200 91,100 ●4I ,300 100.0 21.1 67.6 7.6 *3.6

Doing heavy housework . . . . . 4,035,400 1,074,400 2,382,500 191,100 387,400 100.0 26.6 59.0 4.7 9.6

Getting outside . . . . . . . . . . . 1,499,200 164,600 1,124,500 114,100 95,900 1W.o 11.0 75.0 7.6 6.4

Walking . . . . . . . . . . . . . . . . . 1,266,900 139,400 971,900 97,200 58,400 100.0 11.0 76.7 7.7 4.6

1Psrsons who rsceivsd help, paid status unknown, were considered unpaid for the pupxme of this analysis.

Tabfe 14. Number and percent distributionof functionally dependent noninstitutiorraliied persons 65 years of age and over receiving home care by type of

home care, according to selected demographic charectenstk United Stete~ 19S4-65

Type of home care Type of home care

Formal Informal Formal informal

Demographic characteristics Total home care’ home care Total home csre~ home care

Sex by age

Both sexes:

Tota165 years And over . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

75-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

85 years And over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Male:

Tota165 years And over . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

75-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

85yearsandover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Female:

Tota165yearsandover . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

75-64years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

85yearsand over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Race

White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Black . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

HLspanic origin

Hispanic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Not Hispanic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Current marital status

Married . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Notmarried . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Poverty status

Belowpovertythreshold . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Abcwepovertythreshold . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number Percent distribution

5,042,900

2,150,000

1,949,500

943,400

1,473,700

744,500

511,300

217,800

3,569,200

1,405,500

1,438,200

725,600

4,425,100

554,100

63,700

164,100

4,878,800

2,177,200

2,865,800

951,600

4,091,300

1,662,500

645,500

679,000

336,000

327,500

151,000

106,800

69,700

1,335,000

494,500

572,200

268,300

1,494,700

159,300

“8,600

52,500

1,609,900

537,200

1,125,300

292,900

1,369,&10

3,380,400

1,504,500

1,270,800

605,400

1,146,200

593,600

404,500

148,100

2,234,300

911,000

866,000

457,300

2,930,400

394,900

55,200

111,600

3,266,900

1,640,000

1,740,400

658,700

2,721,800

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

33.0

30.0

34.8

35.8

22.2

20.3

20.9

32.0

37.4

35.2

39.8

37.0

33.8

28.7

‘13.4

32.0

33.0

24.7

39.3

30.8

33.5

67.0

70.0

65.2

64.2

77.8

79.7

79.1

68.0

62.6

64.8

60.2

83.0

66.2

71.3

86.6

68.0

67.0

75.3

60.7

69.2

66.5

llncludes persons receiving both fotmal and informal home care services.

NOTE: ADLsare ativities ofdaily llving: lADLsare instmmental activities ofdally PNing. Eguresmay notaddto to~labeHuse ofmunting.

29
Table 15. Number andpercent distribution of functionally dependent persons 65years ofageand over by~peof lon&temcaw used, according to

selected demographic characteristics: United States, 1964-35

Functionally Type of Iongterm care Functionally Type of long-term care

dependent Nursing Formal Informal dependent Nursing Formal Informal

Demographic characteristics elderly Total home care home care’ home care elderly Total home care home care’ home care

Sex by age Number Percent distribution

Both sexes:

Total 65 years and over

65-74 years, . . . . . . . .

75–84 years, . . . . . . . . .

65 years and over

Male:

Total 65 years and over

65–74years. .

75–84 years ..,..,...

85 years and over

Female:

Total 65 years and over ~ .

65–74years . . . . . . . ..’...

75-84 years . . . . . . . . .

85 years and over . . . . .

42.0

45.2

41.3

36.7

46.3

49.4

44.7

40.3

40.1

42.8

40.0

35.7

41.0

47.8

64.1

45,2

41.9

52.0

35.5

32.2

45.3

8,051,100

3,328,600

3,072,900

1,649,700

6,361,300 1,318,300

2,362,100 212,100

2,458,500 509,000

1,540,700 597,300

1,662,500 3,380,400

645,500 1,504,500

679,000 1,270,600

338,000 605,400

327,500 1,146,200

151,000 593,600

106,800 404,500

69,700 148,100

1,335,000 2,234,300

494,500 911,000

572,200 666,000

268,300 457,300

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100,0

100.0

100.0

79.0 16.4

6.4

16,6

36.2

13.5

6.7

15.6

30.6

17.6

6.2

17.0

37.8

17.2

9.9

10.4

14.3

16.4

5.3

23.5

36.7

9.5

20.6

19.4

22.1

20.5

13.2

12.6

11.8

19.0

23.9

23.2

26.4

20.9

20.9

19.3

“1 0.0

21.3

20.6

17.0

23.0

14.3

22.8

71.0

80.0

93.4

73.1

68.7

72.1

89.9

61.6

72.2

83.3

94.4

79.2

77,1

84.5

80.6

79.0

74.4

82.0

83.2

77.6

2,473,800

1,200,600

905,700

367,500

1,808,100 334,400

625,100 80,600

652,700 141,300

330,400 112,600

5,577,300

2,128,000

2,167,200

1,282,100

4,553,100 983,900

1,537,000 131,500

1,805,900 367,700

1,210,300 464,700

Race

White . . . . . . . . . . . . . . . . .

Black. .

Other . . . . . . . . . .

7,139,800

825,300

86,000

5,652,500 1,227,400

636,200 82,000

72,600 8,900

1,494,700 2,930,400

159,300 394,900

‘8,600 55,200

Hispanic origin

Hispanic, . . . . . . . . . . .

Not Hispanic . . . . . . . . . . . . ,..

246,600

7,804,300

199,400 35,300

6,161,900 1,283,000

52,500 111,600

1,609,900 3,268,900

Current marital status

Married . . . . . . . . . . . . . . . . .,

Not married . . . . . . . . . . . . .

3,152,700

4,698,500

2,345,500 168,400

4,015,700 1,150,000

537,200 1,640,000

1,125,300 1,740,400

Poverty status

Below poverty threshold . . .

Above poverty threshold .

2,044,500

6,006,700

1,651,200 749,400

4,710,000 568,900

292,900 658,700

1,369,600 2,721,800

‘Includes persons recewmgboth formal and Informal home care

30
Table 16. Numkrof noninstiutiona~ued persons 65yeara of age and over, by Ievelof tinctional de~ndency in ADL'sand lADUsand *Medmeasums

of health cereand community sewice utilizationlast yeafi percent distnbutkm of persons by number of short-stay hospiteiepisodes andwfsetharina

nursing home lestyear, according to level of functiinel dependenc~ and percent of pereons using commun”Ryservices last year, by level of functional

dependency: United Steteq 1964

Level of functional dependency in ADL’s and IADL’s

Dependent in ADL 3 or IADL k

Health care and All S7 ADL +4 ADL 1-2 ADL Dependent m Not dependent in

community service utilization levels Total dependencies dependencies dependencies /ADL’s only either ADL’s or IADL 3

Number of persons . . . . . . . . . . . . . . . 26,433,000 6,732,800

Number of physician contacts

Iast year . . . . . . . . . . . . . . . . . . ...217.041.500 93,507,900

Average number of physician contacts

perperson peryear . . . . . . . . . . . . . . . 8.2 13.9

Number of hospital days last year . . . . . 67,752,800 41,390,500

Number of persons with hospital

stays last year . . . . . . . . . . . . . . . . . . 5,151,800 2,328,400

Average number of hospital days

per person hospitalized . . . . . . . . . 13.2 17.8

Number of short-stay hospital

episodes last year

None . . . . . . . . . . . . . . . . . . . . . . . 80.4 65.3

l . . . . . . . . . . . . . . . . . . . . . . . . . . 13.7 21.0

2 . . . . . . . . . . . . . . . . . . . . . . . . . . 3.9 6.6

3 or more . . . . . . . . . . . . . . . . . . . . . 1.9 5.1

In a nursing home last year

Oneormore days . . . . . . . . . . . . . . . . 0.5 1.6

Notina nursing home . . . . . . . . . . . . . . 99.5 98.4

Used community services last year

Usedone service or more . . . . . . . . . . . . 22.7 30.3

Senior center . . . . . . . . . . . . . . . . . . . 15.2 13.2

Senior center meals . . . . . . . . . . . . . . . 8.5 8.8

Special transportation forthe elderly . . . . . 4.5 7.3

Home-delivered meals . . . . . . . . . . 2.1 5.4

Homemaker services . . . . . . . . . . . . . . . 1.6 4.4

Homehealth servicesl . . . . . . . . . . . . . . 3.6 11.0

561,700

20,503,100

36.5

10,570,700

337,900

31.3

39.8

29.2

15.6

15.3

4.2

95.8

46.9

5.0

3.5

5.2

5.2

5.9

38.2

Number

539,800 3,729,800

10,044,300 43)050,300

18.6 11.5

4,094,500 18,252,600

230,800 1,147,200

17.7 i 5.9

Percent distribution

56.9 69.2

25.6 18.9

12.2 7.2

5.3 4.7

1.6 1.4

98.4 98.6

Percent

27.4 29.6

4.5 15.5

4.0 10.4

4.9 7.7

7.6 5.1

6.3 4.2

16.8 8.3

1,901,500

19,910,300

10.5

8,472,700

612,400

13.6

67.7

21.3

8.1

3.0

1.2

96.8

27.7

13.7

8.7

7.8

5.3

3.9

6.5

19,700,200

123,533,600

6.3

26,362,200

2,623,500

9.3

85.6

11.3

2.3

0.9

0.1

99.9

20.1

15.8

8.5

3.5

1.0

0.6

1.0

1Includes visiting nurses and home health aides.

NOTE: ADL% sre actwties of daily Ihving;IADL’s are instmmental actiwies of daily Iiwing. Figures may not add to totals because of rounding.

31
Table 17. Number of functionally dependent noninatitutionalized persons 65 years of age and over, by type of home care received and selected measures

of health care and community service utilization last year percent d~tribufion of persons by number of short-stay hospital episodes and whether in a

nursing home last year, according to type of home care received; and percent of persons using community services last year, by type of home care

received: United States, 1984

Type of home care received

Health care and community service utdization Total Formal home care’ Informal home care No home care received

Number

Number of persons . . . . . . . . . . . . . . . . . . . .

Number of physlc!an contacts last year

Average number of physician contacts perperson per year.

Number ofhosptal days last year

Number of persons wrth hospital stays last year .

Average number of hospital days perperson hosptahzed

Number ofshort-stay hospital epieodeslaet year

None . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1 . . . . . . . . . . .

2.........,,,,:::::: :::::::::::::,::::: ::

3ormore . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

In a nursing home last year

Oneormoredays, . . . . . . . . . .

Notina nursinghome . . . . . . . . . . . . . . . . . . . . . . . .

Used commumty services last year

Usedone serwceormore . . . . . . . . . . . . . . . . . . . . . . .

Seniorcenter . . . . . . . . . . . . . . . . . . . . . . . .

Seniorcentermeals, . . . . . . . . . . . . . . . . . . . . . . . .

Specialtransporfationfortheelderly . .

Home-delivered meals . . . . . . . . . . . . . . . . . . . . . . . . .

Homemakerservices . . . . . . . . . . . . . . . . . . . . .

Homehealth servicesz . . . . . . . . . . . . . . . . . . . . .

6,732,800

93,507,900

13.9

41,390,500

2,328,400

17.8

65.3

21.0

8.6

5.1

1.6

98.4

30.3

13.2

8.8

7.3

5.4

4.4

11.0

1,662,500 3,380,400

33,371,700 46,212,900

20.1 13.7

14,705,400 22,052,700

728,600 1,252,000

20.2 17.6

Percent distribution

56.2 62.8

25.8 22.1

11.2 9.5

6.8 5.6

2.4

97.6

46.2

12.5

8.7

11.5

12.5

13.1

23.0

1.6

98.4

Percent

25.4

11.1

7.3

5.5

3.8

1:9

9.2

1,689,900

13,923,300

8.2

4,632,500

347,800

13.3

79.4

14.0

4.1

2.5

0.9

99.1

24.8

18.1

11.9

6.8

1.4

0.9

2.7

‘Includespersonsrecewingbothformalandinformalhomecare services,

‘Includeswsitmgnursesandhome health aides,

NOTE: AD~aare activities ofdaily Kvlng; lADLaare instrumental actlvltiea ofdtily living. Figures maynotadd tototala because of rounding,

32
Appendixes

Contents

I. Technical notes on methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

National Health Interview Survey methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

National Nursing Home Survey methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

II. Definitions ofcertain terms used in this report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

Demographic terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...37

Terms relating to residents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...-..37

Terms relating to physician contacts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...38

Terms relating to hospitalization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...38

Dependence terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...38

111.Selected questions on functional dependency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

Questions on functional dependency: National Health Interview Survey, 1984 Supplement on Aging . . . . . . 39

Questions on functional dependency: National Nursing Home Survey, 1985 Current Resident Questionnaire . . 44

IV. Notes onstandard errors and statistical tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

Standard errors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...47

Statistical tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...48

Appendix figures

I. Relative standard errors for estimated numbers of noninstitutionalized persons: United States, 1984 . . . . . . . . 49

11. Relative standard errors for estimated numbers of current nursing home residents: United States, 1985. . . . . . . 50

Appendmtable

1. Parameters used to compute relative standard errors, by type of estimate . . . . . . . . . . . . . . . . . . . . . 47

33
Appendix I

Technical notes on methods

National Health Interview Survey methodology

Source and description of data

The National Health Interview Survey (NHIS) is a continuous, cross-sectional, nationwide survey conducted by household interview. Each week a probability sample of households

is interviewed by personnel of the U.S. Bureau of the Census

(as agents for NCHS) to obtain information on the health

and other characteristics of each member of the household.

The population covered by the NHIS is the civilian, resident, noninstitutional ized population of the United States living

at the time of the interview. The sample does not include

persons residing in nursing homes, members of the Armed

Forces, institutionalized persons, or U.S. nationals living

abroad.

The NHIS questionnaire contains two major parts: The

first consists of topics that remain the same from year to

year, Among these topics are the incidence of acute conditions,

the prevalence of chronic conditions, persons limited in activity

due to chronic conditions, restriction in activity due to impairment or health problems, and utilization of health care services

involving physician care and short-stay hospitalization. The

second part consists of questions on special health topics

that change each year. In 1984, the special topic was the

concerns of the aged and the supplement to the NHIS was

called the Supplement on Aging (SOA).

●

●

●

●

●

●

34

The objectives of the 1984 SOA were:

To characterize the health and social status of people

55 years of age and over in the United States.

To provide information about how psychosocial and environmental factors interact with health factors to influence

the aging individual in a changing society.

To provide a knowledge base for investigating issues

of prevention and postponement of disability and dependency and for framing research questions and hypotheses

on the interplay between changing home environment

and the aging individual.

To delineate issues and data for research on the enhancement of care, social support, and coping for those older

people who do become disabled.

To provide information about factors that influence individuals’ ability to live independently in the household

and the community as they grow older.

To form the basis for a prospective study. the Longitudinal

Study of Aging.

The completion rate for the NHIS survey has been between

96 and 98 percent over the years. In 1984, there were 41,471

eligible households in the NHIS sample. Interviews were conducted for the basic health and demographic household questionnaire in 39,996 (96 percent) of these households, yielding

data on 105,290 persons of all ages who resided in them

at the time of the interview(21 ).

A total of 16,697 sample persons in the 39,996 households

responding to the 1984 NHIS were selected for the SOA

interview. The SOA interviews were completed for 97 percent

of the sample, or 16,148 persons. Self-response, which was

the primary respondent rule, accounted for 90 percent, and

proxy response for 7 percent; 3 percent did not respond to

the SOA. Less than 1 percent were partial interviews. Thus,

the effective response rate was 97 percent (the SOIA response

rate) multiplied by 96 percent (the NHIS household interview

response rate) for a value of 93 percent.

Full descriptions of technical aspects for the National

Health Interview Survey and the Supplement on Aging have

been published elsewhere (13, 34, 49). This description excerpts and summarizes from those reports.

Sample design

National Health Interview Survey—The NHIS sample is

designed to produce national estimates for the civiIian noninstitutionalized population residing in the United States. The

approach to doing this is first to divide the United States

into geographically defined areas called primary sampling units

(PSU’S), which collectively cover the 50 States and the District

of Columbia. The PSU’S are classified into strata (combinations

of PSU’S with similar characteristics), and, in 1984 and earlier

years, one PSU was selected from each stratum. Within the

selected PSU’S, small compact clusters, called segments, of

housing units are then selected.

There is clustering within the PSU, within the segment,

and within the household because all family members in the

selected housing unit are in the sample. This clustering causes

the procedures for analysis, especially the variance estimation,

to differ from those in simple random sampling.

An important aspect of the NHIS sample design is that

it is a multistage probability design that permits a continuous

sampling of the civilian noninstitutionalized population in the

United States. It is designed in such a way that the sample

scheduled for each week is an independent sample of the

population; the weekly samples are additive over time. Thus,
the design permits estimates for high-frequency measures (or

for large groups) to be produced from a short period of data

collection and estimates for low-frequency measures (or for

smaller population subgroups) to be obtained from a larger

period of data collection. Because interviewing is done

throughout the year with about 800 households in the sample

each week, there is no seasonal bias in the annual estimates.

The NHIS sample is updated or redesigned after each

decennial census. The design that was implemented in 1973

was an update and modification of earlier sample designs

rather than an entirely new design. This update formed the

basis for the 1984 NHIS sample.

Supplement on Aging (SOA)-One of the objectives of

the SOA was to provide finer statistical measures of functional

limitations and the presence of chronic health conditions among

older persons than is provided in the NHIS basic questionnaire.

To produce a broader base for estimating these and other

critical characteristics of this subpopulation, a sample design

was developed that permitted the collection of the maximum

amount of information about older people, namely people

65 years of age and over, among whom the occurrence of

these health problems is greatest. Another objective of the

SOA was to provide information about older people that could

be used as baseline data in measurements of change over

time through a later prospective study. With this objective

of later contact to ascertain changes, the age level established

for the SOA sample was 55 years and over. Because problems

among younger people are less prevalent than among older

people and for the cost savings it provided, it was decided

further that including all people in the younger ages in the

sample was not necessary.

Consequently, the design of the SOA sample was as

follows:

. A systematic one-half sample of people in the 1984 NHIS

households who were 55–64 years of age.

● All people in the 1984 NHIS households who were 65

years of age and over.

Presentation of estimates

Because the design of NHIS is a complex multistage

probability sample, it is necessary to reflect these complex

procedures in the derivation of estimates. The NHIS estimates

presented in this report are based upon sample person counts

for each year weighted to produce national estimates. The

weight for each sample person is the product of four component

weights: probability y of selection, household nonresponse adjustment within segment, first-stage ratio adjustment, and poststratification by age, sex, and race.

The main effect of the ratio-estimating process is to make

the sample more closely representative of the target population

by age, sex, race, and residence. The poststratification adjustment helps to reduce the component of bias resulting from

sampling frame undercoverage; furthermore, this adjustment

frequently reduces sampling variance.

Because NHIS estimates are based on a sample, they

may differ somewhat from the figures that would have been

obtained had a complete census been taken using the same

survey and processing procedures. To the extent possible,

sampling and nonsampling errors are kept to a minimum by

methods built into the survey procedures.

NHIS hospital discharge data are based on hospital discharges reported to have occurred within 6 months of the

week of interview. Analysis has shown that there is an increase

in underreporting of hospitalizations with an increase in the

time interval between the discharge and the interview. The

underreporting of discharges within 6 months of the week

of interview is estimated to be about 5 percent (50). Because

hospitalization is common in the period immediately preceding

death or institutionalization and older persons are much more

likely to die than younger ones, the underrepresentation for

this specific NHIS estimate of elderly persons in particular

may be sizable.

National Nursing Home Survey methodology

Source and description of data

The National Nursing Home Survey (NNHS) is a crosssectional nationwide survey of nursing homes, their residents,

discharges, and staff conducted by the National Center for

Health Statistics. The most recent survey, which was conducted

from August 1985 through January 1986, was the third of

a continuing series of nursing home surveys. The first survey

was conducted from August 1973 through April 1974, and

the second was conducted from May through December 1977.

In this report only data from the current resident survey

of the 1985 NNHS are presented. The NNHS, however, included not only data on residents but also on nursing home

discharges and staff. Resident data were collected in personal

interviews with a nurse familiar with the care provided to

the resident. The nurse relied on the medical record and personal knowledge of the resident. Additional data about current

and discharged residents were obtained by telephone interviews

with next of kin in the 1985 survey only.

The scope of the 1985 NNHS included all types of nursing

homes in the conterminous United States. The sample of

1,220 homes was selected from a sampling frame of 20,479

nursing and related care homes. The frame consisted of all

homes in the 1982 NMFI (51), homes identified in the 1982

Complement Survey of the NMFI as “missing” from the 1982

NMFI, facilities that opened for business from 1982 through

June 1984, and hospital-based nursing homes identified in

the records of the Health Care Financing Administration. Data

were obtained from 1,079 facilities, 1,763 registered nurses,

5,243 residents, and 6,023 discharges. Response rates were

93 percent for facilities, 68 percent for expenses, 80 percent

for registered nurses, 97 percent for residents, 95 percent

for discharges, and 90 percent for next of kin. The effective

response rate for residents was 93 percent multiplied by 97

percent or 90 percent.

Sample desgn

The sampling was basically a stratified two-stage probability design. The first stage was the selection of facilities,

and the second stage was a selection of residents, discharges,

and staff from the sample facilities. In the 1985 NNHS, 20

certification-size primary strata were used in the selection

35
of facilities. For a more detailed description of the survey

design of the 1985 NNHS, see (52).

The second stage sampling of residents was carried out

by the interviewers at the time of their visits to facilities,

in accordance with specific instructions given for each sample

facility. The sample frame for residents was the total number

of residents on the register of the facility on the evening

prior to the day of the survey. Residents who were physically

absent from the facility because of overnight leave or a hospital

visit but who had a bed maintained for them at the facility

were included in the sample frame. In the 1985 survey, a

sample of five or fewer residents per facility was selected.

Presentation of estimates

Because the design of the NNHS is a complex, multistage

probability sample, it is necessary to reflect these complex

procedures in the derivation of estimates. The NNHS estimates

presented in this report are based upon sample person counts

weighted to produce national estimates. The estimating procedure used to produce these estimates has three principal components: inflation by reciprocals of the probabilities of sample

selection, adjustment for nonresponse, and ratio adjustment

to fixed totals.

Because NNHS estimates are based on a sample, they

may differ somewhat from the figures that would have been

obtained had a complete census been taken using the same

survey and processing procedures. To the extent possible,

sampling and nonsampling errors were kept to a minimum

by methods built into the survey procedures.

Descriptive material on data collection, field procedures,

and questionnaire development in the NNHS have been published, as well as a detailed description of the sample design,

estimation procedure, and qualifications of the data (28).
Append~ II

Definitions of certain terms used

in this report

Demographic terms

Age

NHIS—The age recorded for each person is the age at

last birthday. Age is recorded in single years and grouped

in a variety of distributions depending on

the table.

NNHS—The age of the resident on the

was conducted, calculated from date of birth.

Race

the purpose- of

day the survey

NHLS—The population is divided into three racial groups:

“white, “ “black,” and “all other. “ “All other” includes Aleut,

Eskimo or American Indian, Asian or Pacific Islander, and

any other races. Race characterization is based on the respondent’s description of his or her racial background.

NNHS—The racial background of the resident as reported

by the nursing home staff respondent.

Hispanic origin

Hispanic

NHLS—Persons are Hispanic if any of the following describes their national origin or ancestry-Puerto Rican, Cuban,

Mexican, Mexicano, Mexican-American, Chicano, other Latin

American, other Spanish. Respondents make this determination by looking at a flashcard containing the above-listed

Hispanic groups and deciding whether one of them describes

their national origin or ancestry. The Hispanic population

includes all Hispanic people, regardless of race.

NNH.S-Hispanic refers to a person of Mexican, Puerto

Rican, Cuban, Central or South American, or other Spanish

culture or origin, regardless of race, as reported by the nursing

home staff respondent.

Not Hispanic

NHIS and NNHS—For this report, persons not classified

as Hispanic are not Hispanic. This includes persons whose

Hispanic status is unknown.

Current marital status

Married

NHLS—Includes all persons not separated from their

spouses for reasons of marital discord. Persons living apart

due to circumstances of their employment are considered married. Persons living together as husband and wife are considered married, regardless of legal status.

NNHS—Marital status of the resident at the time of the

survey reported as married by the nursing home staff.

Not married

NHLS—Includes persons who are legally separated or divorced or who are living apart for reasons of marital discord,

persons who have lost their spouse due to death, persons

who were never married, and persons whose only marriage

was annulled.

NNHS—Marital status of the resident at the time of the

survey reported as not married by the nursing home staff.

Poverty

NHLS—Families and unrelated individuals are classified

as being above or below the poverty level, using the poverty

index that originated at the Social Security Administration

in 1964 and was revised by Federal Interagency Communities

in 1969 and 1980. The poverty index is based solely on

monetary income and does not reflect the fact that many

low-income persons receive noncash benefits such as food

stamps, Medicaid, and public housing. The index is based

on the Department of Agriculture’s 196I economy food plan

and reflects the varying consumption requirements of families

based on their size and composition. The poverty thresholds

are updated every year to reflect changes in the Consumer

Price Index. Because NHIS data on family income are collected

by income categories rather than specific amounts of money,

NHIS estimates of the number of persons living in poverty

will vary slightly from Current Population Survey estimates.

The 1984 poverty index is based on the 1983 poverty levels

in the March 1984Current Population Survey.

NNHS—For this report, residents who used Medicaid,

State-funded indigent care, or other public assistance or welfare

as a primary or secondary source of payment in the last

month were classified as below the poverty threshold. Medicaid

is a joint Federal-State program providing medical benefits

to persons who qualify for welfare and some of the “medically

needy” (those who would be on welfare if their incomes

were a little lower). The State-set criteria for Medicaid eligibility vary from State to State but cover most poor people in

the United States (53). Residents who did not use these payment sources were classified as above the poverty threshold.

Terms relating to residents

Resident

NNHS—A person on the roster of the nursing home as

of the night before the survey. IncIuded are all residents

for whom beds are maintained, even though they may be

away on overnight leave or in a hospital.

37
Terms relating to physician contacts

fhysiciun contact

NHIS—A physician contact is defined as consultation

with a physician, in person or by telephone, for examination,

diagnosis, treatment, or advice. (Physician contacts with hospital inpatients are not included. ) The contact is considered

to be a physician contact if the service is provided directly

by the physician or by a nurse or other person acting under

a physician’s supervision. For the purpose of this definition,

“physician” includes doctors of medicine and osteopathic physicians. However, the concept toward which all instructions

are directed is that which is described here.

Physician contacts for services provided on a mass basis

are not included in the tabulations. A service received on

a mass basis is defined as any service involving only a single

test (such as a test for diabetes) or a single procedure (such

as a measles inoculation) when this single service is administered identically to all persons who are at the place for this

purpose. Hence obtaining a chest x ray in a tuberculosis

chest x-ray trailer is not included as a physician contact.

However, a special chest x ray given in a physician’s office

or in an outpatient clinic is considered a physician contact.

If a physician is called to a house to see more than

one person, the call is considered a separate physician contact

for each person about whom the physician is consulted.

A physician contact is associated with the person about

whom the advice is sought, even if the person does not actually

see or consult the physician. For example, if a mother consults

a physician about one of her children, the physician contact

is ascribed to the child.

Terms relating to hospitalization

Hospital

NHIS—For this survey, a hospital is defined as any institution either (1) named in the listing of hospitals in the current

American Hospital Association Guide to the Health Care Field

or (2) found on the Master Facility Inventory List maintained

by the National Center for Health Statistics.

Short-stay hospital

NHLS—A short-stay hospital is one in which the type

of service provided is general; maternity; eye, ear, nose, and

throat; children’s; or osteopathic, or it may be the hospital

department of an institution.

Hospital day

NHIS—A hospital day is a day on which a person is

confined to a hospital. It is counted as a hospital day on] y

if the patient stays overnight. Thus a patient who enters the

hospital on Monday afternoon and leaves Wednesday noon

is considered to have had 2 hospital days.

Hospital days during the year

NHIS—The number of hospital days during the year is

the total number for all hospital episodes in the 12-month

period prior to the interview week. For the purposes of this

estimate, episodes overlapping the beginning or end of the

12-month period are subdivided so that only those days falling

within the period are included.

Hospital episode

NHLS—A hospital discharge is the completion of any

continuous period of stay of I night or more in a hospital

as an inpatient except the period of stay of a well newborn

infant. A hospital episode is recorded for a family member

whenever any part of his or her hospital stay is included

in the 12-month period prior to the interview week.

Dependence terms

Dependence in instrumental activities of daily

[i\ing (iADL’s)

NHIS—Persons are considered dependent in IADL’s if

they are reported to have difficulty or to be unable to perform

specific activities by themselves because of a health problem.

These activities include preparing meals, shopping for personal

items, managing their own money, using the telephone, doing

light housework, doing heavy housework, and going outside.

NNHS—Nursing home residents are considered dependent

in IADL’s if they were reported by nursing home staff to

receive personal help or supervision in the following activities:

care of personal possessions, handling money, securing personal items (such as newspapers, toilet articles, or snack food),

and using the telephone (dialing or receiving calls). For the

purposes of this report, care of personal possessions was considered equivalent to doing light housework and securing personal items was considered equivalent to shopping. The two

IADL’s not appropriate for nursing home residents (preparing

meals and doing heavy housework) were considered to be

activities that the residents were dependent in for the purposes

of this report.

Dependence in activities of daily living (ADL’s)

NHIS—Persons are considered dependent in ADL’s if

they (1) have difficulty performing specific activities because

of a health or physical problem and receive the help of another

person in performing the activity or (2) are unable to perform

the activity without special equipment and do not have that

equipment. These activities include bathing, dressing, using

(and getting to) the toilet, transferring into or out of a chair

or bed, mobility, continence (that is, difficulty with bowel

and/or bladder control or if they have had a colostomy, have

a catheter, or have a device to control urination or bowels),

and eating.

NNHS—Nursing home residents are considered dependent

in ADL’s if they were reported by nursing home staff to

currently ( 1) require assistance of another person or special

equipment in performing the activity or (2) did not currently

perform the activity because the resident was tube-fed, chairFast, had an ostomy, or some similar reason. For example,

residents were considered dependent in eating if they currently

were intravenously fed. The ADL’s include bathing, dressing,

using the toilet, transferring, mobility, continence, and eating.

38
Appendw Ill

Selected questions on functional

dependency

Questions on functional dependency: National

Health Interview Survey, 1984 Supplement on

RT 7(

Section RI. ACTIVITIES OF DAILY LIVING (ADL’SI 3-a

Read to respondent – The next question.% are about how wall you ●m able to do certain activities -

by yourself and wafhout using SPecul equipment.

1. ❑u.um of ●health or phvsical (1) 6

(2) & (3) &

probl.m, do YOUh.v. ANY

difficulty –

Bathing or show-ring? C2rmsslng? Eating?

Ask if “Doesn’t do.-:

1 E Yes I G Yes

1s this b.c.u.. of mHEALTH or

1❑ Yes

PHYSICAL probt.m?

/f ‘, Yes,90mafk box 1: if ‘-No, ”

2DN0 ZONO 20N0

mark box 3 3❑ Does”l do for other reason 3 ❑ D.xsir do for other mason 3❑ Doesn,t do for other reason

Ask 2-5 for each ADL marked

‘Ves,- m 7.

~ ~ ~

2. lfyyour,df .“d withouf using 7 ❑ Some 1 ❑ Some I ❑ Some

speci.1 ●wtlpmmt, bow much

difficulty do YOU have M@).,

2nA10t 2a Alot 2DA{ot

somm, a lot, or ●rmyou un.ble 3 ❑ Unable 3 ❑ Unable

to do it?

3 ❑ Unable

3. Do you r.cdv. h.!p from ~ ~ &

●noth.r p.rson i.=? 1❑ Yes I ❑ Yes I ❑ Yes

z ❑ No (5/ 2 ❑ No (5J 2 ❑ No {5)

Q.. Who givss this%lp? 4.. Source of help (

4b. Paid .% Source of help ,

4b. Paid 4s. Source of help / 4b. Paic!

8-1> 1 12-1s 26-28[

Anyone .1s07

2S-32 +2-461 46- 4i

HH mombw I 0 ❑ s/c/P (5) HH member I o ❑ SIC/P (5) HH member I 0❑ s/c/P 6}

Maikih; ~i~lP-b;x–wfih;ui – – -

I ❑ Relaove. ~ ,mYes 2DN0 lo Relative . . ..~ I ❑ Y.s 20N0 10 Re!ative . . ..~ 7 ❑ Y,s 2DN0

risking if ONL Y he!p IS from z ❑ Nonrelative ; I ❑ Yes 2 ❑ No 2 ❑ Nonrelative / I ❑ Yes 2 ❑ No 2 ❑ Nonrelaove ~ I ❑ Yes 2 a No

spouselch!ldrenlparents.

b. Is this hMp paid for? Non-HH member ~ Ncm-HH member ~ Non-HH member ~

smfle!at,ve . .. I I~Yes 2DN0 30 Re!ative . . ..l IO Yes 20N0 30 Relati . . . . ..l IO Yes ZDNO

Ask If necessary:

Which hmlpers m. paid?

a ❑ No”relat,ve / , ❑ Y.S2 ❑ No d ❑ Nonrelative ~ 7 ❑ Yes ZONO 4 ❑ Nonrelative ~ I ❑ Ye. z ❑ No

6a. Do you us. my special .quiv ~ ~ ~

maw or aids in (ADL)7 1❑ Yes 1❑ Yes I ❑ Yes

— 2 ❑ No (2 for nexr ADL 2 ❑ No (2 fornexf ADL 2 ❑ No 12 for next ADL

twth “)’.s<< i“ 1) wirh V’es<r m 1) with ‘,Yes” in lJ

b. What SP=I.I .quipm.nt or Special equipment or aflds Special equipmen? or a,ds Special eqwpment or aids

●ids do you .80?

Anylhlng ●l,.? 17-38 K -

~ w E

Ask 6!f a.v ADL marked .,Yes” m 1.

a Old age (6c)

lm. What (oth.r) condition C.US..

tha lroublm [n (readADLIs)I?

Ask if injury or operaoon:

Whmt did [th. (!.’. Ioccur?/

you have th. op.r.t -J-% on?]

Enrer lnjurv if over 3 months ago.

Ask or reask 6b, !f O-3 months

tnjury or operat,om

Ask If opemoo” over 3 mo”rh.+

ago: For what condition did

you h... th. operation? Enter

condit!on.

b. ❑.sldu (@@,@nl, is them ..Y

oth.r condition which C.US.S ~ & ,~fRk 6a and b)

this troubl. in (readADL(sJI?

c. 1. this troubl. in (read ADL(sil

mu..d by ●ny {oth*r) SP.CNTC ❑ Yes (Reask 6a and b] =ondltlo”? ❑ No

If mulrple condmions, rncludmg old (11 ~ (2) & (3) &

age, are listed m 68, ask 6d for

each AOL with a ,<Yes’, in 7.

I ❑ o-3 month lnj/Op ONLY

}

I ❑ O–3 month lnj/Op ONLY

}

I ❑ O-3 month lnj/Op ONLY

Otherw;se, mark appropriate box 2 ❑ Old age J

2 ~ Old age

d

2 ❑ Old age } 4

or transcribe rh. only listed

co”dirion for each ADL. Ask 6d fornexr ADL with ‘-Y..’,!. 7 Ask fid fo, ne.m ADL with “Yess< t. 1 Ask 6d fornexCADL w#2h ‘*Y..” in 1

d. Which of thmsm conditions,

that is (read cond!t!ons i. 6a) 3D 30 30

would you ..y 1sth. MA7K Cmd,t,on - Emerin ADL box on C.ond#t,on - Enter;n ADL box on Comdit@n – Enter in ADL box on

cm.. of tha troubl. in&L)7 Condmon Summary Chart, THEN ask Cond,tio. S.mm.srv Chart, THEN ask

6d for nexr ADL wmh ,’Yes” in 1.

Condmon Summary Char2, THEN ask

fid for noxr AOL wnh ,<Yes” in 7. 6d for next AOL wnh ,“Yes’, in 1.

‘OOTNOTES

IM“Is t (w ,!,84, ,1,8.!

39
Section RI. ACTIVITIES OF DAILY LIVING (ADL’S), Continued *

Reask 1

(4) 56 (5) 73 (6) 90 (7] ~

Gatling in and out of bed or chairs? Walking? Getting outside? Using the toilet, including gatting

to the toilet?

1 ❑ Yes 1 ❑ Yes 1 ❑ Yes 1 •l Yes

2DN0 2DN0 2DN0 2DN0

3 ❑ Doesn’t do for other reaaon 3 ❑ Doesn’t do for other reason 3 ❑ Doesn’t do for other reason 9 ❑ Doesn’t do for other reason

57 74 I

9’7 l-_K1 •l Some 1 ❑ Some 1 •l Some 1 ❑ Some

zn Alot zD Alot 2n Alot 2D Alot

3 ❑ Unable 3 ❑ Unable 3 ❑ Unable 3 ❑ Unable

58 76 92 ~

1 ❑ Yea I ❑ Yes 1 ❑ Yes 1 ❑ Yea

2 ❑ No (5) 2 ❑ No (5) 2 ❑ No (5) 2 ❑ No (5)

4a. Source of help I I I

!

4b. Paid 4a. Source of help 1

4b. Paid 4a. Source of help 1

4b. Paid 4a. Source of help ~ 4b. Paid

169-621 [ 63-66 I 76-791 180–83 ~83–981 ~97-1oo 8–11 I 12–1[

{H member I o ❑ s/c/P (5) HH member I o ❑ s/c/P (5) Hi member I o ❑ s/c/P (5) HH member I o ❑ s/c/P (5)

lDRelative. ... ~ In Yes 2DN0 !DRelative . . ..~ In Yea 2DN0 lDRelative . . ..~ lD Yea 2DN0 lDRelative. ,.. ~ In Yes ZDNO

2 ❑ Nonrelative . I I ❑ Yes 2 ❑ No 2 Q Nonrelative I I ❑ Yes 2 ❑ No 2 ❑ Nonrelative I I ❑ Yes 2 ❑ No 2 ❑ Nonrelative I I ❑ Yea 2 H No

Jon-HH member I Non-HH member \ Non-HH member ~ Non-HH member \

3DRelative . . ..~ In Yes 2DN0 3a Relative . . ..l In Yes 2DN0 3n Relative . . . I In Yes 2DN0 3nRelative . . ..l !DYea 2DN0

4 ❑ Nonrelative ~ !n Yes 2DN0 4 ❑ Nonrelative lnYeszDNo 4 ❑ Nonrelative ~ In Yes 2DN0 4 ❑ Nonrelative ~lDYes2nNo I

1 1 1

67

1 ❑ Yes

84 101 ~

1 ❑ Yes 1 ❑ Yes 1 ❑ Yes

2 ❑ No (2 for next ADL 2 ❑ No (2 for next ADL z ❑ No (2 for next ADL 2 ❑ NO (6)

with “Yes” in 7) with “Yea”in 1) with “Yes” in 1)

Special aquipment or aida Special equipment or aids Special equipment or aids Special equipment or aids

68 – 69 65–86 102-103

=

70–71 87–38 104–105 m

(4) 72 (5) 89 (6) 106 (7) &

1 ❑ O–3 month lnj/Op ONLY

}

I ❑ O–3 month lnj/Op ONLY

} }

I ❑ O–3 month lnj/Op ONLY I ❑ O—3 month

2 ❑ Old age

1

2 ❑ Old age

J

2 ❑ Old age J’

lnj/Op ONLY

}

(Next page)

2 ❑ Old age

Aak 6d for next ADL with “Yes” m 1 Ask 6d for next ADL with “Yes” m 7 Ask 6d for next ADL with “Yea” in 1

30 30

Condition – Enter in ADL box on

30 30

Condmon – Enter in ADL box on

Condition Summary Chart, THEN ask

Condition – Enter in ADL box on

Condition Summary Chart, THEN aak

Condition – Enter in ADL box on

6d for next ADL twth “Yes” in 1,

Condition Summary Chart, THEN ask

6d for next ADL with “Yes” in 1.

Condit!on Summary Chart, THEN

6d for next ADL with “Yes” m 1, next page,

FOOTNOTES

-—2RM HIS.I [SB)(1S841 13-13.861

40
Section RI. ACTIVITIES OF DAILY LIVING (ADL’S), Continued

1

7a. Do you have difficulty controlling your bowels?

@

I

10 Yes

I 20 No (7c)

---- --—- ---- -— -- —-—- --—— --—— -—-— —

b. How fraquantly do you have this difficulty – deily, severel

;------ —-- ——- -—- —-- ——— —-— --— -—- --

I I❑ Daily E

timas a weak, once a waak, or less than once a week? 20 Several times a week I

I 3D Once a week

40 Less than once a week I

9UDK

--- --- --- —-— ——— -—— ——. ——. —__ ___ ___

c. Do you have a colostomy or a device to help control

;––––--–--–-’-___– ________________

I E

bowel movaments?

10 Yes [

20No (8)

---- ---- ---— -——. ———— -—— -—- -—- ——— _ +-------------- -------------- –-–-–

d. Doyouneed helpfromanothet personintakingcareof I E IU Yes

this devica? I

I 20No

1

8a. Do you have difficulty controlling urination?

I @

I❑ Yes

I 20No (8C)

—-- -—- —-- —- —-——- ————— ————— —— —-— -— :--–--–-_--_–_–-–– -––––-––––-–--– –-

b. How frequently doyouhavethis difficulty -daiIy, several E-zz

times a week, once a weak, or less than once a week?

1 ID Daily

20 Several times a week I

30 Once a week

I

40 Less than once a week I

SIDDK

-—-— -—-- --—- --—— -——— --—- --—— ———— - ;–-–--–-_–-––- ––––-–--–-––- –-––-–

c. Doyouheve aurinary catheter oradevicetohalp E

control urination?

I 10 Yea

I 2~ No (R7J

—-—— -—-— --—- —--— ---- —--- ---- —-

d. ;~y;uneed help fromanother person intakingcareof

:–-----–.-.-––––– -------------- _____

F

thisdevica?

IU Yes I

I 20No

I

I❑ Respondent is a proxy

@

I

RI Mark first appropriate box I

I

I

}

20 Sample person has only been

seen in a bed or chair (9)

3U Telephone interview

I SD All other (Next page) I

Markifknown I @

I

9. Because ofahealth orphysical problem, doyouusually– I

lCIYes(lO) I

a. Stay in bed all or most of the time?

---- -—-— -—-- ---— --—- —-—— --—- —-.— - :__9_%–--–_–_ --------------- ---

b. Stay inachairall ormostofthatime? E I

lCIYes(lO)

I

I 20No (Next page)

,

Oa. What (otherl condition causes youtostay in[bed/a chair]?

I

I ❑ Old age (70cJ

I

r

Ask if injury or operation: I

I

When did [the (iQu@ occur? I you have the operetion?l I

Enter injury if over 3 months ago.

I

I

I

I

Askorreask 70b, if0–3months injury oroperation. I

!

1

Ask if operation over 3 months ago: [

For what condition did you have the operation? I

1

Enter condition. I

—-—- ---— --—- ——-— —-—- -—-— —-.— ____ _

b. Besides (cortdition~isthere anyother condition which

:----- --- ----–------–– - --–--–- ---–

I

causas this? I

I U Yes (Reask 70. and b) 1

I ❑ No(70d)

I

—-—- -—-— --—- —--— --—— --—— ——-- —___

c. Isthiscaused byany(other) specific condition?

;_______________ --–--––-------–– --–-

[

I U Yes (Reask 10a and b) I

! ❑ No

1

I

—--- -—-— —-—— -——— —-—— ____ ____ ____ –b------- --- - --------- ------------

Askifmuftiple conditions, including oldage, arelistedin 10a.

1

t-z

I

Otherwise, mark appropriate box or transcribe the only listed I

condition.

lDO–3month lnj/OpONLY I

I }

(Next page) 20 Old age

d. Which of these conditions, thatis (read conditions inl Oa)wouId \

you say is the MAIN cause of your staying in [bed/a chair] all I 3CI

or most of the time? I

I Condition – En?er’’9’’ in ADLboxon Condition Summary Chart, THEN

I next page.

I

I

.,, L,!.. ,.. ! ,...”, ,. ,, .“,

r.,.. , l.”, ! ,... ! ,.. !....,

41
Section R2. INCIDENTAL ACTIVITIES OF DAILY LIVING (IADL’S)

Read to respondent – Now I will ask about some other activities. Tell me about doing them by yourself.

1. Because of a heslth or physical problem, do you (1} 34 (21 46

hrws ANY difficulty – Preparing your own msals? Shopping for psrsonal items, (such

as toilet items or medicines]?

Ask if “Doesn ‘t do”: I ❑ Yes I ❑ Yes

Is this because of a HEALTH or PHYSICAL problem?

If “Yes,” mark box 1; if “No,” mark box 3

2DN0 2DN0

3 ❑ Doesn’t do for other reason 3 ❑ Doesn’t do for other reason

Ask 12– 14 foreach L4DL marked “Yes”in 11, 35 &

2. By yourself, how much difficulty do you havs ~, 1❑ Some 7 ❑ Some

some, n lot, or are you unable to do it? 2DAlot zn Alot

3 ❑ Unable 3 ❑ Unable

3. DO YOU rsceive help from another person in (L4DL)? 36 n

1 ❑ Yes 1 ❑ Yes

z ❑ No (12 for next L4DL with 2 ❑ No (12 fornextIADL with

“Yes”in 71) “Yes”in 11)

40. Who gives this help?

I I

Source of help I Paid Source of help I Paid

Anyone else7 14s. 1

14b. 14a. 1

14b.

137-401 [41–44 149-521 @

HH member

I

I o ❑ s/c/P HH member

——— —— ——— ———

10 ❑ s/c/P

Mark the S/C~P–box with;u;a;k;~if–D~L Y help; ;o; ;p;u;e?c~l;re;/– – –

lnRelative .,. .\lD Yes ZDNO ? ❑ Relstive . . ..~lnYes 20N0

parents, THEN 12 for next IADL with “Yes” in 11,

2 H Nonrelative , I I ❑ Yea 2 ❑ No 2 ❑ Nonrelative I I ❑ Yes 2 ❑ No

Non-HH member \

b. Is this help paid for?

Non-HH member \

3DRelatwe . . ..l!D Yes 2DN0 3nRel@ive,.,,llnyea ZDNO

Ask if necessary: Which helpers are paid? 4 ❑ Nonrelative ~ I ❑ Yes 2 ❑ No 4 ❑ Nonrelative f f ❑ Yes 2 ❑ No

I

Ask 15 if any IADL marked “Yes” m 11. ❑ Old age (15cI

5a. What (other) condition causes ths troubls in (read IADL(s))7

Ask if injury or operation:

When did [the (injury) occur7 / you have the operation?]

Enter injury if over 3 months ago.

Ask or reask 15b, {f O– 3 months injury or operat!on,

Ask if operation over 3 months ago:

For what condition did you have the operation?

Enter condition.

b. Besides (condition), is thare any other condition which

causes the troub16 in (read TADL(sJ) ? ❑ Yes (Reask 15a and b)

❑ No (15d)

c. Is the trouble in (read IA DL(s)) caused by any (other]

specific condition? ❑ Yes 07eask 15a and b)

❑ No

If multiple conditions, mcludmg old age, are listed m 15a, ask 15d (1) 45 [2) ~

for each .IADL with a “Yes” m 11. Otherwise, mark appropriate

box or transcribe the onl y listed condition.

I ❑ O–3 month lnj/ Op ONLY

}

I ❑ O–3 month lnj/ Op ONLY

2 ❑ Old age J

2 ❑ Old age

d. Which of these conditions, that is (read conditions in 15a)

} i

would you say is ths MAIN cause of the troubls in

~)?

Ask 15dfor next L4DL with “Yes” in 11 Ask 15d for nextL4DL with “Yes” in 11

30 3D

Condition – Enter mIAOL box on Condmon Condtion – Enter in .iXDL box on Condiuon

Summary Chart, THEN ask 15d for next3ADL Summary Chart, THEN ask 15d for next IAD1

wfth “Yes” in 77, with “Yes”in 17.

FOOTNOTES

IRM HIS.? 1S0) (19S41 (3.13.S41

42
Section R2. INCIDENTAL ACTIVITIES OF DAILY LIVING (IADL’S), Continued

(3) 58

(41

70 (5) 82 (61 &

Managing your money, (such as keep. Reask 11 Doing heavy housework, (like scrub- Doing fight housework, [like doing track of expenses or paying bills)? Using the telephcme? bing floors, or washing windows)? ing dishes, straightening up, or

light cleaning)?

1 Cl Yes 1 Cl Yes 1 U Yes 1 ❑ Yes

2DN0 2DN0 2~No 2~N0

3 ❑ Doesn’t do for other reason 3 ❑ Doesn’t do for other reason 3 ~ Doesn’t do for other reason 3 ~ Doesn’t do for other reason

59 71 83 95

7 Cl Some 1 ❑ Some I 0 Some I ❑ Some

zn Alot zD Alot 2 mA lot 2 HA lot

3 D Unsble 3 ❑ Unable 3 D Unable 3 ❑ Unable

60 I72 L

84 ~

1 0 Yes 1 •l Yes 1 ❑ Yes 1 ❑ Yes

2 D No (12 for nextIADL with 2 ❑ No (72 for next IADL wkh 2 D No (72 for nextIADL with 2QNo (75)

“Yes” in 77) “Yes”m 77) “Yes”m 7 7)

I 1 I I

Source of help I Paid Source of help I Pa!d Source of help I Paid Source of help I Paid

14s. 1

14b. 14a. I14b. 14a. I 1

\61-641

14b, 14a. 14b.

165-68 73–761 177–80 185-88) 189–92 a7-7oo I @

I

,

HH member 1 0 n s/c/P HH member ~ o ❑ SIC/P HH member

1

I o •1 S(CIP HH member I o ❑ s/c/P

lBRelative, . ..~lD Yes 2DN0 I ❑ Relstive ~lDYes 2GN0 I ❑ Relative ~lDYes 2HN0 lmRelative, ,,. ~lD Yes 20N0

2 D Nonrelative I I ❑ Yes 2 ❑ No 2 ❑ Nonrelatwe I I ~ Yes 2 D No 2 D Nomelat,”e I I D Yea 2 u NO 2 ~ Nonrelatwe I I ~ Yes 2 ❑ No

I

Uon-HH member \ Non-HH member ~ Non.HH member ~ Non-HH member ~

3 D Relative . . llDYes 2DN0 3 ❑ Relative ll~Yes 2@N0 3 ~ Relative tl~Yes 2DN0 3 ~ Relative llnYes 2HN0

4 ❑ Nonrelative \ I ❑ Yes 2 n No 4 ❑ Nonrelatwa ! I ~ Yes 2 ~ No 4 ~ No.relatwa \ I ~ Yes 2 D No 4 ~ Nonrelatwe \ I U Yes 2 ❑ No

1 I I {

(31 1

69 (4) 8’7 (5) 1

93

}

(6) ~

I D O–3 month lnj/ OP ONLY

}

I q O–3 month Inj! Op ONLY

}

I ❑ O– 3 month lnj/ Op DNLY 1~0–3 month

2 ❑ Old age

J

2 ~ Old age

)

2 fl Old age

J

}

Injl Op ONLY Next page

Ask 75d for nextIADL with “Yes” m 17 Ask 75d for nextIADL wnh ‘-Yes” m 71 Ask 15d fornext TADL wtth “Yes”m 71

z ~ Old age

30 3CI 3C

Condition - Enter in IADL box on Cond!Oon

3LI

Condmon - Enter m lADL box on Condmon Condmon – Enter m L4DL box on Condmon

Summary Chart, THEN ask 15d for nextIADL

Cond!t!cm – Enter m IADL box on Condmon

Summary Chart, THEN ask 15d for next lADL Summary Chart, THEN ask 15d for nextIADL

with “Yes” in 71, w(th “Yes” m 7 f

Summary Chart, THEN nexr page.

wIrh “’Yes”m 71,

FOOTNOTES

..,, .,..! ,.O. ,, ...,,” ,. .“, ......!.. ! ,.., .=.., ,.-, .-.

43
Questions on functional dependency: National

Nursing Home Survey, 1985 Current Resident

Questionnaire

19a. Does currently require any assistance in bathing or showering?

01 •l Yes 02 ❑ No (SKIP TO Q. 20) ‘W ❑ Don’t know (SKIP TO Q. 20)

19b. Does bath or shower with the helo of

(1) Special equipment? 01 •l Yes 02 ❑ No

(2) Another person? 01 •l Yes 02 ❑ No

20a. Does currently require any assistance in dressing?

01 •l Yes

02 ❑ No (SKIP TO Q. 21)

03 ❑ Remains partiaUy or completely undressed or is dressed by another and does not participate (SKIP TO

Q. 21)

94 ❑ Don’t know (SKIP TO Q. 21)

20b. Does dress with the help ofi

(1) Special equipment? 01 •l Yes 02 ❑ No

(2) Another person? 01 •l Yes 02 ❑ No

21a. Does currently require tiy assistance in eating?

01 IJ Yes

02 ❑ No (SKIP TO Q. 22)

03 @ Requires tube or intravenous feeding (SKIP TO Q. 22)

94 ❑ Don’t know (SKIP TO Q. 22).

21b. Does eat with the help ofi

(1) Special equipment? 01 •l Yes 02 ❑ No

(2) Another person? 01 •l Yes 02 ❑ No

21c. Is fed totally by another person? 01 •l Yes 02 ❑ No

22a. Is bedfast?

01 ❑ Yes (SKIP TO Q. 23) 02 ❑ No

22b. k chairfast?

01 Cl Yes 02 ❑ No
23a. Does currently require —any assistance transferring in and out of bed or chairs?

01 •l Yes

02 ❑ No (SKIP TO Q. 24)

94 ❑ Don’t know (SKIP TO Q. 24)

23b. Does require the help ofi

(1) Special equipment? 01 •l Yes 02 ❑ No

(2) Another person? 01 •l Yes 02 ❑ No

IF YES TO EITHER Q. 23b(l) OR 23b(2), SKIP TO Q. 25

24a. Does currently require any assistance in walking?

01 El Yes 02 ❑ No (SKIP TO Q. 25) ‘M ❑ Don’t know (SKIP TO Q. 25)

24b. Does walk with the help ofi

(1) Special equipment? 01 •l Yes 02 ❑ No

(2) Another person? 01 •l Yes 02 ❑ No

~5a. D~s go outside the grounds of this facility?

01 •l Yes 02 •l No (SKIP TO Q. 26) 94 ❑ Don’t know (SKIP TO Q. 26)

25b. When goes outside the grounds, does require the help ofi

(1) Special equipment 01 •l Yes 02 ❑ No

(2) Another person? 01 El Yes 02 ❑ No

26a. Does have an ostomy, an indwelling catheter or similar device?

01 •l Yes 02 ❑ No (SKIP TO Q. 26c)

26b. Does require any — assistance from another person in caring for this device?

01 •l Yes 02 ❑ No

26c. Does currently require any — assistance using the toilet room?

01 •l Yes

02 ❑ No (SKIP TO Q. 27)

03 @ Does not use toilet room (ostomy patient, chairfast, etc.) (SKIP TO Q. 27)

94 ❑ Don’t know (SKIP TO Q. 27)

26d. Does require the help ofi

(1) Special equipment? 01 •l Yes 02 ❑ No

(2) Another person? 01 •l Yes 02DN0
27a. Does current ly have any difficulty in controlling bowels?

01 ❑ Yes

02 ❑ No (SKIP TO Q. 28)

03 ❑ Not applicable, hashadan ostomy(SKIPTOQ. 28)

94 ❑ Don’t know (SKIP TO Q. 28)

27b. How frequently does have this difficulty?

01 ❑ Daily

02 ❑ Several times a week

03 0 Once a week

04 n Less than once a week

94 0 Don’t know

“.

28a, Does currently have any difficulty in controlling bladder?

01 •l Yes

02 ❑ No (SKIP TO Q. 29)

03 0 Not applicable has indwelling catheter, ostomy, or external device (SKIP TO Q. 29)

94 ❑ Don’t know (SKIP TO Q. 29)

28b. How frequently does have this difficulty?

01 ❑ Daily

02 u Several times a week

03 ❑ Once a week

04 n Less than once a week

94 n Don’t know

28c. Does this occur only at night?

01 Cl Yes 02 ❑ No 94 ❑ Don’t know

29. Does receive personal help or supervision in any of the following activities:

Yes No Don’t know

a. Care of personal possessions’? 01 ❑ 02 •1 94 Q

b. Handling money? 01 •1 02 ❑ 94 •1

c. Securing personal items such as newspapers,

toilet articles, snack foods? 01 •1 02 ❑ 94 ❑

d. Using the telephone? (dialing or receiving calls) 01 •1 02 •1 94 •1

46
Appendix IV

Notes on standard errors and

statisticaltests

Standard errors

The two surveys used as primary sources for the data

contained in this report are based on multistage probability

samples. The sampling errors for each survey were calculated

taking their complex sample designs into account.

For the Supplement on Aging (SOA) to the National

Health Interview Survey and the National Nursing Home Survey (NNHS), estimates for sampling variability were calculated

using the method of half-sample replication. A description

of the development and evaluation of the replication technique

for error estimation has been published (54, 55).

To derive error estimates that would be applicable to

a wide variety of statistics and could be prepared at moderate

cost, several approximations were required.

Rather than calculate standard errors for particular estimates Sx, the calculated variances for a wide variety of estimates for each of these surveys were fitted into curves using

the empirically determined relationship between the size of

an estimate X and its relative variance (rel var X). This relationship is expressed as

S2X b

relvarX == = a +x

where a and b are regression estimates determined by an

iterative procedure.

The relative standard error is then derived by taking the

square root of the relative variance curve. The relative standard

error estimates used for this report were read directly from

these curves. Because of the relationship between the relative

standard error of an estimate and the estimate, the standard

error Sx can be derived from its relative standard error by

multiplying the relative standard error of the estimate by the

estimate itself. Figure I presents the relative standard error

curve for estimated number of noninstitutionalized persons

from the 1984 Supplement on Aging. Figure II presents the

relative standard error curve for estimated number of nursing

home residents from the 1985 NNHS. The parameters used

to compute relative standard errors by type of estimate are

also presented in table 1.

Table 1. Parameters used to compute relative standard errors, by type of

estimate

Parameters

Type of estimate a b

Noninstitutionalized persons

(SOA) - 0.00009539 3,989.9

Nursing home residents (NNHS) - 0.00017690 530.2

For combined estimates from the SOA and NNHS, for

example, the percent of the functionally dependent elderly

with five to seven ADL dependencies shown in table 4, the

relative variance of the combined percent was based on the

combined contributions of the fitted relative variance (rel var)

from the SOA and from the NNHS. The contributions of

each survey were determined from the following formulas

h+n where p = combined percent =

H+N

and h, Hare from the SOA and n, N are from the NNHS.

(

h+n

‘el ‘ar H + N )

= relvar(h + n) + relvar(H + M

2Cov(h + n,H + N) —

(h+ n)(H+ N)

where Cov (h + n, H + N) is the covariance between h + n

and H + N.

Because

Cov(h + n,H + N) = Cov(h, H) + Cov(h, N)

+ Cov (H, n) + Cov (n, N)

= COV (h, H) + COV (h, N)

(Cov(h, N) = O and Cov (H, n) = O because the NNHS

and SOA were sampled independently) and because it can

be shown that under the assumption of a simple random sample

Covh, H = hHrelvarH ~

Covn, N = nNrelvarN

rel var (

h+n

)

can be simplified into the following formula:

H+N

(

h+n

)

= h2relvarh + rz2relvarn

rel var

H+N (h + n)’

+ H2relvarH + N2relvarN

(H + N)’

— 2(h H rel varH + n N rel var N)

(h + n)(H + N)

47
In this report, the relative standard error (RSE (p)) and standard

error (SE (p)) of a percent p were approximated by the following formulas:

RSE( p) = ~~

SE(p) = p RSE(p)

530.? relvarn = relvar N = – 0,00017690 +

1,318,300

= 0.000225

In the case of the combined percent p = ~ ~ ~‘

—

~ + ~)= (6,732.800)’ (0.000497) + (1.318,300)’ (0.000225 relvar ( ~

(8,051 , 100)2

+

-::— bO“ar(*N)

where rel var (

h+n

H+N )

is defined above.

In the case of p = ~ .100, where x is the numerator of

the estimated percent, y is the denominator, and both x and

y are from the same survey, the following formula applies:

b(loo – p), rel var (j) =

PY

where b is the appropriate parameter from table 1.

Examples of calculating the standard error for these two types

of percentages follow:

Example of combined percent

Table 4 shows that 29 percent of the elderly were dependent in at least one ADL or IADL. The numerator of this

percent (8,05 1, 100) is the sum of 6,732,800 functionally dependent noninstitutionalized elderly persons (table 2) and

1,318,300 nursing home residents (table 3). The denominator

of this percent (27,75 1,300) is the sum of 26,433,000 noninstitutionalized elderly persons (table 2) and 1,318,300 nursing

home residents. Let:

h = 6,732,800 H = 26,433,000

n = 1,318,300 N = 1,318,300

h + n = 8,051,100 H + N = 27,751,300

Then, rel varh = – 0.00009539 +

rel var H = – 0.00009539 +

3,989.9

6,732,800

= 0.000497

3,989.9

~6,433,0()() = 0.000055

(26,433,000)2 (0.000055) + ( 1,3 18,300)2 (0.000225)

(27,75 1,300)2

2((6,732,800) (26,433,000) (0.000055) + (1 ,3 18,300)2 (0,000225))

(8,05 1, 100)(27,75 1,300)

= 0.000313

= 0.017692

SE (p) = (29.0) (0.017692)

= 0.51

Example of percent from a single survey

Table E shows that 67 percent of the 5,042,900 noninstitutionalized functionally dependent elderly persons receiving

home care received informal home care from friends and

family members. Let y = 5,042,900 and p = 67.0.

Then rel var (p) =

3,989.9(100 – 67)

(67) (5,042,900)

= 0.000390

RSE (p) = ~-

= 0.019748

SE(p) = (67.0) (0.019748)

= 1.32

Statistical tests

In this report, the determination of statistical inference

of rates and percents is based on the t-test with a critical

value of 1.96 (0.05 level of significance). For more details

on hypothesis testing performed for SOA and NNHS, see

references 32 and 28, respectively.

48
100

90

80

70

60

50

40

30

20

10

9

8

7

6

5

4

3

2

0.:

0.8

0.7

0.6

0.5

0.4

0.3

0.2

0.1

A 2 3 4 56789A 2 3 456789A 2 3 456789A 2 3 456789A 23 4 56789A

10 100 1,000 10,000 100,000

Size of estimate in thousands

100

90

80

70

60

50

40

30

20

10

9

8

7

6

5

4

3

2

:.9

0.8

0.7

0.6

0.5

0.4

0.3

0.2

0.1

FUure 1. Relative standard errors for estimated numbers of noninstitutionatiiedpersons: United States, 1984
I

.

WI

w

0

0

0

m

100 1ml

90

80

70

60

50

40

30

20

10

9

8

7

6

5

4

3

~

1

09

08

07

06

05

04

03

02

01

1.

A 2 3 456789A 2 3 456789A 2 3 456789A 2 3 456789A 2 3 456789A

.000 10,000 !00,000 1,000,000 10,000,000

Size of estimate

50

40

30

20

10

9

8

7

6

5

4

3

2

:9

08

07

06

05

04

03

02

01

F~ure Il. Relative standard errors for estimated numbers of current nursing home residentx United States, 1985
Vital and Health Statistics

series descriptions

SERIES 1.

SERIES 2.

SERIES 3.

SERIES 4.

SERIES 5.

SERIES 6.

SERIES 10,

SERIES 11.

SERIES 12.

SERIES 13.

SERIES 14

Programs and Collection Procedures—Reports describing

the general programs of the National Center for Health

Statlstlcs and Its offices and dtvlslons and the data collection methods used. They also include definitions and

other material necessary for understanding the data.

Deta Evaluation and Methods Research—Stud)es of new

statistical methodology Includlng experimental tests of

new survey methods, studies of vital statistics collection

methods, new analytical techniques, objectwe evaluations

of rellablllty of collected data, and contr!but!ons to

stat[stlcal theory. Studies also Include comparison of

U.S. methodology with those of other countries.

Analytical and Epidemiological Studies—Reports presenting analytical or Interpretive studies based on vital

and health statistics, carrying the analysfs further than

the exposnory types of reports in the other series.

Documents and Committee Reports-Final reports of

ma)or committees concerned with wtal and health stat!stlcs and documents such as recommended model v]tal

registration laws and revised birth and death certificates.

Comparative International Vital and Health Statistics

Reports-Analytical and descriptive reports comparing

U.S. wtal and health statistics with those of other countries.

Cognition and Survey Measurement—Reports from the

National Laboratory for Collaborative Research In Cognltlon and Survey Measurement using methods of cogn[tlve

science to design, evaluate, and test survey Instruments

Data From the National Health Interview Survey—Statlstlcs on Illness, accidental Injuries, dlsablllty, use of hospital, medical, dental, and other sew!ces, and other

health-related topics, all based on data collected in the

continuing national household Interwlew survey

Data From the National Health Examination Survey and

the National Health and Nutrition Examination Survey—

Data from direct exam! nation, testing, and measurement

of nattonal samples of the clvtllan nonlnstltutton allzed

population provide the basis for (1 ) estimates of the

medically defined prevalence of speclf[c diseases In the

Un!ted States and the dlstrlbutlons of the population

with respect to physical, physiological, and psychological characteristics and (2) analysis of relationships

among the various measurements without reference to

an expliclt flnlte unwerse of persons.

Data From the Institutionalized Population Survey s-D!scontlnued in 1975. Reports from these surveys are lnciuded In Series 13.

Data on Health Resources Utilization—Statwtlcs on the

utlllzatlon of health manpower and facllltles providing

long-term care, ambulatory care, hospital care, and family

planning services.

Data on Health Resources: Manpower and Facilitiea—

Statlsmcs on the numbers, geographic distribution, and

characteristics of health resources including physicians,

dentists, nurses, other health occupations, hospitals,

nursing homes, and outpatient facilities.

SERIES 15.

SERIES 16.

SERIES 20.

SE RI ES 21,

SERIES 22.

SERIES 23.

SERIES 24.

Data From Special Survey s—Statlstlcs on health and

health-related topics collected {n spec[al survey’s that

are not a part of the continuing data systems of the

National Center for Health Statistics.

Compilations of Advance Data From Vital and Health

Statistics—These reports provjde early release of data

from the Nat!onal Center for Health Statlstlcs’ health and

demographic surveys. Many of these releases are followed

by detailed reports In the V!tal and Health Statlstlcs

Series.

Data on Mortality-Various statistics on mortal[ty other

than as tncluded In regular annual or monthly reports,

Special analyses by cause of death, age, and other demographic variables; geographic and time series analyses:

and Statlstlcs on characteristics of deaths not available

from the vital records based on sample surveys of those

records.

Data on Natality, Marriage, and Divorce—Various statlst!cs on natal !ty, marr!age, and divorce other than as

Included In regular annual or monthly reports. Special

analyses by demographic variables; geographic and ttme

ser!es analyses; studies of fertility; and statistics on

characterlatlcs of b!rths not available from the vital

records based on sample surveys of those records.

Data From the National Mortality and Natality Surveys—

Dlscontlnued In 1975. Reports from these sample surveys

based on v:tal records are Included In Ser!es 20 and 21,

respectively.

Data From the National Survey of Family Growth—

Statlst!cs on fertility, fam!ly formation and d[ssolutlon,

family planrmng, and related maternal and Infant health

top(cs derwed from a per!odlc survey of a nationwide

probability sample of women 1 5–44 years of age.

Compilations of Data on Natality, Mortality, Marriage,

Divorce, and Induced Terminations of Pregnancy—

Advance reports of births, deaths, marriages, and divorces

are based on final data from the National V!tal Statlstlcs

System and are publwhed annually as supplements to the

Monthly Vital Stattstlcs Report (MVSR). These reports are

followed by the publication of detailed data In Vital Statlstlcs of the Un/ted States annual volumes. Other reports

Includlng Induced terminations of pregnancy Issued perl -

od!cally as supplements to the MVSR provide selected

f!ndlngs based on data from the National Vital Statlstlcs

System and may be followed by detailed reports in Vital

and Health Statistics Series.

For answers to questions about this report or for a Ilst of titles of

reports publlshed in these series, contact:

Sclentlfic and Technical Information Branch

National Center for Health Statistics

Centers for Disease Control

Publlc Health Service

Hyattsvllle, Md. 20782

301 -436–8500
DEPARTMENT OF

IiEALTIi & }iULIAN SERVICES

Public Health Serwce

Centers fo( Dmease Control

Nahona[ Center for Health Statism.s

6525 Belcrest Road

Hyattswlle, Mayland 20782

OFFICIAL BUSINESS

PENALTY FOR PRIVATE USE, $300

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DHHS Publlcatlon No IPliSI 9131765, Series 13, i!o 10.4