Vital and

Health Statistics

Health Data on

Older Americans:

United States, 1992

Series 3:

Analytic and Epidemiological Studies

No, 27

Includes data from various sources concerning the health status and

determinants of health of older persons, Data on persons aged 55-64 years are

Included for comparison purposes

U.S, DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Sewice

Centers for Disease Control and Prevention

National Center for Health Statistics

Hyattsvllle, Mayland

January 1993

DHHS Publication No. (PHS] 93-1411

For sale by the U.S. Government Printing Office

Superintendent of Documents, Mail Stop SSOP, Washington, DC 20402-9328

ISBN 0-16-041645-0
Trade name disclaimer

The use of trade names ISfor identification only and does no! im~ly

endorsement by the Public Health Service. U S. Department of Health and

Human Services.

Copyright Information

All material appearing in this report, except for Chapter 11 where speclflc

source is given, is mthe pubhcdoma(n and maybe reproduced or copied

without permlss!on; citation as to source, however, IS appreciated.

Suggested Citation

Van Nostrand, JF, Furrier SE, Suzman R,eds. Health data on older Americans

Un(fed States, 1992. National Center for Heaith Stafstlcs.V ital Health Stat

3(27). 1993.

Library of Congress Cataloging-in-Publication Data

Health data on older Americans : Un!ted States, 1992.

p. cm. – (DHHSpublicatlon : no. (PHS)93–1411) (Vtal and health

statistics. Series3, Analytical and empidem!ological studies ; no. 27)

Includes bibliographical references.

ISBN O-8406-0470-X

l. Aged -Health andhygiene- United States -Statistics.2. United

States–Statistics, Medical.1. National Center for Health Statistics (U.S.) II

Series. Ill. Series: Wal and health statistics. Series 3, Analytical and

epidemlological studies ; no. 27.

[DNLM: 1. Aged. 2. Health Serv!ces for the Aged–United

States –statistics. 3. Health Status.4. Health Survey s- United States.

W2 A N148VC no.27]

RA407.3. H4 1992

362.1 ‘9897’00973021 – dc20

DNLM/DLC

for Library of Congress 92-48880

CIP
National Center for Health Statistics

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

Jack R, Anderson, Acting Deputy Director

Jacob J. Feldman, Ph.D., Associate Direclorfor

Analysis and Epidemiology

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

and Extramural Programs

Peter L. Hurley, Associate Director for Vital and

Health Statistics Systems

Robert A, Israel, Associate Director for International

Statistics

Stephen E. Nieberding, Associate Director for

Management

Charles J. Rothwell, Associate Director for Data

Processing and Services

Monroe G. Sirken, Ph.D., Associate Director for

Research and Methodology

David L. Larson, Assistant Directo~ Atlanta

Office of Vital and Health Statistics Systems

Peter L. Hurley, Associate Director for Vital and

Health Statistics Systems

Joan F. Van Nostrand, NCHS Coordinator of Data

on Aging
Part 1. Introduction

Ba.cliground by Joan F. Van Nostrand, Sylvia E. Fumeq and Richard Suzman . . . . . . . . . . . . . . . . . . . . 1

Part II. Health status

Chapter 1. Measures of health by Robin Mermelstein, Baila Miller, Thomas Prohaska, Veronica

Benson, and Joan F. Van Nostrand . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Chapter2. Functional status and living arrangements by Thomas Prohaska, Robin Mermelstein,

Baila Miller, and Susan Jack . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

Chapter 3, Changes in functional status and risk of institutionalization anddeathbyBai/a kfille~

Thomas Prohaska, Robin Mermelstein, and Joan F. Van Nostrand . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

Chapter 4. Mortality by Sylvia E. Fumeq Je@ey Maurer, and Hany Rosenberg . . . . . . . . . . . . . . . . . . . . . 77

Part Ill. Health care use and its cost

Chapter 5. Acute care by Sylvia E. Fumer and Lola Jean Kozak . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115

Chapter 6. Selected issues in long-term care: Profile of cognitive disability of nursing home

residents and the use of informal and formal careby elderly in the community by JoanF. Van

Nostrand, Bailaillilleq and Sylvia E. Fumer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143

Chapter 7, Patterns of drug prescribing by Todd P. Selma, Arthur Schwartz, Hugo Koch, and Cheryl

Nelson . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187

Chapter 8. Cost of health care and sources of payment by Lawrence J. Frateschiarzd Sylvia E.

Furrier.,, ,,... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209

Part IV. Special topics

Chapter 9. Health ofolder black Americans by Karen Smith Blesch and Sylvia E. Fumer . . . . . . . . . 229

Chapter 10. Musculoskeletal disorders: Time trends, comorbid conditions, self-assessed health

status, and associated activity limitations by Toni f’. Miles, Katherine Flegal, and Tamara

Haris . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...275

Chapter ll. International aging by Toni P. Miles and Jacob Brody . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 289

Part V. Appendixes

I. Technical notes on methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 301

II. Howtoorder PC Lotus Diskette of tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 307

III. Guide to tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 309

...

Ill
List of tables

Chapter 1

Table l. Average annual percent distribution ofpersons 55years ofageand over byrespondentassessed health status, according tosex, race, and age: United States, 1985–87 . . . . . . . . . . . . . . . . . .

Table 2. Percent distribution ofpersons 65years ofageand over bynumber ofactivities of daily

living for which difficulty was reported, according to sex, age, and respondent-assessed health

status: United States, 1986 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... .,.,, . . . . . . . . .

Table 3, Percent distribution of persons 65years of age and over by number of instrumental

activities of daily living for which difficulty was reported, according to sex, age, and respondentassessed health status: United States, 1986 . . . . . . . , . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , ,

Table 4. Average annual number of selected reported acute conditions per 1,000 persons 55

years of age and over, by type of acute condition, race, sex, and age: United States, 1985-87.,..

Table 5. Average annual number ofselected reported impairments perl,OOO persons 55yearsof

ageandover, bytypeof impairment, race, sex, and age: United States, 1985-87 . . . . . . . . . . . . . . . . .

Table 6. Average annual number of selected reported chronic conditions per l,000persons55

years of age and over, by type of chronic condition, sex, and age: United States, 1979-81, 1982-84,

and 1985–87 . . . ...?... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,,, ..,,.., . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Chapter 2

Table A. Percent who reported “does not do” for instrumental activities of daily living, by sex

and age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,0

Table B. Percent distribution ofpersons with difficul~in activities ofdaily living andinstrumental activities of daily living, by sex and age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Table l. Percent distribution ofpersons 65years ofageand over bynumber ofactivities of daily

living for which difficulty was reported and percent of persons who received the help of another

person in performing activities of daily living, according to race, sex, and age: United States,

1986 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Table 2. Percent ofpersons 65years ofageand overwith reported difficul@ performing activities

of daily living, byrace, sex, andage: United States, 1986 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , .,..,.,., ,

Table 3. Percent ofpersons 65years ofageand overwho reported receiving thehelp of another

person with performing activities of daily living, by race, sex, and age: United States, 1986 . . . . . .

Table 4. Percent distribution of persons 65 years of age and over by number of instrumental

activities of daily living for which difficulty was reported and percent of persons who received the

help of another person in performing instrumental activities of daily living, according to race, sex,

andage: United States, 1986 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Table 5. Percent of persons 65 years of age and over with reported difficulty performing

instrumental activities of daily living, by race, sex, and age: United States, 1986 . . . . . . . . . . . . . . . . .

Table 6. Percent ofpersons 65years ofageand overwho reported receiving thehelp of another

person with performing instrumental activities of daily living, by race, sex, and age: United States,

1986 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,,, . . .

Table 7. Percent distribution of persons 65 years of age and over by living arrangement,

according to race, age, and sex: United States, 1986 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .,, ,., ,., , . . . . . .

Table 8. Percent distribution ofpersons 65years ofageand over bynumber ofactivities of daily

living for which difficulty was reported, according to living arrangement, sex, and age: United

States, 1986 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,,, ,,, . . . .,, ,. ..,, . . . . . . . . . . . . . . . .

Table 9. Percent ofpersons 65years ofageand overwith reported difficul& performing activities

of daily living, by living arrangement, sex, age, and activity: United States, 1986 . . . . . . . . . . . . . . . . .

Table 10. Percent distribution of persons 65 years of ageandover bynumber of instrumental

activities of daily living for which difficulty was reported, according to living arrangement, sex, and

age: United States, 1986 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

14

15

17

19

20

21

24

26

29

30

31

32

33

34

35

36

37

38

iv
Table 11. Percent of persons 65 years of age and over with reported difficulty performing

instrumental activities of daily living, by living arrangement, sex, age, and activity: United States,

19S6.,., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Chapter 3

Table A. Percent distribution of persons 70 years of age or over by extent of difficulty in

performing activities of daily living in 1984 and at 1986 recontact for those living in the

community between 1984 and1986 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Table B, Percent distribution of persons 70 years of age or over, by extent of difficulty in

performing instrumental activities of daily living in 1984 and at 1986 recontact for those living in

thecommuni~ betieen 1984and 1986 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Table 1. Percent distribution ofpersons70 years of age andover in 1984 by outcome at 1986

recontact, according toage, sex, and 1984 marital status: United States . . . . . . . . . . . . . . . . . . . . . . . . . .

Table 2, Percent distribution ofpersons70 years of age andover in 1984 by outcome at 1986

recontact, according to number of activities of daily living for which difficulty or the help of

another person was reported in 1984: United States , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Table 3. Percent distribution ofpersons70 years of age andover in 1984 by outcome at 1986

recontact, according tonumber ofinstrumental activities of daily living forwhich difficulty or the

help of another person was reported in 1984: United States.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Table 4. Percent distribution of persons 70 years of age and over in 1984 by outcome at 1986

recontact, according to sex, age, and extent of difficulty with performing activities of daily living

reported in 1984: United States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Table 5. Percent distribution ofpersons70 years of ageandover in1984by outcome at 1986

recontact, according to sex, age, and extent of difficulty with bathing reported in 1984: United

states ,. ..,.0.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Table 6, Percent distribution ofpersons70 years of ageandover in1984by outcome at 1986

recontact, according to sex, age, and extent of difficulty with dressing reported in 1984: United

States ,. ..,0... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Table 7, Percent distribution ofpersons 70years ofageand over in1984by outcome at 1986

recontact, according to sex, age, and extent of difficulty with walking reported in 1984: United

States . . . . . . . . . .. 0,,.... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..$ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Table 8. Percent distribution ofpersons70 years of age andover in 1984 by outcome at 1986

recontact, according to sex, age, and extent of difficulty with transferring reported in 1984: United

States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Table 9, Percent distribution ofpersons70 years of age andover in 1984 by outcome at 1986

recontact, according to sex, age, and extent of difficulty with performing instrumental activities of

daily living reported in 19S4:United.States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Table 10. Percent distribution ofpersons 70years ofageand over in1984by outcome atl986

recontact, according to sex, age, and extent of difficulty with meal preparation reported in 1984:

United States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Table 11. Percent distribution of persons 70 years of age and over in 1984 by outcome at 1986

recontact, according to sex, age, and extent of difficulty with shopping reported in 1984: United

States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Table 12. Percent distribution of persons 70 years of age and over in 1984 by outcome at 1986

recontact, according to sex, age, and extent of difficulty with heavy housework reported in 1984:

United States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Table 13. Percent distribution of persons 70 years of age and over in 19S4 by outcome at 1986

recontact, according to sex, age, and extent of difficulty with walking up 10 steps reported in 1984:

United States .,, .0,,,. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Table 14. Percent distribution ofpersons 70years ofageand over in1984by outcome atl986

recontact, according to sex, age, and extent of difficulty with walking one-quarter mile without

rest reported in1984: United States. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

39

44

46

48

49

50

51

54

56

58

60

62

64

66

68

70

72

v
Table 15. Percent distribution ofpersons70 years of age andover in

recontact, according to sex, age, and extent of difficulty with lifting 25

United States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Chapter 4

Table A. Provisional death rates for all causes, according torace, sex,

1984 by outcome at 1986

pounds reported in 1984:

. . . . . . . . . . . . . . . . . . . . . . . . . . . 74

and age: 1988–90 ..,,,... 78

Table B. Comparison of death rates per 100,000 for persons 65 years of age-and over: 1960-86, 79

Table C. Percent change indeath rates forpersons55 years of age and over, according to age,

sex, and race: 1960–86 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,,, .,..,. . . . . . . . . . . . . . . . . . . ,., ,, 80

Table D. Life expectancy at65years ofage, according toraceand sex: 1986-90 . . . . . . . . . . . . . . . . 81

Table E. Percent change indeath rates fordiseases of theheart forpersons 55yearsof age and

over, according to age, sex, and race: 1980–86 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81

Table F. Comparison of age-adjusted death rates per 100,000 for diseases of the heart for

persons 65 years of age and over: 1960-86 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82

Table G. Percent change indeath rates forcancer forpersons 55years ofageand over, according

toage, sex, and race: 1980–86 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82

Table H. Comparison ofage-adjusted death rates perlOO,OOOforcancer forpersons 65yearsof

age and over: 1960–86 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83

Table J. Percent change in death rates for respiratory cancer for persons 55 years of age and

over, according toage, sex,and race: 1980–86 . . . . . . . . ... .,... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83

Table K, Comparison of age-adjusted death rates per 100,000 for respiratory cancer forpersons

65 years of age and over: 1960-86 . . . . . . . . . . . . . . . . . . . . . . . , . , , . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . 84

Table L, Percent change in death rates for cerebrovascular disease for persons 55years ofage

and over, according toage, sex, and race: 1980–86 . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . , . . . . . . . . . . 84

Table M. Comparison of age-adjusted death rates per 100,000 for cerebrovascular disease for

persons 65 years of age and over: 1960-86 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84

Table N. Percent change indeathrates for diabetes mellitus forpersons55 years ofage andover,

according to age, sex, and race: 1980–86 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84

Table O. Percent change in death rates for suicide for persons 55 years of age and over,

according to age, sex, and race: 1980-86 . . . , . . . . . . . . . . . . . . , , . . . . , , , , . . . . , . . . . . . . . . . . . . . . . . , . . . . . . . 85

Table l. Death rates for allcauses among persons 55 years ofage and over, by sex, race, and age:

United States, selected years 1960-86 . . . . . . . . . . . . . . . . . . ,., ..,,,, ,. ..,,.,, ., .,,..,, .,, ..,,,. .,,,.,, 87

Table 2, Life expectancy at specified ages, by race and sex: United States, selected years

1960.86 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89

Table 3. Life expectancy at individual ages 65–85years, by race andsex: United States, 1986,.. 90

Table 4. Death rates for the 10 leading causes of death in rank order among persons 55 years of

age andover: United States, 1986 .,0, ,,.,, . . . . . . . . . . . . . . . . . . ,, .,..,,, ,., .,..,, . . . . . . . . . ,.. ..O,., ,, 91

Table 5. Death rates for diseases of the heart among persons 55 yearsof age andover, bysex,

race, andage: United States, selected years 1980–86 .,, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93

Table 6. Death rates formalignant neoplasms, includingneoplasms oflymphatic andhematopoietictissues, among persons55years ofage andover, bysex, race, and age: United States, selected

years 1980-86 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..O. . . . . . . . . ,. .,.,,,. ... ,,,,,. . . . . . . . . . . . . . . . . . . ,,.,, 95

Table 7, Death rates for malignant neoplasms of the respiratory and intrathoracic organs among

persons 55 years of age and over, by sex, race, and age: United States, selected years 1980-86.. 97

Table 8. Death rates forcerebrovascular diseases among persons 55years ofageand over, bysex,

race, andage: United States, selected years 1980–86 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99

Table 9. Death rates fordiabetes mellitus among persons 55 years of ageandover, bysex, race,

andage: United States, selected years 1980-86 . . . . . . . . . ,,, ,., .,. . . . . . . . . . . . . . . . . . . . . . . . . . . . ., .,., 101

Table 10. Death rates forpneumonia andinfluenza among persons 55years ofageandover, by

sex, race, and age: United States, seIected years 1980–86 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103

vi
Table ll. Death rates forsuicide among persons 55years ofageand over, bysex, race, and age:

United States, selected years 1980-86 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105

Table 12. Number of deaths from the 10 leading causes of death in each age-sex-race group

among persons 65years of age and over, by reported or underlying cause and ratio of reported

causes to underlying causes: United States, 1986 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107

Chapter 5

Table l. Average annual number ofphysician visits perperson, byrace, sex, respondent-assessed

health status, and age: United States, 1985-87 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121

Table 2. Number of mentions of most common patient reasons for a physician visit for

ambulatory patients 55 years of age and over and rank for males and females, by age: United

States, 19S5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122

Table 3. Percent of office visits by persons 55 years of age and over to selected physician

specialists, bysexandage: United States. 19S5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124

Table 4. Number of mentions of most frequent all-listed diagnoses for ambulatory patients 55

years of age and over and rank for males and females, by age: United States, 1985 . . . . . . . . . . . . . . 125

Table 5. Number of mentions per 1,000 visits of common diagnostic services for ambulatory

patients 55 years of age and over, according to sex and age: United States, 1985 . . . . . . . . . . . . . . . . 127

Table 6. Number of patients discharged, rate of discharges, days of care, and average length of

stay for males 55 years of age and over, by age and selected first-listed diagnoses: United States,

19S1 and 1987. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..0...... . . . . . . ..$. . . . . . . . . . . . ..0.. 12s

Table 7. Number of patients discharged, rate of discharges, days of care, and average length of

stay for females 55 years of age and over, by age and selected first-listed diagnoses: United States,

19Sland 19S7. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130

Table S. Number and rate of surgical procedures for males 55 years of age and over discharged

from short-stay hospitals, by age and selected procedures: United States, 1981 and 1987 . . . . . . . . 132

Table 9. Number and rate of surgical procedures for females 55 years of age and over discharged

from short-stay hospitals, by age and selected procedures: United States, 19S1 and 1987 . . . . . . . . 134

Table 10. Number and rate of diagnostic and other nonsurgical procedures for males 55 years of

age and over discharged from short-stay hospitals, by age and selected procedures: United States,

19S1 and 19S7, ..0,..... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136

Table 11. Number and rate of diagnostic and other nonsurgical procedures for females 55 years

of age and over discharged from short-stay hospitals, by age and selected procedures: United

States, 19S1 and 1987 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13s

Table 12. Number of patients discharged, rate of discharges, and average length of stay for

persons 55 years of age and over with a diagnosis of pneumonia or influenza, by sex and age:

United States, 19S1 and 19S7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140

Table 13. Rate of patients discharged with a diagnosis of fractures, all sites, or hip fracture

(fracture of neck of femur) for persons 55 years of age and over, by sex and age: United States,

19S1 and 19S70, .,!.... . . . . . . . . . . . . . . . ..$ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141

Table 14. Percent distribution of patients55 years of age and over discharged from short-stay

hospitals bydisposition status, according tosexand age: United States, 19Sland 19S7 . . . . . . . . . . 142

Chapter 6

Table A, Nursing homeresidents 65years ofageand overper l, OOOpopulation, according to age,

sex, andrace: United States, 1963, 1973–74, 1977, and 1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144

Table B. Codes for items in the current resident questionnaire of the 19S5 National Nursing

Home Sumeyused toidenti& cognitive disabili~ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145

Table C. Rate ofcognitive disabilities perl,OOO nursing home residents: United States, 19S5... 146

Table D. Rate of cognitive disabilities per l, OOOnursing home residents by age: United States,

19s5................................................................,,.,,.,..,$,.................... 146

vii
Table E. Rate of cognitive disabilities per 1,000 nursing home residents by race: United States,

19s5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , 147

Table F. Rate of cognitive disabilities per 1,000 nursing home residents by sex: United States,

1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147

Table G. Percent of young-old and oldest-old nursing home residents in fair or poor physical

health, by selected cognitive disabilities: United States, 1985 . . , , . . . . . . . . . . . . . . . . . , . . . . . , , . . . , . . . , 148

Table H. Rate of cognitive disabilities per 1,000 nursing home discharges: United States,

1984-85 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , , . . . . 152

Table J. Percent of frail persons 65years ofageand overusing onlyinformal helpers inl982by

the number of informal helpers in 1982, according to race, sex, age, and help with activities of

daily living: United States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156

Table 1, Number and percent of nursing home residents, by presence of selected cognitive

disabilities, sex, age, and race: United States, 1985. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .,. ,., ..O,,, 160

Table 2. Percent of nursing home residents, by presence of selected cognitive disabilities, sex,

age, race, and staff-assessed physical health status: United States, 1985 . . . . . . . . . . . . . . . . . . . . . . ..OO 161

Table 3. Percent of nursing home residents, by presence of selected cognitive disabilities, sex,

age, race, and number of disruptive behaviors: United States, 1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163

Table 4. Percent of nursing home residents, by presence of selected cognitive disabilities, sex,

age, race, and whether memory impaired: United States, 1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165

Table 5. Percent of nursing home residents, by presence of selected cognitive disabilities, sex,

age, race, and presence of depression or anxiety: United States, 1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167

Table 6. Percent of nursing home residents, by presence of selected cognitive disabilities, age,

and number and type of activities of daily living for which help of another person is required:

United States, 1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,,. .. O,. 169

Table 7. Percent of nursing home residents, by presence of selected cognitive disabilities, age,

and number and type of instrumental activities of daily living for which help of another person is

required: United States, 1985 . . . . . . . . . . . . . . . . . . . . ., ..,,,,., ,, .,.,..,. . . . . . . . . . . . . . . . . . . . . .,, ,, .,,.. 171

Table 8. Percent of nursing home residents, by presence of selected cognitive disabilities, age,

and continence status: United States, 1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173

Table 9. Percent of nursing home residents, by presence of selected cognitive disabilities, age,

and type of therapy received in past month: United States, 1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174

Table 10. Percent of nursing home residents, by presence of selected cognitive disabilities, age,

and primary source of payment: United States, 1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , 175

Table 11. Percent of nursing home residents, by presence of selected cognitive disabilities, age,

and living arrangement prior to admission: United States, 1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177

Table 12. Percent of nursing home discharges, by presence of selected cognitive disabilities, age,

duration of stay, and discharge status: United States, 1984-85 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179

Table 13. Percent of frail persons 65 years of age and over using selected community health and

social services, by race, sex, age, and help with activities of daily living: United States, 1984 .,,.. 181

Table 14. Percent of frail persons 65 years of age and over using only informal helpers in 1982 by

use in 1984, according to race, sex, age, and help with activities of daily living: United States ,.. 182

Table 15. Percent of frail persons 65 years of age and over using both formal and informal

helpers in 1982 by use in 1984, according to race, sex, age, and help with activities of daily living:

United States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184

Chapter 7

Table A. Distribution of therapies for persons 55 years of age and over . . . . . . . . . . . . . . . . . . . . . . . . . 188

Table B. Number and percent distribution of mentions of cardiac glycosides by selected principal

diagnoses and ICD-9-CM codes for persons 55 years of age and over, according to patient age:

United States, 1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .190

...

Vlll
Table C. Number andpercent distribution ofmentions of benzodiazepines, antidepressants, and

antipsychotics by selected principal diagnoses and ICD–9–CM codes for persons 55 years of age

and over, according to patient age: United States, 1985.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192

Table 1. Number and percent distribution of office visits and drug mentions, and percent of office

visits during which 1 drug or multiple drugs were mentioned for persons 55 years of age and over,

according to age, sex, race, and ethnicity: United States, 1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 194

Table 2. Percent distribution of drug mentions by selected dimensions of drugs by persons 55

years of age and over, according to patient age: United States, 1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195

Table 3, Number of mentions, rank order, and therapeutic use of 50 generic ingredients most

frequently mentioned by physicians in office-based practice for patients in age groups 55 years

andover: United States, 1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196

Table 4. Number and percent distribution of office visits to physicians by persons 55 years of age

and over and of drug mentions by physicians and percent of office visits during which 1 drug or

multiple drugs were mentioned by principal diagnosis, according to patient age: United States,

19s5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199

Table 5, Number and percent distribution of drug mentions by therapeutic categories for persons

55 years of age and over, according to patient age: United States, 1985 . . . . . . . . . . . . . . . . . . . . . . . . . . 202

Table 6. Number and percent distribution “of office visits and drug mentions, and percent of

office visits during which 1 drug or multiple drugs were mentioned by physician identity and

specialty for persons 55 years of age and over, according to patient age: United States, 1985 . . . . 204

Table 7. Number and percent of persons 55 years of age and over currently using vitamin or

mineral supplements, by selected characteristics: United States, 1986 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206

Table & Percent of persons 55 years of age and over using vitamin or mineral supplements, by

sex, age, and vitamin or mineral supplement used: United States, 1986 . . . . . . . . . . . . . . . . . . . . . . . . . . 207

Chapter 8

Table 1. Percent distribution of persons 70 years of age and over by Medicare coverage,

according to sex and age: United States, 1984.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215

Table 2, Medicare enrollment, persons served, and payments for Medicare enrollees 65 years of

age and over, by selected characteristics: 1967, 1977, and 1986.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 216

Table 3, Percent distribution of persons 70 years of age and over by type of private health

insurance coverage, according to age and sex: United States, 1984 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217

Table 4, Percent distribution of persons 70 years of age and over by health care coverage,

according to age and sex: United States, 1984. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217

Table 5. Percent distribution of persons 70 years of age and over by type of Medicare and/or

private health insurance coverage, according to age and sex: United States, 1984 . . . . . . . . . . . . . . . . 218

Table 6. Percent distribution of hospital discharges for persons 55 years of age and over by

expected principal source of payment, according to sex and age: United States, 1987 . . . . . . . . . . . . 219

Table 7, Percent of visits to office-based physicians by persons 55 years of age and over by

expected sources of payment, according to sex and patient age: United States, 1985 . . . . . . . . . . . . . 220

Table 8, Number of nursing home residents 55 years of age and over and average monthly

nursing home charge, by sex, age, and primary source of payment in month before interview:

United States, 1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..$ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221

Table 9, Percent distribution of persons 70 years of age and over by whether Medicaid benefits

were received in previous 12 months, according to sex and age: United States, 1984 . . . . . . . . . . . . . 222

Table 10. Percent distribution of persons 70 years of age and over in 1984 by whether Medicaid

benefits were received in 1986, according to sex, age, and whether Medicaid benefits were

received in 1984: United States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223

Table 11. Amount and percent distribution of per capita personal health care expenditures for

persons 65 years of age and over by source of funds, according to type of service and age: United

States, 19S7,,, ...,,. ..! . ...0. . . . . . .. . . ,, .,,,... .. . . . . .. . . ...0.... .. . . . .. . . . . .. . . . . .. .. . . . . .. .. . . .. . 225

ix
Chapter 9

Table A. Projections in thousands and percent change in the black and white populations 65

years of age and over, by age subgroup, for the years 2000 and 2010 . . . . , . . . . . . . . . . . . . , , , , . , . . . , , 229

Table B. Percent distribution of activities of daily living difficulties, by respondent-assessed

health status, sex, and race for persons 65 years of age and over: United States, 1986 . . . . . . . . . . . 231

Table C. Percent distribution of instrumental activities of daily living difficulties, by respondentassessed heahh status, sex, andrace for persons 65 years of ageandover: United States, 1986,. 232

Table D. Discharge rates for black and white persons 65years of age and over, by selected

first-listed diagnoses: United States, 1987 . . . . . . . . . . . . . . . . . . . , , . . . . , . . . . . . . . . . . . . . . . . . . . , . . . . . , . . , . 237

Table E. Average length ofstay, byrace, sex, and selected first-listed diagnoses forpersons65

years of age and over: United States, 1981 and 1987 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 238

Table F. Discharge rates for pneumonia-influenza for black and white persons,65 years ofage

and over: United States, 1987 , . . . , . . . . . , , , . . , , . . . . . . , . . . , . . . . . . . . . . . . . . . . . . . . . . . . . , , . , . . . . , ., . . , , . 238

Table G. Percent distribution of males and females 65 years of age and over, by race and

discharge disposition: United States, 1981 and 1987. . . . . . , , . . . . . . . . . . . . . . . . . . . . . . . . . . , . , . , , . . , , . , . 239

Table 1. Average annual percent distribution of black persons 55 years of age and over by

respondent-assessed health status, according to sex andage: United States, 1985–87 ., . . . . . . . . . . 243

Table 2. Percent distribution ofblackpersons 65 years of age and over bynumber ofactivitiesof

daily living for which difficulty was reported, according to sex and respondent-assessed health

status: United States, 1986 , . . . . . . . . , . , . . . . . . . . . . . . . . , , . . . , . . . , , , . . . . , . , , , . . . , . . . . . . , . . . . . . , . . . . . , . . 244

Table 3. Percent distribution of black persons 65 years of age and over by number of

instrumental activities of daily living for which difficulty was reported, according to sex and

respondent-assessed health status: United States, 1986 . . . , . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . , . , ., , . . 245

Table 4. Average annual number ofselected reported chronic conditions per 1,000blackpersons

55 years of age and over, by sex and age: United States, 1985-87 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 246

Table 5. Average annual number of selected reported impairments per 1,000 bIack persons 55

years of age and over, by sex and age: United States, 1985-87 . . . . . . . . ,. . . . . . . . . . . . . . . . . . , . , . . . . . , 247

Table 6. Percent distribution ofblackpersons 65 years of age and overbynumber ofactivitiesof

daily living for which difficulty was reported and percent of persons who received the help of

another person in performing activities of daily living, according to sex and age: United States,

1986 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .0 247

Table 7. Percent distribution of black persons 65 years of age and over by number of

instrumental activities ofdaily living for which difficulty was reported and percent ofpersons who

received the help ofanother person in performing instrumental activities ofdaily living, according

to sex andage: United States, 1986. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , 248

Table 8. Percent distribution ofblack persons 65 years of age andover by living arrangement,

according to sex andage: United States, 1986 . . . . . . . . , . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . , . . , , . . . 249

Table 9. Percent distribution of black persons 70 years of age andoverin 1984 by outcomeat

1986 recontact, according to sex, age, and extent of difficulty with performing activities of daily

living reported in 1984: United States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..OO. . . . . . . . . . . . . . . . 250

Table 10. Percent distribution of black persons 70 years of age andover in 1984 by outcome at

1986 recontact, according to sex, age, and extent of difficulty with performing instrumental

activities ofdaily living reported in 1984: United States . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. OO...O,,, ,.. , 252

Table 11. Death rates for all causes among black persons 55 years of age and over, by sex and

age: United States, selected years 1960–86 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 254

Table 12. Life expectancy atspecified ages for black persons, bysex:United States, 1960, l97O,

1980, and 1986 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..OO. 255

Table 13. Life expectancy for black persons atindividual ages 65-85 years, bysex: United States,

1986 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 00. . . 256

Table 14. Death rates forselected causes among black persons 55years ofageandover, by sex

andage: United States. selected years 1980.86 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...257

x
Table 15. Average annual number of physician visits per person for black persons, by sex,

respondent-assessed health status, and age: United States, 1985–87 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 260

Table 16. Number of mentions of most frequent all-listed diagnoses per 1,000 visits to officebased physicians by black patients 55 years of age and over and rank for males and females, by

age: United States, 1985 , . ., , , , , . , , , . . ,, , . . . . , , . . . , , . . ,. , . , . ,, ,. . , . . . , . . . . , . . . . . . . . . . . ., , . . . . . . . . . . 261

Table 17. Number of mentions of common diagnostic services per 1,000 visits to office-based

physicians for black patients 55years of age and over, by sex andage: United States, 1985. . . . . . 262

Table 18, Number of patients discharged from short-stay hospitals, days of care, and average

length of stay for black persons55 years of age andover, by sex, age, and selected first-listed

diagnoses: United States, 1981 and 1987 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 263

Table 19. Number of patients discharged from short-stay hospitals and average length ofstay for

black persons 55years of age andover with adiagnosis ofpneumonia or influenza, bysex and

age: United States, 1981 and 1987 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265

Table 20. Percent distribution of black patients 55 years of age and over discharged from

short-stay hospitals by disposition status, according to sex and age: United States, 1981 and

1987 , , , ,, , , , , ,,- . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . , . . . . . . . . . . . . $. . . . . . . . . . . . . . . . . . . . $. . . . . . . . . . . . . . . . . . , 266

Table 21. Number and percent of nursing home residents, by presence of selected cognitive

disabilities and race: United States, 1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267

Table 22, Percent of nursing home residents, by presence of selected cognitive disabilities, race,

and staff-assessed physical health status: United States, 1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 268

Table 23, Percent ofnursing home residents, bypresence ofselected cognitive disabilities, race,

andwhether memory impaired: United States, 1985 . . . . . . . . . . . . . . . . . . . , . . . . . . . . . ,, ., . . . . . . . . . . . . . 269

Table 24, Number andpercent ofvisits to office-based physicians and drug mentions andpercent

of office visits for which drugs were mentioned for black persons 55 years of age and over,

according to age: United States, 1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 270

Table 25. Number and percent ofblack persons 55 years ofage andover currently usingvitamin

or mineral supplements, by selected characteristics: United States, 1986 . . . . . . . . . . . . . . . . . . . . . . . . . 270

Table 26. Percent of black persons 55years of age and over currently using vitamin or mineral

supplements, by sex, age, and vitamin or mineral supplement used: United States, 1986. .,...... 271

Table 27, Percent distribution of black persons 70 years of age and over by whether Medicaid

benefits were received in previous 12months, according tosex: United States, 1984 . . . . . . . . . . . . . 271

Table 28. Percent distribution of black persons 70 years of age and over in 1984 by whether

Medicaid benefits were received in 1986, according to sex and whether Medicaid benefits were

receivedin 1984: United States ., . ...0. . . . . . . . . . . . . . . . . ... !.... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 272

Table 29. Percent of black persons 55 years of age and over who reported joint pain or

physician-diagnosed arthritis, bysexand age: United States, selected time periods . . . . . . . . . . . . . . 273

Table 30. Rate of selected comorbid conditions among black persons 55 years of age and over

reporting arthritis, bysex and age: United States, 1984 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 273

Chapter 10

Table A, fhmveyand response items used in table 1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 276

Table 1, Percent of persons 55 years of age and over who reported joint pain or physiciandiagnosed arthritis, bysex, race, andage: United States, selected time periods . . . . . . . . . . . . . . . . . . 283

Table 2, Percent of persons 55–74 years of age who reported any painin joints, bysite ofpain,

according to race, sex, and age: United States, 1971–75 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 284

Table 3. Percent distribution ofrespondent-assessed health status among persons 55years of age

andover reporting arthritis, according to race, sex, and age: United States, 1984 . . . . . . . . . . . . . . . . 285

Table 4, Percent of selected comorbid conditions among persons 55 years of age and over

reporting arthritis, byrace, sex,and age: United States, 1984 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 286

Table 5, Percent of persons 55 years of age and over, reporting arthritis, with difficulty

performing activities ofdaily living, byrace, sex, andage: United States, 1984 . . . . . . . . . . . . . . . . . . . 287

xi
Table 6. Percent ofpersons 55years ofageand overreporting arthritis, withdifficul~ performing

instrumental activities of daily living, by race, sex, and age: United States, 1984 . . . . . . . . . . . . . . . . . 288

Chapter 11

Table 1. Average expected remaining years of life for persons 65, 75, and 85 years of age, by sex:

Selected countries, selected years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .,, ,. .,,. .,, 292

Table 2. Percent of population 65 years of age and over and deaths of persons 65 years of age and

over as a percent of all deaths: Selected countries, selected years . . . . . . . . . . . . . . . . . . . . . . . . . . . ... .O 293

Table 3. Mortality rates per 1,000 population for selected age groups, by sex: Selected countries,

selected years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .,. ... ..O. . . . . . . . . , 294

Table 4. Percent of deaths from diseases of the heart, cerebrovacular disease, cancer, and all

other causes among persons 65 years of age and over: SeIected countries, selected years, .,...,, 295

Symbols

--- Data not available

. . . Category not applicable

Quantityzero

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
Part I

Introduction
Background

by Joan F. Van Nostrand, M.P.A., National

Center for Health Statistics; Sylvia E. Furrier,

Ph. D., University of Illinois at Chicago; and

Richard Suzman, Ph. D., National Institute on

Aging, Editors

The “graying” of America is a phenomenon age groups, from the young-old (aged 65–74

of the 20th century that is without precedence. years) to the oldest-old (aged 85 and over). Data

More and more Americans are living to older on those who are approaching older ages (perages, At the turn of the century, life expectancy sons 55–64 years of age) are presented for comwas 47.3 years, By 1991, life expectancy (provi- parison purposes.

sional estimate) had increased to 75.7 years. This report is an update and expansion of a

This increase has raised questions about the 1986 report on the health of older Americans

quality of these additional 28.4 years of life (l). An advisory group was convened to review

gained over the century. Are these added years the 1986 report and advise on the content and

ones of vigor or ones of dysfunction and disabil- format of this update. Organizations that were

ity’?To address these questions, this report analyzes health data on older Americans from a

variety of perspectives. Data cover functioning,

mortality, use of health care, and changes in

health status over time. The report is comprehensive in that it includes in one volume information from virtually all of the data systems of

the National Center for Health Statistics, The

report also includes data from sources other

than the National Center for Health Statistics,

most notably data on health care financing, international comparisons, and long-term care. A

subject matter guide to the 170 tables in this

report is presented in the appendix. The tables

are cross-indexed by certain variables, such as

race, the oldest-old, activities of daily living, use

of nursing homes, and selected chronic conditions, Because older Americans are a heterogeneous population, the tables emphasize detailed

~uppmtfor preparationof thisreportwasprovidedby the

Federal Interagency Forum on Aging-Related Statistics

sponsored by the National Institute on Aging of the National

InstitutesofHealth.Preparationofthisreportwasa cooperative

~ctivitybehvwntheNationalCenter for Health Statistics and the

School of Public Health of the University of Illinois at Chicago

through the Association of Schools of Public Health.

members of the advisory group were:

American Association of Retired Persons

Brookings Institution

Congressional Budget Office

Congressional Research Service

General Accounting Office

Gerontological Society of America

National Council on Aging

National Institute on Aging

Office of Technology Assessment

U.S. Senate Special Committee on Aging

U.S. House of Representatives Select Committee on Aging

The advisory group recommended two different formats for releasing health data on older

Americans: a detailed data report aimed at those

who wanted indepth information for research

and a chartbook aimed at those who wanted

summary information. This is the detailed data

report; the chartbook is also available (2). The

advisory group also recommended:

. development of a pocket edition for both the

detailed data report and the chartbook so

that data highlights could be easily accessed

1
● a separate chapter on long-term care (see

chapter 6)

. a chapter on minority aging (see chapter 9 on

older black Americans)

. a focus on chronic conditions that, although

not generally fatal, result in serious disability

(see chapter 10 on musculoskeletal

conditions).

The report has two innovations compared

with the 1986 edition. The first innovation is the

emphasis on statistical testing of hypotheses.

Because many of the estimates in this report are

based on a sample survey, they may differ somewhat from the figures that would have been

obtained if a complete census had been taken

using the same survey and processing procedures. The validity of hypotheses about sample

survey estimates was evaluated according to statistical protocols described in the appendix. Terms

in the text relating to differences, such as “higher”

and “less,” indicate that the differences are

statistically significant. Terms such as “similar”

or “no difference” mean that no statistically

significant difference exists between the estimates being compared. Generally, statistical tests

performed were two-tailed tests unless the authors had an a priori one-tailed hypothesis. All

comparisons were tested at the 5-percent level

of significance. See the appendix for details.

The second innovation is the availability of a

PC Lotus diskette of all 170 tables in this report.

The diskette was created to assist researchers

and others interested in manipulation and analysis of the data. Users can conduct analyses

based on their own hypotheses, See the appendix of the report for information on how to order

the diskette.

Highlights

This section highlights the significant findings

for each chapter of the report.

Chapter 1: Measures of health. Respondentassessed health status was inversely associated

with age; as age increases, perceptions of health

decrease. Across all age groups and both sexes,

significantly greater numbers of white than black

persons rated their health as excellent or very

good, and significantly greater numbers of black

than white people rated their health as fair or

poor. Respondent-assessed health status was also

clearly related to difficulties in both activities of

daily living (ADL’s) and instrumental activities

of daily living (IADL’s), such that as the number

of ADL’s or IADL’s causing difficulty increased,

perceptions of health decreased. Difficulties in

both ADL’s and IADL’s were also related to sex

and advanced age.

Acute and chronic conditions, as well as

impairments, may affect perceptions of health,

Among older persons, respiratory illnesses were

a frequently reported acute condition, hypertension was one of the most common chronic conditions, and hearing impairments were frequently

reported. In persons 65 years of age and over,

females reported significantly lower rates of ischemic heart disease than did men, but higher

rates of hypertension.

Chapter 2: Functional status and living arrangements, Most adults, aged 65 years and

over, reported no difficulty with either ADL’s or

IADL’s, and two-thirds of the total older population reported no difficulties with any of the

ADL’s or IADL’s. Significantly more adults in

the group aged 65–74 reported being free of

ADL difficulties than did those in the 75-andover group. All other races were less likely than

whites, and females were less likely than males

to report having no basic ADL or IADL

difficulties.

More than 30 percent of those 65 years and

over and residing in the community lived alone,

and more than one-half of those 85 and over

lived alone (52 percent). For the group aged

65-74, there were no significant differences by

2
living arrangement in the percent of men and

women who had no ADL difficulties. However,

older women (75 years and over) who lived

alone were more likely to report having no ADL

difficulties than were women of the same age

group who lived with others. There were no

significant differences by living arrangement for

males aged 75 years and over who reported no

basic ADL difficulties.

Chapter 3: Changes in functional status and

risk of institutionalization and death. The presence of two or more limitations in basic ADL’s

and IADL’s was associated with risk of death

and nursing home residence. Within each ADL

limitation, those 80 years and over had lower

proportions of persons who maintained independence over the 2-year period. When the level of

individual changes in functional limitations was

assessed, there were no sex differences in either

rates of decline or rates of improvement for all

limitations, except for difficulty lifting 25 pounds.

Chapter 4: Mortality. In 1986, 71 percent of

the deaths occurred in people 65 years of age

and over. This was in contrast to 1960, when the

corresponding percentage was 59. From 1960 to

1986, age-specific death rates for males were

higher than for females for both black and white

people, In 1986, life expectancy at birth was 74.8

years. Life expectancy for females was 7 years

longer than for males, and life expectancy for

white persons was 6 years longer than for black

persons. From 1960 to 1989, life expectancy at

age 65 was highest for white females, followed

by black females, white males, and black males.

In 1989, life expectancy at age 85 showed a

crossover in that for each sex, it was higher for

black than for white people. This crossover also

occurred in 1960 and 1970.

The three leading causes of death for this

population included diseases of the heart,

malignant neoplasms, and cerebrovascular disease. Death rates for diseases of the heart and

cerebrovascular disease declined in virtually all

of the race–sex groups during the 1980’s, while

death rates for malignant neoplasms increased.

Most of the increase in deaths from malignant

neoplasms was the result of substantial increases

in lung cancer death rates.

Chapter 5: Acute care. An estimated 130.5

million office visits were made to nonfederally

employed office-based physicians in the United

States from 1985 to 1986 by persons 65 years of

age and over (21 percent of all visits). The

number of visits to office-based physicians increased by 60.6 million from 1980 to 1985 for the

older population. In 1987, 31 percent of discharges and 42 percent of hospital days were

reported for older patients treated in short-stay

non-Federal hospitals in the United States. Additionally, the hospital discharge rate increased

from 1970 until 1983, when the prospective payment system was introduced. From 1983 to 1987,

the total discharge rate decreased 17 percent,

with the rate of decrease being less for older

persons than for persons under 65 years of age.

The average length of stay decreased from 1965

to 1987 by 4.4 days for patients 65 years of age

and over.

The discharge rate for persons diagnosed

with malignant neoplasms decreased for both

males and females 65 years of age and over from

1981 to 1987. The discharge rate for persons

with pneumonia increased for males 65 years of

age and over as a group. There were substantial

declines from 1981 to 1987 in average length of

stay for some of the diagnoses.

Persons 65 years of age and over who rated

their health as fair or poor had a greater number

of physician visits than those who rated their

health as good or excellent. Health status, more

than increasing age, appeared to dictate the

need for physician service. Essential hypertension was the most common diagnosis rendered

by office-based physicians for older patients. In

conjunction with this, the most frequent diagnostic procedure was the blood pressure check. For

3
hospitalized older persons, the most frequently

listed diagnosis was diseases of the heart.

Variation in hospital discharge disposition

was evident over time and within age and sex.

More females than males were discharged to

long-term care facilities, and older patients were

more likely to be discharged to long-term care

than were younger patients,

Chapter 6: Selected issues in long-term care:

Profile of cognitive disability of nursing home

residents and the use of informal and formal

care by elderly in the community. For every

1,000 nursing home residents, 674 had at least

one cognitive disability. The most prevalent cognitive disability was organic brain syndromes;

females had higher rates than males. In comparison to nursing home residents without cognitive

disabilities, those with Alzheimer’s disease, organic brain syndromes, anxiety, and depression

had significantly higher proportions who required help with five to seven ADL’s. Residents

with schizophrenia and alcohol and drug abuse,

in contrast, had significantly lower proportions

who required help. For most who were cognitively disabled, Medicaid was the major primary

source of payment. In contrast, own income or

family support was the major primary source for

those with Alzheim.er’s disease and with no

cognitive disability,

Among community-living functionally impaired Medicare-eligible persons 65 years of age

and over (frail elderly), physician office care and

hospitalization were frequently used health services, at 39 and 34 percent, respectively. White

people were more likely to be hospitalized than

people of all other races, and women were more

likely to use auxiliary health services than

A smaller proportion of those 85 and over

physician office care and hospitalization

those 65–74 years of age. Use of health

services was to some extent dependent on

of ADL disability.

men.

used

than

care

level

In 1982, persons of all other races, those 85

years of age and over, and persons receiving help

with three to five ADL’s were significantly more

likely to have more than one informal helper

than were white people, elderly persons in

younger age groups, and elderly persons with

less ADL dependency. The number of informal

helpers a frail elder had was associated with

subsequent mortality. A trend of increasing mortality rates with increasing number of helpers

was evident for males but not females, In contrast to the association seen with mortality, there

was no trend evident between institutionalization rates and number of informal helpers,

Chapter 7: Patterns of drug prescribing. For

67 percent of office visits by persons 55 years of

age and over, a therapy involving drug treatment

was mentioned. For all age groups, between 67

and 75 percent of all medications reported were

a continuation of existing therapy. Cardiovascular agents dominated prescribing patterns, representing 8 of the 10 most frequently mentioned

medications. Two analgesics, aspirin and acetaminophen, accounted for the remaining two most

frequently mentioned medications.

Chapter 8: Costs of health care and sources

of payment. Health care spending for the older

population totaled $162 billion in 1987. Total

enrollment in the Medicare program in 1986 was

29 million; Medicare served 732 persons per

1,000 enrollees. Nearly two-thirds of the population 70 years of age and over have some private

health insurance in addition to Medicare.

Medicare was the expected principal source

of pay’ment for 93 percent of hospital discharges

for the population 65 years of age and over. The

primary sources of payment for nursing home

care were Medicaid and the patient’s own income. When all sources are considered, Medicare was the expected source of payment for

more than 70 percent of the older population

for visits to office-based physicians.
Chapter 9: Health of older black Americans.

Fewer black Americans aged 65 and over rate

their health as excellent or very good, compared

with their white counterparts. More older black

Americans rate their health as fair or poor. For

black males and females, significantly more of

those reporting excellent or very good health

reported no ADL difficulties, compared with

those reporting fair or poor health. Fewer elderly black females reported no ADL difficulties

than their white counterparts; however, this difference by race did not hold for males.

Among black persons aged 70 and over,

those aged 70–79 were more likely to show

2-year improvement in functional status than

those aged 80 years and over. Of the population

aged 70 and over, a smaller proportion of black

Americans was able to maintain independence

in ADL’s and IADL’s over a 2-year period than

were white Americans. Of the population aged

70 and over reporting some ADL and some

IADL difficulties in 1984, black persons experienced lower 2-year mortality than white persons.

Average length of stay in short-stay hospitals

for diagnoses of pneumonia/influenza decreased

significantly for elderly black persons between

1981 and 1987. In 1981, elderly black persons

had a longer average length of stay than their

white counterparts, but there was no difference

in 19S7, A higher proportion of black elders

received Medicaid benefits in 1984 than did

their white counterparts. However, of those receiving Medicaid benefits in 1984, a greater

proportion of white elders than black elders

continued to receive benefits in 1986.

Chapter 10: Musculoskeletal disorders: Time

trends, comorbid conditions, self-assessed health

status, and associated activity limitations. The

most prevalent of chronic conditions among older

persons are skeletal disorders such as osteoarthritis, osteoporosis, and chronic low back pain.

Among persons 55 years of age and over with

arthritis, 48 percent also reported hypertension.

Ability to walk was most commonly limited,

particularly among those 85 and over (46 percent). Starting with a cohort aged 55–59 years,

increased pain and diagnosis prevalence was

observed over a 25-year period.

Chapter 11: International aging. Crossnational comparisons of age-specific life expectancy, causes of death, and mortality rates can

provide clues to the development of public health

promotion efforts that capitalize on the experiences of other countries. For all countries examined, female life expectancy at age 65 exceeded

male life expectancy by at least 1.4 years. In

most countries, the proportionate contribution

to all deaths made by persons 65 and over was

well in excess of their representation in the

population. There was considerable variation in

mortality risk with age across the listed countries, however, the contribution to overall mortality from heart disease, cancer, and stroke was

consistently more than 50 percent in all countries studied.

Appendix: The average annual growth rate

for the segment of the population 65 years and

over for the decade of the 1980’s was 2.2 percent, more than twice the corresponding rate for

the total population. Included in the expansion

of the older population is a disproportionate

increase in the oldest-old, those 85 years of age

and over. During the decade of the 1980’s, the

average annual growth rate of this group was

3.5 percent.

References

1<

2.

Havlik RJ et al. Health Statistics on Older Persons: United States, 1986. National Center for

Health Statistics. Vital Health Stat 3(25). 1987.

Cohen RA, Van Nostrand JF, Furrier SE. Chartbook of Health Data on Older Americans: United

States, 1992. National Center for Health Statistics. Vital Health Stat 3(29). 1993.

5
Part II

Health status
Measures of health

by Robin Mermelstein, Ph. D., Baila Miller,

Ph. D., and Thomas Prohaska, Ph. D.,

University of Illinois at Chicago; Veronica

Benson, and Joan F. Van Nostrand, M.P.A.,

National Center for Health Statistics

Introduction

There are a variety of ways of measuring

health status, including the presence of disease,

functional limitations, and general health perceptions, This chapter examines factors that may

contribute to or vary with the elderly’s perceptions of health and also presents data on selected acute and chronic conditions among the

elderly, Factors considered include both demographics (age, sex, and race) and functional

status (ability to perform everyday personal care

and home-management activities). The different

measures of health often show high intercorrelations (l-3). For example, one might hypothesize

that both acute and chronic conditions could

certainly influence functional limitations and perceived health, and perceived health could, in

turn, influence role functioning and other illness

behaviors, Despite the presence of chronic conditions, however, many older adults may still

respond positively to the question, “Would you

say your health is excellent, very good, good,

fair, or poor?” It is likely that both an individual’s subjective perceptions of his or her health

status and more objective measures, such as

disease states, are important in predicting risk of

hospitalization, institutionalization, or death (4).

This chapter considers measures of health

only among older persons living in the community. Thus, the segment of the older population

The authors wish to acknowledge Richard Suzman, Ph. D.,

National Institute on Aging, National Institutes of Health, for his

helpful comments on the manuscript.

with the poorest health —those in nursing homes

or long-term hospitals —is not included. Because

institutionalized older adults are likely to have

more chronic conditions and functional limitations than those residing in the community, the

figures reported in this chapter are an underestimate of the prevalence of these conditions in

the total older population.

This is especially true of the segment of the

population aged 85 and over. In 1985, approximately 22 percent of the population aged 85 and

over resided in long-term care facilities (5).

Therefore, comparisons of the noninstitutionalized population aged 85 years and over with

younger age groups must be interpreted with

great caution.

Sources of data

The two sources of data for this chapter are

the health status and demographic components

of the National Health Interview Survey (NHIS)

(1985-87) and the 1986 Functional Limitations

Supplement of the NHIS. The NHIS is a continuing nationwide survey based on household

interviews of the civilian noninstitutionalized population of the United States. By combining data

from several years of the survey, sufficient sample size is available to consider health conditions

in race, sex, and age subgroups. Also, because of

the recurrent nature of the survey, trend analysis

is possible. In this chapter, age-specific prevalence rates are shown for ischemic heart disease,

hypertension, and diabetes for 1979-81,1982-84,

and 1985–87.

9
In 1986, the Functional Limitations Supplement of the NHIS focused on activities of daily

living (ADL’s) and instrumental activities of

daily living (IADL’s) for the population 65 years

of age and over. The 1986 NHIS is the most

recent one to collect detailed information on

ADL’s and IADL’s of the entire elderly population living in the community. The ADL’s covered in the supplement were seven personal care

activities: eating, toileting, dressing, bathing, walking, getting in and out of a bed or chair (transferring), and getting outside. IADL’s covered in

the supplement were six home-management activities: preparing meals, shopping for personal

items, managing money, using the telephone,

doing heavy housework, and doing light housework. Respondents were considered to have

difficulty with either an ADL or an IADL if they

answered “yes” to the question, “Because of a

health or physical problem, do you have any

difficulty in performing the activity?” In some

cases, proxies responded to the question.

Results and comments

Health assessment

Respondent-assessed general health is one

of the simplest but also one of the most informative measures of health, given its association

with objective health status, such as physical

exams and physician ratings (6), mortality (4),

and life satisfaction. It was hypothesized that

respondent-assessed health status would show

an inverse relationship with age, such that as age

increases, the level of assessed health decreases.

The data support this hypothesis. About onethird (33 percent) of the population aged 65

years and over rated their health as good, and

this proportion remained stable with increasing

age (table 1). However, the proportion of older

adults who rated their health as excellent declined from ages 55–59, when almost onequarter (24 percent) of the respondents rated

their health as excellent, through the age group

60–64 years, when only 20 percent rated their

health as excellent, and stabilized at approximately 18 percent for the age groups over 60-64

years, The proportion of older adults who rated

their health as only fair or poor increased significantly at two points:

. after ages 55–59, when 20 percent of respondents rated their health as fair or poor,

compared with 25 percent of respondents

aged 60–64

. after ages 70–74, when 30 percent of respondents rated their health as fair or poor,

compared with 34 percent of those aged

75-79.

When race-specific responses were investigated, significant differences in self-assessed

health emerged between black and white people.

Across all age groups and both sexes, significantly greater numbers of white than black persons rated their health as excellent or very good,

while significantly greater numbers of black than

white persons rated their health as fair or poor,

Health assessment and functional

limitations

It was also hypothesized that respondentassessed health status would be clearly related to

difficulties in both ADL’s (table 2) and IADL’s

(table 3), such that as the number of ADL’s or

IADL’s causing difficulty increases, perceptions

of health decrease. Respondents who reported

that they did not do an ADL were counted with

those who reported difficulty in performing the

activity (table 2). Given that ADL’s are necessities, not doing one most likely means that an

individual is unable to do so, However, for

IADL’s, respondents who reported not doing an

activity were counted as not having difficulty

(table 3). Unlike the ADL’s, IADL’s are not

necessities of life and may not be done for a

variety of reasons (e.g., role socialization) other

than disability.

10
AS expected, self-ratings of health were related to reported difficulties in performing ADL’s

and IADL’s (tables 2 and 3). Across all age

groups, and for each sex, a significantly greater

percentage of respondents who rated their health

as at least good reported no difficulties in ADL’s

than did those who rated their health as fair or

poor. Individuals who reported difficulties in

three or more ADL’s or IADL’s were most likely

to rate their health as fair or poor, compared

with good, or with excellent or very good.

Difficulties in ADL’s are also related to age

and sex. As has been found in other national

surveys, problems with ADL’s increase with advancing age. However, specific prevalence rates

of difficulties with ADL’s may vary slightly across

difierent surveys because of methodology differences in classification and selection of ADL’s,

wording of questions, or timeframe and methods

used to collect the data (7). Overall, 15 percent

of males 65-69 years had difficulty performing at

least one ADL, By ages 85 and over, 35 percent

of male respondents reported difficulty performing at least one ADL, which was a significant

increase from the age group 65–69 years old.

There was a significant jump in the percentage

of men reporting difficulty in performing three

or more ADL’s between the age groups of 65–69,

when 6 percent reported difficulty with three or

more ADL’s, and 85 and over, when 18 percent

reported difficulty, Women also showed a significant jump in the percentage of respondents

reporting difficulty in performing three or more

ADL’s at two points: between the ages of 70-74

and 75–79, when the percentage reporting difficulty rose from 8 to 15 percent; and between the

ages of 75-79 and 80–84, when the percentage

reporting difficulty with three or more ADL’s

jumped from 15 to 21 percent.

In the age groups 75–79 and 80-84, women

who rated their health as either fair or poor

reported significantly more problems in

performing ADL’s than did men with similar

self-reported health status. For example, in the

75–79 age group, about twice as many women

(33 percent) as men (16 percent) who rated

their health as fair or poor reported difficulty in

performing three or more ADL’s, and significantly fewer women than men reported no difficulties in ADL’s. Thus, in these age groups,

women who rated their health as less than good

reported more difficulties performing everyday

personal care tasks than did men with similar

self-assessed ratings of health.

Similar age and sex differences can be found

with IADL’s (table 3). For men aged 65–69

years, 15 percent reported difficulty in performing at least one IADL, and 4 percent reported

difficulty in performing three or more. For men

aged 85 years and over, however, these rates

increased significantly, to 43 percent reporting

difficulty in performing at least one IADL, and

24 percent reporting difficulty in performing three

or more. At every age group, significantly more

women than men reported difficulty in performing IADL’s. For example, in the group aged

65–69 years, 24 percent of the women reported

difficulty with at least one IADL (compared with

15 percent of the men), and in the group aged

85 years and over, 64 percent reported difficulty

with at least one IADL (compared with 43 percent of the men). The same pattern held true in

the age groups 70–74, 75–79, and 80–85 for those

reporting difficulty with three or more IADL’s.

By the age of 80-84 years, 21 percent of the

women reported difficulty with three or more

IADL’s (versus 10 percent of the men). These

sex differences may not, however, be the result

of true functional differences between men and

women. Rather, they may be the result of differences in role socialization (with men typically

performing fewer IADL’s than women and thus

men’s reports of difficulty may be underestimates), or the result of an age bias within each

age grouping (on average, within any given age

group, women have higher mean ages than men).

11
The differences may also be the result of the

analytic decision to count those who reported

that they did not do an IADL as not having

difficulty.

Acute conditions

The incidence of acute conditions (table 4),

based on respondents’ reports of illnesses occurring during the 2 weeks prior to the week of the

interview, tended to remain stable with age, with

the exception of respiratory illnesses. The group

aged 55–64 years reported more respiratory infections than the age groups of 75-84 and 85 and

over. Respiratory illnesses were the most frequently reported acute condition, followed by

the group “other” acute conditions (which included eye conditions; ear conditions; urinary

tract infections; skin conditions; acute back, spine,

and neck pain; other musculoskeletal conditions;

headache, excluding migraine; and all other acute

conditions), injuries, and lastly, digestive conditions. Because the category “other” acute conditions comprises many more diverse conditions

than do the more specific categories of respiratory illnesses, injuries, and digestive conditions,

comparisons with it need to be interpreted with

caution.

Impairments

The rates of reported visual impairment and

cataract appeared higher with increasing age

and varied by sex and race (table 5). The category of visual impairment includes blindness in ,

both eyes and other problems with seeing. The

rates of cataract, but not visual impairment,

increased significantly in the group aged 65–74

years, compared with those 55–64 years of age,

and again in the group aged 75–84 years, compared with those aged 65-74 years. After age 65,

white women had significant \y higher rates of

cataract than did white men. There were no

significant sex differences for visual impairment.

The category of hearing impairment (table 5) includes deafness in both ears and other

hearing impairments. Hearing impairments were

the most common type of impairment among the

elderly, with 383 per 1,000 of those 65 years and

over reporting some hearing impairment, and

approximately one-half (530 per 1,000) of the

respondents aged 85 and over reporting a hearing impairment. White males reported significantly higher rates of hearing impairment than

did white women in all age groups, but this sex

difference did not hold true for black persons.

Despite some seemingly apparent differences

between black and white males, there was no

significant difference in rates of reported hearing impairment between either black and white

males or black and white females.

Among white females, there was an increase

in deformities or orthopedic impairments with

age (table 5), but this was not true for white or

black males or for black females, For white

females, the reported rates of orthopedic impairment increased from 164 per 1,000 in the group

aged 55-64 years to 231 per 1,000 for those 65

years and over.

Chronic conditions

The reported rates of both ischemic heart

disease and hypertension in 1985-87 showed

significant increases from the group aged 55–64

years to those 65–74 years of age (table 6). After

age 65, however, there was no significant difference in reported rates of ischemic heart disease

for men, but there continued to be an increase

in the rates for women by age group, Women

aged 75 years and over reported significantly

higher rates of ischemic heart disease than did

those 65–74 years of age. Except for the youngest age group (55–64), for which there was no

sex difference, women reported significantly lower

rates of ischemic heart disease than did men.

Unlike the sex pattern shown with ischemic

heart disease, women reported significantly higher

rates of hypertension than men in every age

group except the youngest (55–64), for which, as

for ischemic heart disease, there was no sex

12
difference. Overall, hypertension was one of the

most common chronic conditions among the

elderly, with almost 40 percent of those 65 years

and over reporting being hypertensive.

As with the chronic cardiovascular conditicms, the reported rates of diabetes increased

significantly from the group aged 55–64 years to

the group aged 65–74 years. Unlike the cardiovascular diseases, however, there were no significant sex differences in the reported rates of

diabetes.

Trends

The increase of ischemic heart disease prevalence that has occurred since the mid-1960’s

may be attributed to the decrease in rates of

ischemic heart disease mortality. This would

occur if the case-fatality rate were dropping in

the absence of a change in incidence. For the

age group 65 years and over, shown in table 6,

the reported rates of ischemic heart disease

increased from 1979–81 to 1985–87. This increase is primarily the result of a significant

increase in rates among males aged 65 and over

between 1979–81 and 1985–87. There was no

significant increase for females aged 65 and

over. It is possible that more diagnostic studies

have been done in recent years, resulting in an

increase in the number of cases being diagnosed,

The rates of hypertension for both men and

women did not change significantly from 1979–81

to 19S5-87. Throughout all these years, there

was an increase in screening and public awareness of the disease (8).

Finally, the reported rates of diabetes increased significantly for the total population

aged 65 or over from 1979-81 to 1985–87. However, the increase was significant only for men.

An increase in reported prevalence may reflect a

decrease in mortality from the disease or an

increase in public awareness and detection, or

both.

References

1.

2.

3.

4.

5.

6.

7.

8.

Stewart AL, Ware JE, Brook RH. Construction

and scoring of aggregate functional status measures, vol 1. Contract No. R-2551-1 -HHS. Santa

Monica, California: The Rand Corporation. 1982.

Ware J, Davies-Avery A, Donald C. Conceptualization and measurement of health for adults in

the health insurance study: Vol V general health

perceptions. Contract No. R-1987/5-HEW. Santa

Monica, California: The Rand Corporation. 1978.

Ware J, Karmos A. Development and validation

of scales to measure perceived health and patient role propensity: Vol 11 of a final report.

Carbondale, Illinois: Southern Illinois University

School of Medicine. 1976.

Kaplan G, Barell V, Lusky A. Subjective state of

health and survival in elderly adults. J Gerontol

43:S114-20. 1988.

National Center for Health Statistics. Health,

United States, 1988. Hyattsville, Maryland: Public Health Service. 1989.

LaRue A, Bank B, Jarvik L, Hetland M. Health

in old age: How do physicians’ ratings and selfratings compare? J Gerontol 34:687–91. 1979.

Wiener JM, Hanley RJ, Clark R, Van Nostrand

JF. Measuring the activities of daily living: Comparisons across national surveys. J Gerontol

45(6) :S229-37. 1990.

National High Blood Pressure Education Program. The 1988 report of the Joint National

Committee on Detection, Evaluation, and Treatment of High Blood Pressure. Bethesda, Maryland: U.S. Department of Health and Human

Services, National Heart, Lung, and Blood Institute. May 1988.

13
Table 1. Average annual percent distribution of persons 55 years of age and over by

respondent-assessed health status, according to sex, race, and age: United States, 1985-87

[Data are based on household interviews of the civilian noninstitutionalized population]

Respondent-assessed health statusl

Very

Sex, race, and age Total Excellent good Good Fair Poor

Total 2

55–59 years . . . . . . . . . . . . . . . . . . .

60-64 years . . . . . . . . . . . . . . . . . . .

65–69 years . . . . . . . . . . . . . . . . . . .

70–74 years . . . . . . . . . . . . . . . . . . .

75–79 years . . . . . . . . . . . . . . . . . . .

80–84 years. . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . .

65–74 years....,.........,.. ,.

75–84 years . . . . . . . . . . . . . . . . . . .

65 years And over. . . . . . . . . . . . . .

75 years And over. .,, ,, . . . . . . . .

85 years and over . . . . . . . . . . . . . .

White male

55–64 years . . . . . . . . . . . . . . . . . . .

65–74 years . . . . . . . . . . . . . . . . . . .

75–84 years. . . . . . . . . . . . . . . . . . .

65 years and over, . . . . . . . . . . . .,

75 years And over . . . . . . . . . . . . . .

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

Black male

55–64 years......,....,,,,.. . .

65 years and over, . . . . . . . . . . . . .

White female

55–64 years . . . . . . . . . . . . . . . . . . .

65–74 years . . . . . . . . . . . . . . . . . ,.

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

65 years And over . . . . . . . . . . . . . .

75 years And over . . . . . . . . . . . . . .

85 years and over. . . . . . . . . . . . . .

Black female

55–64 years.......,,.,.,.,.. .,

65 years and over. . . . . . . . . . . . . .

Numberof

persons in

thousands Percent distribution 3

11,105

10,779

9,456

7,444

5,312

3,161

21,884

16,900

8,473

27,405

10,505

2,032

9,144

6,721

2,868

10,201

3,480

612

929

921

10,227

8,470

4,794

14,509

6,038

1,244

1,141

1,372

24.3

19.8

17.8

16.0

14.0

13.9

22.1

17.0

14.0

15.9

14.2

14.9

24.7

18.3

14.3

17.0

14.5

15.6

16.1

10.6

21.6

17,1

14.6

16.1

14.7

15,0

10.7

8.6

24.9

23.5

21.3

21.2

19.7

19,2

24.2

21.3

19.6

20.7

19.7

20.2

25.2

21.5

19.6

20.8

19.5

19.0

16.8

16.2

24.8

21.9

20.2

21.3

20.3

21.0

17.5

16.9

30.5

32.2

33.9

32.8

32.4

31.7

31.3

33,4

32.1

32.8

31,8

30.4

29.5

32.5

32.4

32.4

32.4

32.0

28.6

28.5

33.1

35.0

32.7

33.8

32.2

30.2

30.2

27.6

13.3

16.0

18.9

20,9

23.0

23.3

14.6

19.8

23.1

20.9

22.8

21.5

12.7

19.1

21,9

20.0

21.7

20,3

23.6

27.7

14.1

18.9

22.6

20.3

22.3

21.2

27.1

29.4

7,0

8.6

8.2

9.0

11.0

1240

7,8

8.5

11,3

9.7

11.7

13.0

7,9

8.7

11.8

9,8

12.0

13.1

14.9

17.0

6.4

7.1

10.0

8.5

10.6

12,6

14,5

17.5

‘Excludes unknown respondent-assessed health status.

‘Includes races otherthan white and black.

3Maynotaddto 100 percent because ofrounding.

SOURCE: National Centerfor Health Statistics: Datafrom the National Health Interview Survey.

14
Table 2. Percent distribution of persons 65 years of age and over by number of activities of daily

living for which difficulty was reported, according to sex, age, and respondent-assessed health

status: United States, 1986

[Data are based on household interviews of the civilian noninstitutionalized population]

Number of activities of daily living causing difficulty

Sex, age, and respondentassessed hea/th status’ Total None 1 2 3 or more

Male, 65-69 years

All health statuses, . . . . . . . . . . . . .

Excellent and very good. . . . . . . . .

Good, .,, . . . . . . . . . . . . . . . . . . . .

Fair and poor, .,, . . . . . . . . . . . .

Male, 70–74 years

Allhealt hstatuses . . . . . . . . . . . . .

Excellent and very good. , . . . . . . .

Good, . . . . . . . . . . . . . . . . . . . . . . .

Fair and poor . . . . . . . . . . . . . . . . .

Male, 75–79 years

All health statuses, . . . . . . . . . . . . .

Excellentand very good . . . . . . . . .

Good . . . . . . . . . . . . . . . . . . . . . . . .

Falrand poor . . . . . . . . . . . . . . . . .

Male, 80–84 years

All health statuses . . . . . . . . . . . . . .

Excellent and very good . . . . . . . . .

Good . . . . . . . . . . . . . . . . . . . . . . . .

Fair and poor . . . . . . . . . . . . . . . . .

Male, 85 years and over

Al lhealthstatuses . . . . . . . . . . . . .

Excellent and very good . . . . . . . . .

Good, .,, , . . . . . . . . . . . . . . . . . . .

Fair and poor . . . . . . . . . . . . . . . . .

Female, 65–69 years

All health statuses, . . . . . . . . . . . . .

Excellent and very good . . . . . . . . .

Good . . . . . . . . . . . . . . . . . . . . . . .

Fair and poor,,..,..,,,,,,.,,.

Female, 70–74 years

Al lhealthstatuses . . . . . . . . . . . . .

ExceHent and very good . . . . . . . . .

Good . . . . . . . . . . . . . . . . . . . . . . . .

Fair and poor . . . . . . . . . . . . . . . . .

Numberof

personsin

thousands2 Percent distribution

4,092

1,615

1,392

1,085

3,223

1,313

1,007

904

2,115

724

666

724

1,081

341

379

362

587

241

178

168

5,095

1,935

1,757

1,403

4,169

1,516

1,481

1,172

85.0

96.0

92.3

59.3

84.7

94.8

89.2

65.1

80.5

94.0

85.8

62.1

74.6

88.1

80.8

55.4

64.6

77.6

70.5

39.9

84.3

96.4

90.4

59.9

78.8

92.0

85.5

53.3

5.3

*1.5

3.4

13.5

7.6

3.0

4.6

17.8

9.4

*4.4

8.7

15.1

11.8

*5.6

11.6

18.0

11.7

*9.4

*9.8

*17.2

6.1

2.4

4.9

12.7

8.7

5.0

5.8

17.0

3.5

*1.7

*1.O

9.2

3.1

*0.6

*3,5

6.2

3.7

*1.O

*3.3

*6.8

*2.4

*2.2

*1 .0

*4.2

5.9

*2.1

*7.2

*1 0.0

3,5

*0.9

*1 .9

9.2

4.7

*1.8

4.3

8.7

6.2

*0.7

3.3

18.1

4.6

*1.6

*2.7

10.9

6.4

*0.6

*2.2

16.0

11.1

*4.2

*6.7

22.4

17.8

*10.9

*12.6

33.0

6.1

*0.4

*2.7

18,2

7.9

*1.3

4.3

20.9

15
Table 2. Percent distribution of persons 65 years of age and over by number of activities of daily

living for which difficulty was reported, according to sex, age, and respondent-assessed health

status: United States, 1986-Con.

[Data are based on household interviews of the civilian noninstitutionalized population]

Number of activities of daily living causing difficulty

Sex, age, and respondentassessed hea/th status’ Total None 1 2 3 or more

Female, 75–79 years

Number of

persons in

thousands2 Percent distribution

All health statuses, . . . . . . . . . . . . .

Excellent and very good. . . . . . . . .

Good . . . . . . . . . . . . . . . . . . . . . . . .

Fair and poor . . . . . . . . . . . . . . . . .

Female, 80–84 years

All health statuses . . . . . . . . . . . . . .

Excellent and very good. . . . . . . . .

Good . . . . . . . . . . . . . . . . . . . . . . . .

Fair and poor . . . . . . . . . . . . . . . . .

Female, 85years andover

All health statuses . . . . . . . . . . . . . .

Excellentand very good. ..,,..,,

Good . . . . . . . . . . . . . . . . . . . . . . . .

Fair and Door, . . . . . . . . . . . . . . . .

3,147

1,083

1,018

1,047

2,037

703

649

685

1,351

492

384

475

70.3 9.1 5.5 15.1

87.1 4.5 *3.6 *4.8

77.0 11.5 4.0 7.4

46.5 11.5 8.9 33.1

60.3 10.4 8.8 20.5

80.8 5.4 7.1 *6.7

64.7 10.4 9.2 15,7

35.1 15.6 10.0 39.3

51.6 12.0 9.2 27.2

70.3 13.2 9.8 6.8

49.4 14.5 13.5 22.6

34.1 8.6 5.2 52.1

‘Excludes unknown respondent-assessed health status,

2Excludes those forwhom information wasmissing onallactivities ofdaily living (ADL’s),

3Maynot addto 100 percent because of rounding.

NOTES: Persons reported as not performing an ADLwere classified withthose reported as having difficulty with thatADL. ADL’s

include eating, toileting, dressing, bathing, walking, getting inandout ofabedorchair, and getting outside.

SOURCE: National Center for Health Statistics: Data from the National Health lntewiew Suwey1986Functional Imitations

Supplement.

16
Table 3. Percent distribution of persons 65 years of age and over by number of instrumental

activities of daily living for which difficulty was reported, according to sex, age, and respondentassessed health status: United States, 1986

[Data are based on household interviews of the civilian noninstitutionalized population]

Number of IADL’s causing difficulty

Sex, age, and respondentassessed hea/th statusl Total None 1 2 3 or more

Male, 65–69 years

All health statuses, . . . . . . . . . . . . .

Excellent and very good. . . . . . . . .

Good . . . . . . . . . . . . . . . . . . . . . . . .

Fair and poor . . . . . . . . . . . . . . . . .

Male, 70–74 years

All health statuses .,, ,, .,.......

Excellent and very good. . . . . . . . .

Good . . . . . . . . . . . . . . . . . . . . . . . .

Fair and poor, . . . . . . . . . . . . . . . .

Male, 75–79 years

Allhealt hstatuses . . . . . . . . . . . . .

Excellent and very good. . . . . . . . .

Good . . . . . . . . . . . . . . . . . . . . . . . .

Fair and poor . . . . . . . . . . . . . . . . .

Male, 80-84 years

All health statuses . . . . . . . . . . . . . .

Excellent and very good. . . . . . , . .

Good . . . . . . . . . . . . . . . . . . . . . . . .

Fair and poor, . . . . . . . . . . . . . . . .

Male, 85 years and over

All health statuses . . . . . . . . . . . . . .

Excellent and very good. . . . . . . . .

Good . . . . . . . . . . . . . . . . . . . . . . . .

Falrand poor.,.,,,..,.....,..

Female, 65-69 years

All health statuses . . . . . . . . . . . . . .

Excellent and very good . . . . . . . . .

Good . . . . . . . . . . . . . . . . . . . . . . . .

Falrand poor .,, ,, .,, .,.......

Female, 70–74years

AHhealth statuses, . . . . . . . . . . . . .

ExceHent and very good . . . . . . . . .

Good . . . . . . . . . . . . . . . . . . . . . . . .

Fair and poor . . . . . . . . . . . . . . . . .

Numberof

personsin

thousands2 Percent distribution

4,083

1,615

1,386

1,081

3,223

1,313

1,007

904

2,111

724

666

720

1,074

338

379

358

584

241

178

165

5,061

1,920

1,738

1,403

4,145

1,510

1,466

1,168

85.1

96.3

91.8

59.9

85.3

96.3

90.4

63.5

78.9

93.1

88.6

55.8

74.3

84.6

77.0

61.7

57,0

75.0

56.1

31.8

75.9

92.7

80.8

47.0

71.2

86.6

77.9

43.0

8.1

2.5

*4.6

20.8

9.0

*2.7

6.3

21.1

10.7

*4.7

7.9

19.2

12.7

*9.1

*11.5

17.2

15.0

11.4

*21 .1

*13.7

14.2

5.8

15.2

24.6

18.2

10.6

15.3

31.6

3.1

*0.9

*2.O

7.9

2.2

*0.7

*0.8

5.8

4.7

*2.3

*2.8

*8.9

3.5

*2.2

*5.7

*2.4

*4.4

*2.8

*4.2

*6.9

4.1

*1 .0

*2. O

10.9

3.5

*1 .0

*2.9

7.5

3.7

*0.2

*1.7

11.5

3.6

*0.3

*2.4

9.6

5.7

0.0

*0.7

16.1

9.6

*4. 1

*5.8

18.7

23.6

*10.8

18.5

47.7

5.7

*0.5

*2.O

17.5

7.1

1.8

3.9

18.0

17
Table 3. Percent distribution of persons 65 years of age and over by number of instrumental

activities of daily living for which difficulty was reported, according to sex, age, and respondentassessed health status: United States, 1986– Con.

[Data are based on household interviews of the civilian noninstitutionalized population]

Number of IADL’s causing difficulty

Sex, age, and respondentassessed health statusi Total None 1 2 3 or more

Female, 75-79 years

Number of

persons in

thousands2 Percent distribution

All health statuses . . . . . . . . . . . . . .

Excellent and very good. . . . . . . . .

Good . . . . . . . . . . . . . . . . . . . . . . . .

Fairand poor . . . . . . . . . . . . . . . . .

3,140

1,079

1,014

1,047

61.8 18.0 6.2 14.1

81.8 11.9 *3.7 *2.6

74.1 16.2 *3.1 6.6

29.1 25.9 11,8 33.2

Female, 80-84 years

All health statuses . . . . . . . . . . . . . .

Excellent and very good. . . . . . . . .

Good . . . . . . . . . . . . . . . . . . . . . . . .

Fair and poor . . . . . . . . . . . . . . . . .

Female, 85 years and over

All health statuses . . . . . . . . . . . . . .

Excellent and very good. . . . . . ., .

Good . . . . . . . . . . . . . . . . . . . . . . . .

Fair and poor . . . . . . . . . . . . . . . . .

2,029

699

649

681

1,343

488

384

471

50.8 17.8 10.8 20.7

71.2 16.6 7,3 *4.9

59.8 16.5 10.3 13.3

21.3 20.1 14.7 43.9

35.8 21.3 10.3 32.6

56.6 26.0 *7,0 10.4

3784 20.6 10.5 31.5

12.9 17.1 13.4 56.5

‘Excludes unknown respondent-assessed health status.

2Excludes those forwhom information wasmissing on all IADL’s.

3May not add to 100 percent because of rounding.

NOTES: Persons reported as not performing an instrumental activity of daily living (IADL) were not classified with those reported

as having difficulty with that IADL. IADL’s include meal preparation, shopping, managing money, using the telephone, light

housework, and heavy housework.

SOURCE: National Center for Health Statistics: Data from the National Health Interview Survey 1986 Functional Limitations

Supplement.

18
Table 4. Average annual number of selected reported acute conditions per 1,000 persons 55 years

of age and over, by type of acute condition, race, sex, and age: United States, 1985-87

[Data are based on household interviews of the civilian noninstitutionalized population

Type of acute condtion

Race, sex, and age Respiratory Digestive Injury Other’

Totalz Number per 1,000 persons

55-59 years, . . . . . . . . . . . . . . . . . . 547.9 *12.4 158.0 253.6

60-64 years . . . . . . . . . . . . . . . . . . . 554.5 39.3 198.0 256.7

65–69 years, . . . . . . . . . . . . . . . . . . 487.4 49.1 177.8 241.5

70-74 years . . . . . . . . . . . . . . . . . . . 416.5 48.5 194,6 325.5

75-79 years . . . . . .. n. . . . . . . . . . . 374.6 94.3 222.3 270.4

80-84 years . . . . . . . . . . . . . . . . . . . 454.6 *63.7 203.6 299.3

55-64 years,,.....,........,,. 551.1 25.7 177.7 255.1

65–74 years . . . . . . . . . . . . . . . . . . . 456.1 48.8 185.2 278.6

75–84 years . . . . . . . . . . . . . . . . . . . 404.5 82.9 215.3 281.2

65 years And over . . . . . . . . . . . . . . 426.7 65.0 205.3 299.5

75 years And over . . . . . . . . . . . . . . 379.4 91.0 237.7 333.1

85 years and over . . . . . . . . . . . . . . 275.0 *125.1 331.1 549.2

White male

55-64 years. . . . . . . . . . . . . . . . . . . 501.0 *20.5 198.4 153.8

65-74 years . . . . . . . . . . . . . . . . . . . 432.9 *24.7 139.2 236.3

75-84 years . . . . . . . . . . . . . . . . . . . 364.6 *34.9 144.2 205.6

65 years and over . . . . . . . . . . . . . . 400,0 27.9 144.9 241.7

75 years And over . . . . . . . . . . . . . . 336.5 *34.O 155.9 252.2

85 years And over . . . . . . . . . . . . . . *204.8 *29.7 *21 0.8 469.9

BIack male

55-64 years, . . . . . . . . . . . . . . . . . . 426.4 — *135.3 *266.1

65 years and over, . . . . . . . . . . . . . *153.5 ‘70.8 *173.O ‘203.3

White female

55–64 years, . . . . . . . . . . . . . . . . . . 625.7 29.7 174.7 328.9

65-74 years, . . . . . . . . . . . . . . . . . . 490.8 49.5 234.0 314.5

75-84 years . . . . . . . . . . . . . . . . . . . 437.2 118.9 254.3 339.5

65 years and over . . . . . . . . . . . . . . 460.0 83.0 253.6 348.9

75 years and over . . . . . . . . . . . . . . 416.8 129.8 281,0 397.0

85 years and over . . . . . . . . . . . . . . 338.3 *171.6 384.0 618.7

Black female

55–64 years . . . . . . . . . . . . . . . . . . . 403.6 *62.1 *92.2 319.2

65 vears and over . . . . . . . . . . . . . . 479.0 119.9 *154.8 262.0

llncludesthefollo~in~ conditions: .eye~onditions; ear concjitions; urina~ tract infections; skin conditions; ZICUteback, SpifIt3,Or

neck pain; other musculoskeletal conditions; headache, excluding migraine; and all other acute conditions.

‘Includes races other than white and black.

SOURCE: National Center for Health Statistics: Data from the National Health Interview Survey.

19
Table 5. Average annual number of selected reported impairments per 1,000 persons 55 years of

age and over, by type of impairment, race, sex, and age: United States, 1985–87

[Data are based on household interviews of the civilian noninstitutionalized population]

Type of impairment

Deformity or

Visual Hearing orthopedic

Race, sex, and age impairment’ Cataract impairment 2 impairmen~

Tota14 Number per 1,000 persons

55–59 years . . . . . . . . . . . . . . . . . . . 43.0 21.0 214.1

60–64 years . . . . . . . . . . . . . . . . . . . 59.8 46.5 278.1

65–69 years . . . . . . . . . . . . . . . . . . . 56.4 74.0 335.5

70–74 years . . . . . . . . . . . . . . . . . . . 81.0 130.4 368.8

75–79 years . . . . . . . . . . . . . . . . . . . 113.8 218,2 405.6

80–84 years . . . . . . . . . . . . . . . . . . . 107.6 259.7 425.5

55–64 years. . . . . . . . . . . . . . . . . . . 51.3 33.6 245.7

65–74 years . . . . . . . . . . . . . . . . . . . 69.7 71.1 365.0

75–84 years . . . . . . . . . . . . . . . . . . . 133.9 197.0 697.6

65 years and over . . . . . . . . . . . . . . 89.5 155,7 383.0

75 years And over . . . . . . . . . . . . . . 125.2 246.9 435.7

85 years And over . . . . . . . . . . . . . . 182.6 302.0 530.4

White male

55–64 years. . . . . . . . . . . . . . . . . . . 66.3 27.3 332.2

65–74 years, . . . . . . . . . . . . . . . . . . 84.9 70.2 443.3

75–84 years..,....,..,,,,,.. . . 103.0 161,6 477.7

65 years And over . . . . . . . . . . . . . . 94.4 107.1 465.1

75 years And over, . . . . . . . . . . . . . 112.9 178.3 507,1

85 years and over . . . . . . . . . . . . . . 159.1 256.2 643.9

Black male

55–64 years . . . . . . . . . . . . . . . . . . . 66.8 *32.7 166.7

65 years and over . . . . . . . . . . . . . . 112.9 79.5 307.8

White female

55–64 years, . . . . . . . . . . . . . . . . . . 36.7 38.3 182.5

65–74 years . . . . . . . . . . . . . . . . . . . 52.5 117.4 287.8

75–84 years . . . . . . . . . . . . . . . . . . . 110.8 282.4 395.5

65 years and over . . . . . . . . . . . . . . 85.0 191.4 342.9

75 years And over . . . . . . . . . . . . . . 130.4 294.9 420.0

85 years and over.....,.,,,.. ., 205.8 343.4 514.6

Black female

55–64 years . . . . . . . . . . . . . . . . . . . 52.3 *20.4 *194.1

65 years and over, . . . . . . . . . . . . . 66.7 189.5 240.2

‘Visual impairment includes blindnessin both eyes and other visual impairments.

2Hearing impairment includes deafness in both ears, other hearing impairments, and tinnitus.

3Deformity or orthopedic impairment includes back, upper extremities, and Iower extremities.

41ncludes races otherthan white and black.

SOURCE: National Center for Health Statistics: Data from the National Health Interview Survey.

173.6

184.3

183.7

200.6

225,3

203,9

178,8

220.2

380.8

203,2

222.4

243.8

190.8

159.7

198.5

172,7

197.8

194.3

224,4

125.2

163,5

216.5

242.7

231.4

252.1

288.4

188.5

190.9

20
Table 6. Average annual number of selected reported chronic conditions per 1,000 persons

55 years of age and over, by type of chronic condition, sex, and age: United States, 1979-81,

1982-84, and 1985-87

[Data are based on household interviews of the civilian noninstitutionalized population]

Type of chronic condition

Ischemic heart disease Hypertension Diabetes

Sex and age 1979–81 1982–84 1985–87 1979–81 1982–84 1985–87 1979–81 1982–84 1985–87

Both sexes

55–64 years . . . . . . . . . . . .

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

65 years and over. . . . . . .

75 years and over. . . . . . .

Male

55–64 years . . . . . . . . . . . .

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

65 years and over. . . . . . .

75 years and over. . . . . . .

Female

55–64 years . . . . . . . . . . . .

65–74 years. . . . . . . . . . . .

65 years andover . . . . . . .

75 vears and over. . . . . . .

58.8

105,0

103.7

101.3

77.6

133.9

125.0

106.6

42.1

82.8

88.8

98.2

75.7

115,7

116.2

117.1

107.5

149.9

142.8

128.9

47.9

89.4

97.9

110.4

70.1

114,1

121.5

133.6

98.9

150.7

152.6

156.3

44.7

85.3

99.8

120.4

Number perl,OOO persons

286.4

365.6

376.6

395.8

275.2

305.6

297.3

280.4

296.4

411.7

431.9

463.7

306.5

392.5

393.8

396.1

291.2

335.7

318.6

285.6

320.0

436.0

445.8

460.0

302.7

400.8

392.5

379.3

287.6

359.3

331.1

276.6

316.1

433.4

435.7

438.9

66.1 71.6 76.1

87.7 92.8 99.0

85.9 89.7 99.7

82.8 84.7 100.8

65.3 72.1 79.1

84.8 79.9 101.9

82.8 83.0 102.5

78.6 88.7 103.6

66.9 71.3 73.4

90.0 102.7 96.7

88.1 94.3 97.7

85.3 82.3 99.1

NOTE: These rates are based onunduplicated counts; aperson was counted only once for each condition regardless of the

numberofmentions ofthat condition.

SOURCE: National Center for Health Statistics: Data from the National Health Interview Survey.

21
Chapter 2

Functional status and living

arrangements

by Thomas Prohaska, Ph. D., Robin

Mermelstein, Ph. D., and Baila Miller, Ph. D.,

University of Illinois at Chicago; and Susan

Jack, M.S., National Center for Health

Statistics

Introduction

Functional status is commonly defined in

terms of the ability of an individual to perform

basic and instrumental activities of daily living

(ADL’s, IADL’s). Functional limitation, along

with whether an individual receives assistance

for functional limitation, and living arrangements are important because they serve as key

indicators of an older person’s ability to remain

independent in the community. These factors

have implications for community service delivery

and affect the older adult’s risk of institutionalization (l–3). The ability to perform activities of

daily living also has implications for quality of

life and active life expectancy (4).

This chapter focuses on both the distribution

of ADL and IADL difficulties and the assistance

received for them among an older, noninstitutionalized population in the United States. As

previously demonstrated (5,6), it is hypothesized

that difficulties in performing both ADL’s and

IADL’s will be related to age, sex, and race, such

that older adults, females, and persons of all

races other than white should report more difficulties in performing these ADL’s and IADL’s.

This chapter also addresses how difficulty with

ADL’s and IADL’s varies by living arrangement

for various demographic groups. It is hypothesized that adults aged 75 and over who live with

The authorswishto acknowledgeRichardSuzmm,Ph,D,,

National Institute on Aging, National Institutes of Health, for his

helpful comments on the manuscript.

others will have greater difficulty with ADL’s

and IADL’s than those who live alone. However,

for the younger elderly (aged 65–74 years), there

should be little association between ADL and

IADL difficulties and living arrangement.

Definitions of activity limitations

ADL’s include seven personal care activities

(eating, toileting, dressing, bathing, transferring,

walking, and getting outside). Respondents were

considered to have difficulty with an ADL if they

reported difficulty performing specific activities,

by themselves and without using special equipment, because of a health or physical problem,

IADL’s refer to six home-management activities

(meal preparation, shopping, money management, telephone use, light housework, and heavy

housework). Respondents were considered to

have difficulty with an IADL if, because of a

health problem, they had difficulty performing

specific activities by themselves.

Respondents were asked if they received

help from anyone for each ADL and IADL,

Only persons who reported difficulty with a

specific activity were asked about assistance received for that activity. Therefore, assistance

received for ADL’s and IADL’s can be considered an underestimate of total assistance provided to the older adult because some receive

assistance when no difficulty is present.

It was decided to count those who reported

that they do not do ADL’s as functionally limited. Because ADL’s are so fundamental to the

23
Table A. Percent who reported “does not do” for instrumental activities of daily living, by sex and

age

Male Female

65 years 65–74 75 years 65 years 65-74 75 years

IADL and over years and over and over years and over

Meal preparation . . . . . . . . . . . . . . . 12.43 11.21 14.81 1.16 0.67 1.86

Shopping . . . . . . . . . . . . . . . . . . . . . 2.79 2.16 4.01 1.21 0.57 2.12

Money management. . . . . . . . . . . . 2.30 2.04 2.81 1.47 1.02 2.11

Telephone use .,, ,, . . . . . . . . . . . 1.10 0!90 1,49 0.29

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

0.18 0.46

9.14 8.64 10.11 0.86 0.41 1.51

Heavy housework . . . . . . . . . . . . . . 15.85 14.02 19.39 5.02 3.23 7,56

NOTE: IADL is instrumental activities of daily living.

existence of the individual, it is likely that a

respondent who “does not do” probably has

functional limitations. The percentages of those

reporting “does not do” were less than 1 percent for any given ADL.

IADL’s, on the other hand, may be performed by others without consequence to the

older adult, Those who reported that they do not

do IADL’s were counted as not limited. Because

many IADL’s are associated with a female gender role (e.g., housework, meal preparation),

this decision may result in some underestimation

of difficulty with IADL’s for older males. This is

further supported by

who reported “does

table A.

Sources of data

the percentages of males

not do” for IADL’s in

The National Health Interview Survey (NHIS)

1986 Functional Limitations Supplement was

the source of data for this chapter. The 1986

survey was the most recent NHIS to collect

detailed information on ADL’s and IADL’s. The

NHIS is a continuing nationwide survey based

on household interviews of the civilian noninstitutionalized population of the United States.

The 1986 survey included a supplementary questionnaire, directed at the population 65 years of

age and over, that focused on ADL’s and IADL’s.

The ADL’s included were seven personal care

activities: eating, toileting, dressing, bathing, walking, getting in and out of a bed or chair (trans24

ferring), and getting outside, IADL’s included

were six home-management activities: preparing

meals, shopping for personal items, managing

money, using the telephone, doing heavy housework, and doing light housework,

Results and comments

Functional status: Basic activities of daily

living

As can be seen in table 1, more than 75 percent of the total population aged 65 and over

reported no problems performing the ADL’s. Of

this age group, 13 percent reported only one or

two such difficulties and 10 percent reported

difficulty with three or more basic ADL’s.

As hypothesized, the number of reported

ADL difficulties varied by age, race, and sex,

Significantly more adults in the group aged 65 to

74 years reported being free of ADL difficulties

than did those in the 75-and-over group (83 percent versus 68 percent). Persons of all other

races were less likely than were white persons,

and females were less likely than were males to

report having no basic ADL difficulties. Also, a

significantly smaller percentage of both males

and females in the group aged 65–74 years

reported having difficulty with three or more

ADL’s than did those 75 years and over. Table 1

also shows the percentage of persons aged 65

and over who had difficulty and received help of

another person, by the number of ADL’s for
which help was received, by race, sex, and age. A

significantly greater percentage of females than

males reported receiving assistance with two or

more ADL’s, For both males and females, a

significantly greater percentage of those aged 75

and over received help for two or more ADL’s

than did those 65–74 years of age.

The extent to which community-residing

adults aged 65 and over reported difficulty in

each of seven basic ADL’s is shown in table 2.

For this population, the most commonly reported basic ADL’s with which this group had

difficulty were walking (18 percent) and getting

outside (12 percent). Difficulty with eating and

toileting were cited the least frequently. For six

of the seven ADL’s, a significantly greater percentage of the group aged 75 and over reported

having difficulty than did those aged 65–74 years

(difficulty with eating did not differ significantly

by the two age groups). Males reported fewer

difficulties than females in five of the seven basic

ADL’s (difficulties in eating and dressing showed

no differences between the sexes).

It is interesting to note that the percentages

of those with specific ADL difficulties were similar to the percentages of those receiving help of

another (table 3) for some ADL’s, such as eating and toileting. For other ADL’s, such as

walking or getting outside, the percentages reporting difficulty and receiving help were not as

similar. This suggests that some basic ADL’s are

more fundamental to human existence than others (e.g., eating, toileting) and that those who

have difficulty with but do not receive help for

the less fundamental ADL’s (e.g., walking and

getting out) survive with a certain level of

difficulty.

Table 3 shows the percentage of persons

who had difljculty and received assistance for

the seven basic ADL’s by race, sex, and age. The

two most frequent basic activities for which help

was received were getting outside (6 percent)

and bathing (6 percent). Females were

significantly more likely than males to receive

assistance with getting outside. Males aged 75

and over were significantly more likely to receive

help than males aged 65–74 in only one

ADL– getting outside. Females, however, showed

more differences between the two age groups. A

significantly greater percentage of those 75 and

over, when compared with those 65–74 years,

reported receiving assistance for all but one of

the ADL’s (eating).

Functional status: Instrumental activities of

daily living

The pattern of IADL difficulties was similar

to that found for the basic ADL’s. Approximately 72 percent (table 4) of the total population aged 65 and over reported having no

difficulties with IADL’s, and less than 10 percent of the population reported difficulty with

three or more IADL’s. Significantly more adults

aged 65–74 years reported no difficulties with

IADL’s than did those in the group aged 75 and

over. Also, a greater percentage of males than

females and white persons than persons of all

other races were free of IADL problems.

The percentage of persons who received assistance with two or more IADL’s (table 4)

varied by race, sex, and age. Fewer white people

reported receiving help with two or more IADL’s

than did people of all other races, and fewer

males received help with two or more IADL’s

than did females. As expected, a greater percentage of respondents aged 75 and over received

help with two or more IADL’s than did those

65–74 years of age.

Table 5 shows the percentage of persons

aged 65 and over who reported difficulty performing each of six IADL’s, by race, sex, and age.

Difficulty with heavy housework was the most

frequently reported limitation (24 percent). Shopping difficulties were also common, with more

than 12 percent of older adults living in the

25
community having such problems. Compared

with white people, a significantly greater percentage of people of all other races had difficulties

with meal preparation, shopping, and light house

work. Sex differences were also found for the

IADL’s, with females generally reporting more

difficulties. Compared with males, significantly

greater proportions of females had difficulty

with all IADL’s except telephone usage. As

noted earlier, this may be partly the result of

sex-role differences in performing the activities.

A significantly greater percentage of those 75

years and over had difficulty in each of the six

IADL’s than did those 65–74 years of age

(table 5).

Table 6 shows the percentage of persons

who had difficulty and received help with each of

six IADL’s. The two IADL’s for which help was

most frequently received were heavy housework

(19 percent) and shopping (12 percent). A significantly greater percentage of all races other

than white received assistance with meal preparation, shopping, and light housework (table 6).

With the exception of telephone usage and money

management, significantly more females reported receiving help with IADL’s than did

males, Finally, for all six IADL’s, those aged

65–74 were less likely to receive assistance than

were those aged 75 years and over.

Table B shows the percentage of persons

reporting on difficulties in performing ADL’s

and IADL’s by sex and age. As can be seen in

the table, 67 percent of the total population had

no difficulties with either ADL’s or IADL’s,

while 17 percent reported one or more difficulties with both. Five percent of the total population reported difficulty with ADL’s only.

Eleven percent of the total population reported

difficulty with IADL’s only.

A greater percentage of males than females

were free of difficulty with both ADL’s and

IADL’s, Males were also more likely to report

difficulties with ADL’s only, but were less likely

to report difficulties with IADL’s only. The percentage of persons reporting difficulty with

IADL’s only and with both ADL’s and IADL’s

increases significantly with age. As expected, the

percentage of persons reporting no difficulties

with IADL’s and ADL’s decreases with age. Age

patterns in those with difficulty in ADL’s only

were not evident.

Living arrangements and functional status

Table 7 shows the percent distribution by

living arrangement according to race, age, and

sex for community-residing adults in the United

States, aged 65 and over. More than 30 percent

of this population reported living alone, and the

Table B. Percent distribution of persons with difficulty in activities of daily living and instrumental

activities of daily living, by sex and age

Difficulties in ADL’s and /ADL’s

ADL difficulty IADL difficulty

Sex and age None only only Both

Total. . . . . . . . . . . . . . . . . . . . . . . . . 66.6 5.2 10.9 17,3

Sex

Male, . . . . . . . . . . . . . . . . . . . . . . . . 74.7 6.6 7.4 11.3

Female. ..,................,.. 60.9 4.3 13.4 21,5

Age

65–74 years . . . . . . . . . . . . . . . . . . . 74.1 4.7 9.2 12.0

75–84 years. . .,, ,, . . . . . . . . . . . . 58,7 6.5 12,5 22.4

85years or over . . . . . . . . . . . . . . . 37.1 4.8 18.3 39.8

NOTE: ADL is activities of daily living, IADL is instrumental activities of daily living,

26
proportion increases significantly with age. More

than one-half of those aged 85 and over lived

alone, White people 65 years of age and over

were more likely to live with a spouse and less

likely to live with others when compared with

persons of all other races, The percentage living

done, however, did not vary by race. Among

those 65 years of age and over, females were

significantly more likely to live alone than males

(43 percent versus 16 percent). This sex difference in the percentage living alone holds within

age categories (65-69, 70–74, 75 years and over).

Another major difference between men and

women in living arrangements was the proportion who lived with a spouse, Although more

than 76 percent of the men aged 65 and over

lived with their wives, less than 40 percent of

the women lived with their husbands. The sex

difference in living with a spouse is significant

within each of the age groups of 65-69 years,

70-74 years, and 75 and over. It should be noted

that in the United States, husbands are generally

older than their wives, and also, age-specific

mortality rates for males at all ages are greater

than for females. These factors result in a greater

percentage of older widows than widowers.

The following comparisons are designed to

assess the relationships between living arrangements, ADL’s, IADL’s, and age. It is hypothesized that the older and more disabled (as defined

by the number of ADL’s and IADL’s) a person

is, the greater the likelihood that that person will

be living with others. Table 8 shows the percentage of those having zero, one, two, and three or

more basic ADL difficulties by living arrangement, age, and sex. For the group aged 65–74

years, there were no significant differences by

living arrangement in the percentage of men and

women with no ADL difficulties. Similarly, for

the same age group, there were no differences by

living arrangement for men and women with

three or more ADL difficulties. However, older

women (75 years and over) living alone were

more likely to report having no ADL difficulties

than were women of the same age group who

lived with others. Also, a greater percentage of

older women living with others reported three or

more ADL difficulties (23 percent) than did

women of similar age who lived alone (16 percent). There were no significant differences by

living arrangement for males aged 75 years and

over who reported no ADL difficulties. There

also were no significant differences by living

arrangement for males aged 75 and over who

reported three or more ADL difficulties.

Table 9 contains the percentage of those

reporting difficulty with each of seven ADL’s by

living arrangement, age, and sex. For the population aged 65–74, there were no significant

differences by living arrangement in the percentage of persons having difficulty with ADL’s. This

was the case for both males and females. The

relationship between specific ADL difficulties

and living arrangement becomes evident in the

group aged 75 and over. Within this group,

women living alone were less likely to have

difficulties in the ADL’s of eating, dressing,

bathing, and getting outside than were women

who lived with others. The pattern between

ADL’s and living arrangement for women was

not evident for men.

Table 10 shows the percent distribution of

older adults reporting zero, one, two, and three

or more IADL difficulties by living arrangement,

age, and sex. Among males aged 65–74 years,

those who lived with others were more likely to

report no IADL difficulties than those who lived

alone. For females aged 75 and over, those who

lived with others were more likely to report

having difficulty with three or more IADL’s than

those who lived alone (26 percent versus 15 percent). These findings of IADL differences by

living arrangement were generally in agreement

with those reported for ADL’s in table 8. For

both ADL’s and IADL’s, a greater percentage of

women aged 75 and over and living with others

27
reported three or more difficulties, compared

with women of the same age living alone.

Table 11 contains the percentage of persons

aged 65 and over reporting di.fliculty with each of

six IADL’s by living arrangement, age, and sex.

As with the findings reported for ADL’s and

living arrangements, for both men and women

aged 65–74 years, there were no significant differences in the percentage of persons having

difficulty with the six IADL’s by living arrangement. There was one exception to this finding. A

significantly greater percentage of women aged

65–74 years and living with others reported more

difficulty with light housework than women of

the same age who lived alone.

Differences in the percentage of persons with

IADL difficulties by living arrangement become

striking in the age group of 75 years and over.

Women in this age group living with others were

significantly more likely to have difficulty with

meal preparation, managing money, using the

telephone, and light housework than were women

of the same age living alone (table 11). Males

aged 75 years and over, on the other hand, did

not differ significantly by living arrangement in

reported difficulty for the six IADL’s.

Given that the findings presented above are

based on cross-sectional data, it is difficult to

determine the direction of influence between

living arrangement and ADL and IADL difficulties. It is possible that, as older adults develop

difficulties in personal care, home management,

and mobility, they may find it necessary to live

with another person. Longitudinal data following changes in ADL’s and IADL’s in older

adults as they change living arrangements would

address this issue.

References

1.

2.

3.

4.

5.

6.

Wolinski F. Assessing the effects of predisposing,

enabling, and illness morbidity characteristics on

health service utilization. J Health Soc Behav

19:384-96.1978.

Branch L, Jette A. A prospective study of longterm care institutionalization among the aged,

Am J Public Health 72:1373-9.1982.

Shapiro E, Tate R. Who is really at risk of

institutionalization? Gerontologist 28(2):237-45,

1988.

Katz S, Branch L, Branson M, et al. Active life

expectancy. N Engl J Med 309(20):1218-23. 1983,

Wiener JM, Hanley RJ, Clark R, Van Nostrand

JF. Measuring the activities of daily living: Comparisons across national surveys. J Gerontol

45(6) :S229-37. 1990.

Fulton JP, Katz S, Jack SS, Hendershot GE.

Physical functioning of the aged: United States,

1984, Vital Health Stat 10(167). Washington:

National Center for Health Statistics. 1989,

28
Table 1. Percent distribution of persons 65 years of age and over by number of activities of daily

Iivingfor which difficulty was reported and percent of persons who received the help of another

person in performing activities of daily living, according to race, sex, and age: United States, 1986

[Data are based on household interviews of the civilian noninstitutionalized population]

Number of ADL’s

Help of another

With difficulty person received

3 or 2 or

Race, sex, and age Total None 1 2 more 1 more

Race

White, ,,, . . . . . . . . . . . . . . . . . .

Another,. . ., ., . . . . . . . . . . . . .

Sex

Male, .,,,,,,.,.,........,..

Female, ,,, . . . . . . . . . . . . . . . . .

Age

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

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

65 years and over . . . . . . . . . . . .

75 years And over . . . . . . . . . . . .

85 years and over........,,..

Male

65–74 years, ., ., . .,, ...,.,. .

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

65 years And over . . . . . . . . . . . .

75 years And over. ,, . . . . . . . . .

85 years and over..,....,,,..

Female

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

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

65 years and over, , . . . . . . . . . .

75 years and over. . . . . . . . . . . .

85 years and over . . . . . . . . . . . .

Numberof

personsin

thousands Percent distribution2 Percent

24,317

2,739

11,133

15,923

16,646

8,456

27,057

10,411

1,954

7,335

3,206

11,133

3,798

592

9,310

5,250

15,923

6,613

1,363

77.9 8.1 4.6

72.6 8.5 5.1

81.9 7,8 3.5

74.2 8.4 5.4

83.2 6.9 3.7

71.1 9.8 5.5

77.4 8.1 4.6

68.2 10.2 6.0

55.5 11,8 8.3

84.8 6.4 3.4

78.5 10.2 3.3

81.9 7.8 3.5

76.4 10.4 3.7

64.9 11,6 5,9

81.9 7.3 4.0

66.6 9,5 6.8

74.2 8.4 5.4

63.5 10.0 7.4

51.5 11.9 9.4

9.4

13.8

6.9

12.0

6.3

13.7

9.9

15.7

24.3

5.5

8.1

6.9

9.6

17.6

6.9

17.1

12.0

19.2

27.3

3.6

4.7

2.4

4.6

2.5

4.9

3.7

5.7

9.2

1.9

2.9

2.4

3.4

*6.O

2.9

6.1

4.6

7.0

10.5

5.9

8.5

4.3

7.5

3.4

8.6

6.2

10.6

19.6

3.3

5.1

4.3

6.3

12.9

3.5

10.7

7.5

13.1

22.4

‘Excludes those for whom information was missing on all ADL’s.

2Maynot addto 100 percent because of rounding.

NOTES: Persons reported as not performing an activity ofdaily living (ADL) are included with those reported as having difficulty

or receiving help with thatADL. ADL’sinclude eating, toileting, dressing, bathing, walking, gettingin and out of abed or chair,

and getting outside.

SOURCE: National Center for Health Statistics: Data from the National Health Interview Survey 1986 Functional Limitations

Supplement.

29
Table 2. Percent of persons 65 years of age and over with reported difficulty performing activities

of daily living, by race, sex, and age: United States, 1986

[Data are based on household intewiews of the civilian noninstitutionalized population]

ADL with difficulty

Trans- Getting

Race, sex, and age Total Eating Toileting Dressing Bathing ferringl Walking outside

Race

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

Another. . . . . . . . . . . . . . . . . .

Sex

Male. .,....,..........,.,

Female. . . . . . . . . . . . . . . . . . .

Age

65–74 years . . . . . . . . . . . . . . .

75–84 years . . . . . . . . . . . . . . .

65 years And over. . . . . . . . . .

75 years and over......,,..

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

Male

65–74 years. . . . . . . . . . . . . . .

75–84 years . . . . . . . . . . . . . . .

65 years and over,......,,.

75 years And over. ..,......

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

Female

65–74 years. ., . . . . . . . . . . . .

75–84 years.......,,,..,.,

65 years Andover....,..,..

75 years And over. . . . . . . . . .

85 years and over...,,,,,..

Numberof

personsin

thousands Percent

24,753

2,784

11,357

16,181

16,987

8,552

27,538

10,551

1,999

7,490

3,251

11,357

3,866

615

9,496

5,301

16,181

6,685

1,384

1.9 4,4

1.3 7.0

1.7 3.4

1.9 5.6

1.5 2.8

1.8 6.3

1.8 4.7

2.4 7.7

5.0 14.0

1.7 2.7

*1.1 3.4

1.7 3.4

1.9 4.7

*5.7 11.6

1.3 2.8

2.3 8.0

1.9 5.6

2.8 9.5

*4.7 15.0

5.7

8.6

5.2

6.5

4.2

7.3

6.0

8.8

15.1

4.5

5.2

5.2

6.4

12,7

4.0

8,6

6.5

10.2

16.1

9.5

14.0

7.1

12,0

6.3

13.9

10.0

16.0

24.8

6.0

7.8

7.1

9.4

18.1

6.5

17,6

12.0

19.7

27.8

8.2

11.6

6.4

10,1

6.2

11.2

8.6

12.3

17.1

5.6

6.9

6.4

8.0

14.0

6.7

13,8

10.1

14.8

18.5

17,8

22.1

14,9

20,6

13,5

23,4

18.2

25.8

35.9

12,6

i 7.3

14.9

19.2

28.9

14.2

27,2

20.6

29,6

39.1

11.3

15.6

7.5

14.8

7.0

16.9

11.7

19.4

30.1

5.7

9.2

7.5

10.9

19,7

8.0

21,6

14.8

24.3

34,7

‘Transferring means getting in and out ofabed or chair.

NOTE: Persons reported as notpetiorming an activity ofdaily living (ADL) were classified with those reported as having difficulty

with that ADL,

SOURCE: National Center for Health Statistics: Data from the National Health Interview Survey 1986 Functional Limitations

Supplement.

30 /
Table 3. Percent of persons 65 years of age and over who reported receiving the help of another

person with performing activities of daily living, by race, sex, and age: United Statesj 1986

[Data are based on household interviews of the civilian noninstitutionalized population]

ADL for which help of another person received

Trans- Getting

Race, sex, and age Total Eating Toileting Dressing Bathing ferringl Walking outside

Race

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

Another. . . . . . . . . . . . . . . . . . . .

Sex

Male, ,,, .,, ,,, ,,, . .,...,..,

Female, , ...,,,.,,,,..,,.,..

Age

65–74 years . . . . . . . . . . . . . . . . .

75–84 years . . . . . . . . . . . . . . . . .

65 years and over . . . . . . . . . . . .

75 years and over . . . . . . . . . . . .

85 years and over . . . . . . . . . . . .

Male

65–74 years, ,, . . . . . . . . . . . . . .

75–84 years. . . . . . . . . . . . . . . . .

65 years and over, . . . . . . . . . . .

75 years and over . . . . . . . . . . . .

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

Female

65–74 years.,,...,,.,,..,,.,

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

65 years and over, . . . . . . . . . . .

75 years and over, ,,, ,, . . . . . .

85 years and over . . . . . . . . . . . .

Numberof

personsin

thousands Percent

24,753

2,784

11,357

16,181

16,987

8,552

27,538

10,551

1,999

7,490

3,251

11,357

3,866

615

9,496

5,301

16,181

6,685

1,384

1.1

*0.6

1.0

1.1

0.8

1.1

1.1

1,6

4.1

0.9

*0.6

1.0

1.3

*4.7

0.6

1.3

1.1

1.8

*3.9

2.3

3.5

1.9

2.8

1.4

3.3

2.4

4.1

7,5

1.5

1.9

1.9

2,5

*5.9

1.3

4.1

2,8

5.0

8.3

4.2

6.1

3.9

4.7

2.9

5.4

4,4

6.8

12.6

3.2

4.2

3.9

5.2

10.0

2.6

6.1

4.7

7.7

13.8

5.6

9.4

4.3

7.2

3.2

8.6

6.0

10.6

19.0

3.3

4.9

4.3

6.4

14.1

3.1

10,9

7.2

13.0

21.2

3.0

5.2

2.6

3.7

2.1

4.0

3.2

5.0

9.4

2,3

2.3

2.6

3.2

7.8

2.0

5.0

3.7

6.1

10.1

4.5

5.8

3.1

5.8

2.6

6.4

4.6

8.0

14.8

2.3

3.7

3.1

4.5

8.3

2.8

8.0

5.8

10.0

17.8

6.1

7.8

3.8

8.0

3.2

9.2

6.3

11.3

20.6

2,7

4.8

3.8

6.0

12.8

3.5

11.9

8.0

14.4

24.1

‘Transferring means gettingin andout ofabed or chair.

NOTE: Persons reported as not performing an activity ofdaily living (ADL) were classified with those reported as receiving help

with that ADL,

SOURCE: National Center for Health Statistics: Data from the National Health interview Survey 1986 Functional Limitations

Supplement.

31
Table 4. Percent distribution of persons 65 years of age and over by number of instrumental

activities of daily living for which difficulty was reported and percent of persons who received the

help of another person in performing instrumental activities of daily living, according to race, sex,

and age: United States, 1986

[Data are based on household interviews of the civilian noninstitutionalized population]

Number of IADL’s

Help of another

With diticulty person received

3 or 2 or

Race, sex, and age Total None 1 2 more 1 more

Race

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

Another. . . . . . . . . . . . . . . . . .

Sex

Male. . . . . . . . . . . . . . . . . . . . .

Female. . . . . . . . . . . . . . . . . . .

Age

65–74 years..,...,.,..,,.,

75–84 years . . . . . . . . . . . . . . .

65 years Andover......,,..

75 years And over . . . . . . . . . .

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

Male

65–74 years............,.,

75–84 years . . . . . . . . . . . . . . .

65 years And over . . . . . . . . . .

75 years Andover,,..,..,.,

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

Female

65–74 years . . . . . . . . . . . . . . .

75–84 years . . . . . . . . . . . . . . .

65 years And over . . . . . . . . . .

75 years And over . . . . . . . .. . .

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

Number of

persons in

thousands Percent distribution Percent

24,218

2,731

11,110

15,839

16,579

8,427

26,948

10,369

1,943

7,326

3,195

11,110

3,783

588

9,253

5,232

15,839

6,586

1,354

72.6

64.9

81,3

65.2

78,8

65.1

71.9

60.8

41.9

85.1

77.3

81.3

74,1

56,6

73.8

57.7

65.2

53.1

35.5

13.9

14,9

4.6

6.3

8.9

13.9

11.2

11.5

11,4

17,2

9.7

17.1

12.7

15.3

14.0

16.1

19.4

8.6

11.3

9.7

11.9

14.9

16.0

17.7

17.1

18.5

21.4

3.4

5.8

3.4

6.7

4.8

7.0

8.7

2.8

4.4

3.4

4.5

*5.2

3.8

8.1

5.8

8.5

10.2

5.7

12.0

5.2

12.9

9.4

16.1

30.0

3.6

7.0

5.7

9,6

23.4

6.4

16.5

12,0

19.9

32.9

6.7

14.4

9.9

12.7

11.3

13,5

16.9

6.3

7.0

6.7

7,6

11.0

12.7

16.2

14.4

16.8

19.4

7.7

15,1

6,6

17,0

12,0

20.7

36.4

5.1

10.1

7,7

12.8

27,2

7,8

21.3

15,1

25.2

40.4

'Excludes those forwhom information wasmissing onallinstrumental activities of daily living (lADL’s).

2May not add to 100 percent because of rounding,

NOTES: Persons reported as not performing an IADL are not included with those reported as having difficulty or receiving help

with that IADL. IADL’s include preparing meals, shopping, managing money, using the telephone, light housework, and heavy

housework.

SOURCE: National Center for Health Statistics: Data from the National Health Interview Survey 1986 Functional Limitations

Supplement.

32
Table 5. Percent of persons 65 years of age and over with reported difficulty performing

instrumental activities of daily living, by race, sex, and age: United States, 1986

[Data are based on household interviews of the civilian noninstitutionalized population]

IADL with difficulty

Meal Managing Using Light Heavy

Race, sex, and age Total preparation Shopping money telephone housework housework

Race

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

Another, . . . . . . . . . . . . . . .

Sex

Male, ,, . .,, ,, . . . . . . . . . .

Female, ,,, ,,, ,, ..,.,...

Age

65–74 years, . . . . . . . . . . . .

75–84 years. .,, ,, ...,...

65 years and over. . . . . . . .

75 years and over, . . . . . . .

85 years and over. , . . . . . .

Male

65–74 years . . . . . . . . . . . . .

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

65 years and over. . . . . . . .

75 years and over. . . . . . . .

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

Female

65–74 years, , .,, . . . . . . . .

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

65 years Andover,. . . . . . .

75 years Andover., . . . . . .

85 years Andover.. . . . . . .

Numberof

personsin

thousands Percent

24,753

2,784

11,357

16,181

16,987

8,552

27,538

10,551

1,999

7,490

3,251

11,357

3,866

615

9,496

5,301

16,181

6,685

1,384

6.6

12.8

4.5

9.2

4.0

9,9

7,3

12.5

23.4

3.1

5.3

4,5

7.3

17.5

4.7

12.7

9,2

15.5

26.0

12.1

18.8

8.1

16.0

7.3

18.1

12.8

21.5

36,0

5.7

10.5

8.1

12.8

25,2

8.7

22.8

16,0

26.6

40.8

4.9

8.2

4.1

6.0

2.5

7.3

5.2

9.6

19.5

2.6

5.7

4.1

7.1

14.5

2.4

8.3

6.0

11,1

21.8

4.8

6.7

5.1

4.9

3.2

5.9

5.0

7.8

16.1

3.4

6.3

5.1

8.4

19.7

3.1

5.6

4.9

7.4

14.4

7.5

12.8

5.6

9.8

4.6

11,1

8.1

13.6

24.4

3.8

6.9

5.6

9.2

21.5

5.3

13.7

9.8

16.2

25.7

23.3

28.0

13.0

31.3

18.0

29.5

23.8

33.0

48.0

10.6

15.2

13.0

17.6

30.7

23.9

38.3

31.3

41.9

55.6

NOTE: Persons reported as not performing an instrumental activity of daily living (lADL)were not classified with those repotied

as having difficulty with that IADL.

SOURCE: National Center for Health Statistics: Data from the National Health Interview Survey 1986 Functional Limitations

Supplement,

33
Table 6. Percent of persons 65 years of age and over who reported receiving the help of another

person with performing instrumental activities of daily living, by race, sex, and age: United States,

1986

[Data are based on household interviews of the civilian noninstitutionalized population]

IADL for which help of another person received

Meal Managing Using Light Heavy

Race, sex, and age Total preparation Shopping money te/ephone housework housework

Race

Number of

persons in

thousands Percent

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

Another., . . . . . . . . . . . . . .

Sex

Male . . . . . . . . . . . . . . . . . . .

Female . . . . . . . . . . . . . . . . .

Age

65–74 years . . . . . . . . . . . . .

75–84 years . . . . . . . . . . . . .

65 years And over . . . . . . . .

75 years and over. . . . . . . .

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

Male

65–74 years . . . . . . . . . . . . .

75–84 years . . . . . . . . . . . . .

65 years And over. ,.....,

75 years And over . . . . . . . .

85 years and over. . . . . . . .

Female

65–74 years . . . . . . . . . . . . .

75–84 years . . . . . . . . . . . . .

24,753

2,784

11,357

16,181

16,987

8,552

27,538

10,551

1,999

7,490

3,251

11,357

3,866

615

9,496

5,301

16,181

6,685

1,384

5.9

11.6

4.2

8.0

3.5

8.7

6.5

11,3

22.3

2,8

5.2

4.2

6.9

15.9

4.0

10.9

8.0

13.8

25.2

11.4

17.0

7.6

15.1

6.7

17.1

12.0

20.5

35.1

5.4

9.5

7.6

11.9

24,6

7.8

21,7

15.1

25.4

39.8

4.6

7.4

3.9

5.6

2.1

7.1

4.9

9.4

19.2

2.4

5,7

3.9

7.0

13.8

2.0

7.9

5.6

10.7

21,5

2.9

4.6

2.8

3.2

1.8

3.6

3.0

5.0

10.8

1.9

3.4

2,8

4.6

10.7

1.8

3.7

3.2

5.2

10.8

6.6

10.9

5.0

8.4

3.8

9.7

7.0

12.2

23,1

3.1

6.4

5.0

8.7

20.9

4.3

11,7

8.4

14.2

24.0

18.7

22.6

10.0

25.4

13.7

24.2

19,1

27.8

43,6

7,9

11.4

10,0

14.2

28.9

65 years and over. . . . . . . .

75 years And over.... . . . .

85 years and over. . . . . . . .

NOTE: Persons reported as not performing an instrumental activity of daily living (lADL) were notclassified with those reported

as receiving help with that lADL.

SOURCE: National Center for Health Statistics: Data from the National Health Interview Survey 1986 Functional Limitations

Supplement.

18.2

32,0

25.4

35.8

50,2

34
Table 7. Percent distribution of persons 65 years of age and over by living arrangement, according

to race, age, and sex: United States, 1986

[Data are based on household interviews of the civilian noninstitutionalized population]

Living arrangement

Lives with Lives with

Race, age, and sex Lives alone others’ spouse

Race Percent distribution

White ,,, .,,,,., . . . . . . . . . . . . . . . . . . . . . 31.7 12.2 56.1

Another., . . . . . . . . . . . . . . . . . . . . . . . . . . . 31.2 27.4 41.4

Age

65-69 years,.,.............,,.. . . . . . . 22.6 10.9 66.5

70-74 years.,,....,.......,.,.. . . . . . . 28.7 11.8 59.6

65years and over. .,, . . . . . . . . . . . . . . . . . 31,7 13.7 54.7

75 years and over. ., ...,...,. . . . . . . . . . 41.9 17,6 40,5

85 years and over . . . . . . . . . . . . . . . . . . . . . 51.9 26.4 21.8

65-69 years. , .,, , . . . . . . . . . . . . . . . . . . . . 12.9 6.3 80.8

70-74 years, . . . . . . . . . . . . . . . . . . . . . . . . . 13.8 7.5 78.7

65 years and over. .,, ,, .,..... . . . . . . . . 16.2 7.5 76.4

75 years and over. . . . . . . . . . . . . . . . . . . . . 21.7 8.8 69.6

85 years and over . . . . . . . . . . . . . . . . . . . . . 34.1 17.8 48.2

Female

65-69 years.,,,...,,.....,,.. . . . . . . . . 30.3 14.6 55.1

70-74 years,,,,,,.,........,,. . . . . . . . 40.1 15.0 44.9

65yearsand over, .,, ,, .,,,...,, ,.,... 42.5 18.1 39.4

75 years and over.,..,,..,,,.. . . . . . . . . 53.6 22.7 23.7

85 years and over,,,..,.,..,.. ., .,.,., 59.8 30.2 10.0

‘Llveswlth a nonrelative or a relative other than aspouse,

2Maynot addto 100 percent because of rounding,

SOURCE: National Centerfor Health Statistics: Data from the National Health interview Suwey 1986 Functional Limitations

Supplement.

35
Table 8. Percent distribution of persons 65 years of age and over by number of activities of daily

living for which difficulty was reported, according to living arrangement, sex, and age: United

States, 1986

[Dataare based on household interviewsof the civilian noninstitutionalizedpopulation]

L/ving arrangement

Lives alone Lives with othersl

Age and number of ADL’s with difficulty Male Female Male Female

65–74 years

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

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

2,, .,.,.. . . . . . . . . . . . . . . . . ,. .,,,.. . . . . . . .

3 or more, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

75 years and over

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

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

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

3 or more . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

80.0

10.1

*4,0

5.9

76.0

7.9

*6.1

10.0

Percent distribution2

80.0 85.6

7.4 5.8

4.7 3.3

7.9 5.4

66.3 76.5

10.1 11.1

7.7 3.0

15.9 9.4

82.9

7.2

3,7

6.3

60.2

9,9

7.0

23.0

‘Includes spouse.

2Maynot addto 100 percent because of rounding.

NOTES: Persons reported as not performingan activity ofdaily living (ADL) are included with those reported as having difficulty

with that ADL, ADL’sinclude eating, toileting, dressing, bathing, getting inandout ofabed or chair, walking, and getting outside,

SOURCE: National Center for Health Statistics: Data from the National Health Interview Survey 1986 Functional Limitations

Supplementc

36
Table 9. Percent of persons 65 years of age and over with reported difficulty performing activities

of daily living, by living arrangement, sex, age, and activity: United States, 1986

[Data are based on household interviews of the civilian noninstitutionalized population]

Living arrangement

Lives alone Lives with othersl

Age and ADL’s with difficulty Male Female Male Female

65–74 years Percent

Eating, , .,, ,, .,, . . . . . . . . . . . . . . . . . . . . . . . . *1.0 1.1 1.8 1.4

Toileting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.1 2.7 2.5 2.9

Dressing .,, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.2 3.0 4.4 4.5

Bathing, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.6 6.3 5.6 6.6

Transferring, . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.2 7.4 5.8 6.4

Walking, , .,, , ., ., . . ...,,..,, . . . . . . . . . . . . 15.8 16.1 12.1 13,1

Gettingoutside,,....,..,,,,,,,, . . . . . . . . . . 7.6 8.9 5.4 7.6

75 years andover

Eating, , .,, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . *1.7 1.1 1.9 4.6

Tolleting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . *4.5 7.7 4.7 11.5

Dressing, ,,, ,,, , . . . . . . . . . . . . . . . . . . . . . . . . *4.6 7.3 6.9 13.4

Bathing, , . ., . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.5 16.2 10.0 23.9

Transferring, . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.7 13.2 7.8 16.6

Walking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20.4 27.8 18.8 31.7

Getting outside . . . . . . . . . . . . . . . . . . . . . . . . . . . 13.3 20,6 10.2 28.5

‘Includes spouse.

2Transferring means getting in and outof abedor chair.

NOTE: Persons reported as not performingan activity ofdaily living (ADL) are included with those reported as having difficulty

wlththatADL,

SOURCE: National Center for Heaith Statistics: Data from the National Health Interview Survey 1986 Functional Limitations

Supplement,

37
Table 10. Percent distribution of persons 65 years of age and over by

activities of daily living for which difficulty was reported, according to

age: United States, 1986

number of instrumental

living arrangement, sex,

[Data are based on household interviews of the civilian noninstitutionalized population]

and

Living arrangement

Lives alone Lives with othersl

Age and number of ADL’s with diticulty Male Female Male Female

65–74 years Percentdistribution

None . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79,5 72.9 85.9 74,3

1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.4 17.3 8.1 15.3

2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,0 4,5 2.4 3,4

3 or more . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.2 5.3 3.5 6.9

75 years and over

None . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71.5 54.8 74,8 51.2

1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,,. 8.7 21.1 12.7 15.5

2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.1 9.5 4.1 7.3

3 or more, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13.6 14.7 8.4 26.0

‘Includes spouse.

2Maynotaddto 100 percent because of rounding.

NOTES: Persons reported as not performing an instrumental activity ofdaily living (lADL)are not included with those reported as

having difficulty with that lADL. lADL’s include meal preparation, shopping, managing money, using the telephone, light

housework, and heavy housework,

SOURCE: National Center for Health Statistics: Data from the National Health lntewiew Suwey1986Functional timitations

Supplement,

38
Table 11. Percent of persons 65 years of age and over with reported difficulty performing

instrumental activities of daily living, by living arrangement, sex, age, and activity: United States,

1986

[Data are based on household interviews of the civilian noninstitutionalized population]

Living arrangement

Lives alone Lives with others’

Age and IADL’s with difficulty Male Female Male Female

65–74 years Percent

Meal preparation . . . . . . . . . . . . . . . . . . . . . . . . . . 4.1 3.1 3.0 5.6

Shopping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.9 8.8 5.0 8.6

Managingmoney . . . . . . . . . . . . . . . . . . . . . . . . . *4.1 2.0 2.4 2.6

Using telephone . . . . . . . . . . . . . . . . . . . . . . . . . . *2.8 2.6 3.5 3.3

Light housework . . . .. t . . . . . . . . . . . . . . . . . . . . *3.3 3.0 3.9 6.5

Heavy housework . . . . . . . . . . . . . . . . . . . . . . . . . 15.2 24.6 9.9 23.5

75 years and over

Meal preparation . . . . . . . . . . . . . . . . . . . . . . . . . . 11.3 10.1 6.1 21.7

Shopping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15.9 23.4 12.0 30.2

Managing money . . . . . . . . . . . . . . . . . . . . . . . . . 8.9 7.8 6.6 14.9

Using telephone . . . . . . . . . . . . . . . . . . . . . . . . . . 7.2 4,0 8.8 11.4

Light housework, . . . . . . . . . . . . . . . . . . . . . . . . . 13.8 11.5 8.0 21.6

Heavy housework . . . . . . . . . . . . . . . . . . . . . . . . . 20.9 40.1 16.7 43.9

‘Includes spouse.

NOTE: Persons reported as not performingan instrumental activity of daily living (lADL) are not included with those reportedas

having difficulty with that IADL.

SOURCE: Nationai Center for Health Statistics: Data from the National Health lntewiew Suwey1986FunctionaI Imitations

Supplement.

39
Chapter 3

Changes in functional status

and risk of

institutionalization and death

by Baila Miller, Ph.D., Thomas Prohaska,

Ph.D., and Robin Mermelstein, Ph.D.,

University of Illinois at Chicago; and Joan F.

Van Nostrand, M.P.A., National Center for

Health Statistics

Introduction

Although the general association of declining

functional status with increasing risk of institutionalization and death has been well established (1,2), estimates of individual patterns of

change in functional status have been limited

because of the lack of longitudinal data. Analysis

of a Massachusetts longitudinal study suggested

that transitions between dependence and independence in functional status and institutionalization vary by age, but do not show uniform

decline in functional ability (3). Results from the

19S2-S4 National Long Term Care Survey of

persons 65 years of age and over show that a

large majority of persons who were nondisabled

in 1982 remained nondisabled in 1984, and significant numbers of community residents showed

improvement in physical functioning. The risks

of becoming disabled were approximately the

same for females and males (2). Other analyses

of the Longitudinal Study of Aging 1984–86 note

that even among people receiving help, some

improved in health status or at least did not

become worse (l). One such recent study that

examined the risk of functional decline among

the cohort aged 70–74 suggested that participation in an active lifestyle may protect against

functional decline (4). Understanding changes

over time in the prevalence of each level of

functional limitations makes it easier to assess

quality of life and the need for health and social

services in the aging population.

This chapter presents trends in functional

status by level of functional difficulty in 1984 of

noninstitutionalized community elderly persons

70 years of age and over. Changes in functional

status (ability to perform everyday personal care

and home-management activities) and risk of

institutionalization and death by age, sex, and

race are examined. The ability to perform everyday tasks is divided into two general categories:

personal care (activities of daily living, or ADL’s)

and home management (instrumental activities

of daily living, or IADL’s). More specifically,

ADL limitations refer to persons having difficulty because of a health or physical problem

with eating, toileting, bathing, dressing, walking,

getting in and out of a bed or chair, and getting

outside. IADL limitations refer to persons having difficulty because of a health or physical

problem with meal preparation, shopping, managing money, using the telephone, light housework, and heavy housework.

An important difference between ADL limitations and IADL limitations involves the way in

which limitations are counted, Respondents who

reported that they did not do an ADL were

counted with those who reported difficulty in

performing the activity. Given that ADL’s are

necessities, not doing one most likely means that

an individual is unable to do so. However, for

IADL’s, respondents who reported not doing an

activity were counted as not having difficulty.

Unlike the ADL’s, IADL’s are not necessities of

41
●

life and may not be done for a variety of reasons

other than disability. For example, as a result of

role socialization, men typically perform fewer

IADL’s than women and thus their reports of

difficulties may be underestimates. This chapter

also presents measures of physical performance,

which represent selected capacities important to

maintaining independent functioning. These measures are assessments of mobility and arm

strength.

The following hypotheses are examined: (a)

increased age will be associated with a decline in

functional status, a smaller probability of improved functional status, an increased risk of

institutionalization, and an increased risk of

death; and (b) sex differences will be found in

the risks of institutionalization and mortality,

such that females are more likely to be institutionalized, but will be at a lower risk of death at

all ages (5). Sex differences in improvement or

decline in functional status are not hypothesized

(4), Recent research suggests that sex differences in the national prevalence of disabilities

arise from the greater longevity of females at any

given level of age and functional impairment (2).

Source of data

The source of data for this chapter is the

Longitudinal Study of Aging (LSOA), conducted by the National Center for Health Statistics in collaboration with the National Institute

on Aging. The baseline data for this longitudinal

followup is the 1984Supplement on Aging (SOA)

to the National Health Interview Survey. The

SOA is a survey specifically directed toward

civilian noninstitutionalized persons 55 years of

age or over. The 1986 LSOA sample included all

persons 80 years of age or over and approximately one-half of those aged 70–79 who participated in the SOA (l).

Results and comments

The extent to which demographic factors and

levels of functional limitations in 1984 influenced

the transition rates for risk of death and institutionalization in 1986 are examined in tables 1-3.

As previously noted, those considered limited in

personal care activities (ADL) include all those

who reported they did not do the specific ADL

task, Those considered limited in homemanagement activities (IADL) did not include

those who reported they did not do the IADL

task. Tables 4–14 further distinguish two levels

of difficulty in performance. The level of “no

difficulty” indicates that a person has no difficulty in performing the activity because of a

health or physical problem. The level of “some

difficulty” includes those persons who have any

difficulty in performing an activity, are unable to

perform it, or receive the help of another person

with the activity. This category is further subdivided into those who receive help of another

person and those who do not. As can be seen in

the data below, older persons receiving help

from another person represent a different, possibly lower, functioning level. Persons in greater

need of help with daily activities may be able to

remain in the community only because they

receive help. Receipt of help may also be dependent on a variety of sociodemographic factors,

such as living arrangements and kin availability,

Risk of death and institutionalization

The risk of death or institutionalization varied by demographic factor and degree and type

of functional limitation. Mortality trends by age

and sex are well documented in table 1. Persons

80 years of age and over and men had the

highest mortality rates. Although both men and

women 80 and over were more likely to be in

42
nursing homes than those in younger age groups,

women SO and over were at significantly higher

risk of nursing home placement than their male

age peers (6,0 percent versus 3.6 percent). Marital status did not affect the death rate, but

nonmarried persons had a higher risk of nursing

home placement than married persons.

Two or more limitations in ADL’s and IADL’s

were associated with risk of death and nursing

home residence (tables 2 and 3, respectively).

Approximately 20 percent of those who in 1984

had two or more limitations in ADL and IADL

were deceased in 1986, and approximately 6–7

percent were institutionalized. Questions about

receipt of help from another person were only

asked of those who reported difficulty in task

performance. Those who received help with two

or more ADL’s or IADL’s in 1984 were more

likely to be deceased in 1986 than those who

received help with only one ADL or IADL.

Although there was no association between nursing home residence in 1986 and the number of

ADL’s help was received within 1984, nursing

home residence in 1986 was more likely for

those who received help for two or more IADL’s

in 1984,

Changes in ADL limitations

Changes in ADL limitations can be analyzed

within two contexts: (a) the total-population

approach, which includes individuals who have

died or become institutionalized over the 2-year

period; and (b) the community-subpopulation

approach, representing those who remain in the

community throughout the 2-year period. Because those with more ADL limitations are more

likely to die or be institutionalized, patterns of

change in ADL limitations may differ by context.

For example, the community subpopulation may

represent a hardier group and thus may exhibit a

higher proportion of improvement in functional

status than in the total population, Policy planners will benefit from knowledge of patterns of

relative stability and change in functional status

of the elderly who are able to maintain themselves in the community.

Within the context of the total-population

approach to nursing home placement and death,

tables 4–8 focus on the degree of population

change in ADL’s. The overall pattern of changes

in difficulties in ADL functioning shows both

positive and negative transitions in functional

abilities among the population aged 70 and over

between 1984 and 1986 (table 4). Among those

without any limitations in 1984, 62 percent remained independent, whereas 21 percent reported some difficulty in 1986. Among those who

reported some difficulty in 1984, 51 percent continued to have difficulties, and 14 percent improved to an independent status. Among those

with no difficulty in ADL functioning in 1984,

1 percent were in nursing homes and 7 percent

died within the next 2 years. Compared with this

group, those who had some difficulty in ADL

functioning in 1984 were at higher risk of being

in a nursing home (5 percent) or deceased

(19 percent) in 1986.

As expected, age was associated with a transition to functional decline. Among those with

no difficulty in 1984, those 80 years of age and

over were less likely than those 70–79 years to

remain independent in 1986 (50 percent versus

66 percent). Similarly, among those with some

difficulty in ADL function in 1984, a smaller

proportion of those 80 years of age and over

improved in functional ability (8 percent versus

19 percent). Differences by sex in decline or

improvement were not significant, however. Because the risks of becoming disabled are similar

for males and females, sex differences in the

national prevalence of disabilities may arise because of the greater longevity of females and

their overrepresentation in the higher age groups

that have the higher risks of disability (2).

These shifts in functional status represent

total-population shifts and thus reflect age- and

.

43
Table A. Percent distribution of persons 70 years of age or over by extent of difficulty in performing

activities of daily living in 1984 and at 1986 recontact for those living in the community between

1984 and 1986

ADL dificulty h 1986

Number in

1984 in No

Age, sex, and ADL difficulty in 1984 thousands difficulty Some

Total

AHlevels of difficulty

No difficulty . . . . . . .

Some difficulty. , . . .

13,472

10,507

2,965

63.1

74.7

22.0

36.9

25.3

78.0

. . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . .

Age

70–79 years:

All levels of difficulty

No difficulty. . . . . . .

Some difficulty. ., . .

10,202

8,341

1,861

67.8

77.1

26.3

32,2

22.9

73.7

. . . . . . . . . . . . . . . . . . . . ...0

. . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . .

80 years and over:

All levels of dificulty

No difficulty, ., . . . .

Some difficulty. . . . .

3,270

2,165

1,105

48.4

65.7

14.6

51.6

34.3

85.4

. . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . .

Sex

Male:

All levels of difficulty

No difficulty . . . . . . .

Some difficulty. . . . .

5,099

4,258

841

66.2

73.9

26.8

33.9

26.1

73.2

. . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . .

Female:

All levels of difficulty

No difficulty . . . . . . .

Some difficulty. . . . .

8,373

6,248

2,124

61,2

75.2

20.1

38.8

24.8

79.9

), .,,...,. . . . . . . . . . .,, ,,,

. . . . . . . . . . . . . . . . . . . . . . . .

,. . . . . . . . . . . . . . . . . . . . . . .

NOTE: ADL is activity of daily living.

sex-linked patterns of mortality and institutionalization. In analyzing only the community

subpopulation, the hypothesis is that because

those who are the oldest and sickest are most

likely to die or be institutionalized, transition

rates among those remaining in the community

may differ. Thus, to assess the association of age

and sex with changes in functional status for

those older persons who resided in the community throughout the 2 years, adjustments for

mortality and institutionalization rates should be

made.

Table A shows the percent distribution of

persons 70 years of age and over performing

44

seven ADL’s in 1984, by functional ability

outcome at 1986 recontact, for only those who

were living in the community at both times. As

in the total-population analysis, age was associated with stability of independence or improvement in functional ability. Among those with no

difficulty in 1984, a smaller proportion of those

80 years of age and over remained independent

in 1986 than those in the group 70–79 years of

age (66 percent versus 77 percent). Among those

with some difficulty in ADL in 1984, a smaller

proportion of those 80 years and over improved

in functional ability compared with the younger

age category (15 percent versus 26 percent),
There were no significant sex differences in

changes in functional abilities for the continuous

community residents. For example, 27 percent

of men who had some ADL difficulty in 1984

reported no difficulty in 1986 compared with

20 percent of the women. The p~tterns of change

among the community subpopulation are similar

to those found in the total population analysis,

although the actual proportions differ as a result

of selection from mortality and institutionalization. Thus, these proportions permit more specific estimates of service needs by age and sex of

those older persons who remain in the

community,

Tables 5-S present descriptions of change in

four specific areas of ADL limitation: bathing,

dressing, walking, and transferring to or from a

bed or chair. Does the total pattern of change in

dependency status by age and sex described

above apply to each specific limitation in the

same way? In general, the answer is yes. Within

each ADL limitation, those 80 years and over

had lower proportions of persons who maintained independence. For example, of those with

no difficulty in 1984, 53 percent in this age

group maintained independence in walking compared with 69 percent among those aged 70-79

(table 7), In table 6, comparable proportions in

maintenance of independence in dressing were

64 percent (80 years and over) and 79 percent

(70-79 years). Similarly, a lower proportion of

those 80 years and over regained independence

across all the specific activities, with differences

between age groups of 10 percent in bathing

(table 5) to 12 percent in walking and transfer

(tables 7 and 8). There w~ no significant sex

differences in stability of independence and proportion improved within each specific ADL

limitation.

Changes in IADL limitations

Limitations in the IADL’s reflect inability to

perform social maintenance and homemanagement activities. Because performance of

these activities is conditioned in part by social

roles and reasons other than disability, persons

reported as not performing the activity were not

classified with those who had difficulty in

performance.

Changes in IADL activities (tables 9-12)

follow the general patterns observed for ADL

limitations. Those aged 80 and over with no

difficulty in 1984 were more likely than those

aged 70–79 to develop some difficulties in IADL’s

by 1986. Differences between men and women

were not significant. Similar proportions of men

and women retained their ability over the 2-year

period to carry out meal preparation, shopping,

and heavy housework,

Table B shows the percent distribution of

persons 70 and over performing IADL’s in 1984

by functional ability outcome at 1986 recontact

for only those who were living in the community

at both times. As in the total-population analysis

of IADL limitations, age was associated with

little change in independence or improvement in

home-management abilities. Among those with

no difficulty in 1984, a smaller proportion of

those 80 years of age and over remained independent in 1986 than those in the group aged

70-79 (54 percent versus 72 percent). Among

those with some difficulty in IADL’s in 1984, a

smaller proportion of those 80 years and over

improved in functional ability compared with the

younger age category (12 percent versus 18 percent). There were no significant sex differences

in changes in functional abilities for the continuous community residents. For example, 16 percent of both men and women who had some

IADL difficulty in 1984 reported no difficulty in

1986. As with the analysis of ADL limitations,

the patterns of change among the community

subpopulation were similar to those found in the

total-population analysis, although the actual

proportions differed as a result of selection from

mortality and institutionalization.

45

51 percent of the women, Furthermore, almost

23 percent of the men improved in function

compared with only 13 percent of the women.

In sum, the pattern of stability and change in

functional limitations, risk of institutionalization, and death are complex. The data confirm

the oft-observed associations between age, sex,

and functional limitations with mortality and risk

of institutionalization. At the level of individual

changes in functional limitations at the time of

2-year followup, however, men and women show

similar rates of decline and improvement in

functional limitations, with the exception of difficulties in lifting. Men were more likely to have

no difficulty and to improve in the lifting function over the 2-year period.

References

1. Harris T, Kovar MG, Suzman R, et al. Longitudinal study of physical ability in the oldest-old.

Am J Public Health 79(6):698-702. 1989.

2. Manton K. A longitudinal study of functional

change and mortality in the United States. J

Gerontol 43(5):S153-61. 1988.

3. Branch L, Katz S, Kniepmann K, Papsider J. A

prospective study of functional status among community elders. Am J Public Health 74(3):266–8.

1984.

4. Mor V, Murphy J, Masterson-Allen WC, et al,

Risk of functional decline among well elders. J

Clin Epidemiol 42(9):895-904. 1989,

5. Hing E, Sekscenski E, Strahan G. The National

Nursing Home Survey, 1985 summary for the

United States. Vital Health Stat 13(97). Washington: National Center for Health Statistics. 1989.

47
Table 1. Percent distribution of persons 70 years of age and over in 1984 by outcome at 1986

recontact, according to age, sex, and 1984 marital status: United States

[Data are based on 1986 telephone followup of 1984 household interviews of the civilian noninstitutionalized

population]

Outcome at 1986 recontact

Alive and In

Total living in the nursing

Age, sex, and marital status in 1984 community 1 Deceased hem.@ Unknown 3

Age in 1984

70–74 years . . . . . . . . . . . . . . . . . . .

75–79 years . . . . . . . . . . . . . . . . . . .

70–79 years . . . . . . . . . . . . . . . . . . .

80–84 years . . . . . . . . . . . . . . . . . . .

80 years and over. ., ., ..,,,,...

85 years and over . . . . . . . . . . . . . .

Sex

Male, . . . . . . . . . . . . . . . . . . . . . . . .

Female. . . . . . . . . . . . . . . . . . . . . . .

Male

70–79 years . . . . . . . . . . . . . . . . . . .

80 years and over . . . . . . . . . . . . . .

Female

70–79 years, . . . . . . . . . . . . . . . . . .

80 years and over. . . . . . . . . . . . . .

Marital status in 19844

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

Not married . . . . . . . . . . . . . . . . . . .

Number in

thousands Percent distribution

7,190

5,311

12,501

2,941

4,834

1,893

6,711

10,624

5,135

1,576

7,366

3,258

8,308

8,984

84.9 6.7 0.7 7.7

80.0 9.5 1.6 9.0

82.8 7.9 1.0 8.2

72.2 15.4 4.3 8.1

69.1 17.2 5,2 8.5

64.2 20.1 6,7 9,0

76.9 14.0 1,4 7.7

80.3 8.3 2.7 8.7

80.4 11.1 *0,7 7.8

65.4 23.4 3.6 7.6

84.5 5.7 1.3 8,6

70.8 14.3 6.0 8.9

81.6 10.6 1.1 6.8

76.6 10.4 3.3 9.7

‘Includes persons hospitalized at time of recontact.

‘Excludes persons discharged from nursing homes prior to recontact.

31ncludes persons not located in 1986.

4Excludes persons whose marital status was unknown,

SOURCE: National Center for Health Statistics: Data from the National Health Interview Survey 1984 Supplement on Aging and

1986 Longitudinal Study on Aging.

48
Table 2. Percent distribution of persons 70 years of age and over in 1984 by outcome at 1986

recontact, according to number of activities of daily living for which difficulty or the help of another

person was reported in 1984: United States

[Data are based on 1986 telephone followup of 1984 household interviews of the civilian noninstitutionalized

population]

Outcome at 1986 recontact

Alive and In

1984 ADL status and number Total living in the nursing

of ADL’s with difficulty in 1984 community 1 Deceased home 2 Unknown 3

Number in

With difficulty thousands Percent distribution

None, ,, . . . . . . . . . . . . . . . . . . . . . . . . 12,643 83.5 7.3 1.1 8.1

1,,, ,,, ,,, ,,, ,., ,., . . . . . . . . . . . . . 1,697 70.8 15.9 4.2 9.1

2 or more, . . . . . . . . . . . . . . . . . . . . . . . 2,898 64.5 21.3 5.8 8.3

Help of another person received

1,,, ,,, .,.., . . . . . . . . . . . . . . . . . . . . 772 63.9 19.0 7.3 9.8

2 or more, ) . . . . . . . . . . . . . . . . . . . . . . 1,244 55.7 31.3 7,2 5.9

‘Includes persons hospitalized at time of recontact.

2Excludes persons discharged from nursing homes prior to recontact.

31ncludes persons not located in 1986,

4Excludes those for whom information was missing on all ADL’s.

NOTES: Persons reported as not performing an activity of daily living (ADL) were classified with those reported as having

difficulty with that ADL, ADL’s include eating, toileting, dressing, bathing, walking, getting in and out of a bed or chair, and

getting outside,

SOURCE: National Center for Health Statistics: Data from the National Health Interview Survey 1984 Supplement on Aging and

1986 Longitudinal Study on Aging.

49
Table 3. Percent distribution of persons 70 years of age and over in 1984 by outcome at 1986

recontact, according to number of instrumental activities of daily living for which difficulty or the

help of another person was reported in 1984: United States

[Data are based on 1986 telephone followup of 1984 household interviews of the civilian noninstitutionalized

population]

Outcome at 1986 recontact

A/ive and In

1984 IADL status and number Total living in the nursing

of /ADL’s with difficulty in 1984 community 1 Deceased home 2 Unknown 3

Number in

With difficulty thousands Percent distribution4

None . . . . . . . . . . . . . . . . . . . . . . . . . . . 11,818 83.1 7.5 1,2 8,2

1. . . . . . . . .0, ,, .,. ., .!.... . . . . . . . 2,692 78.7 10.7 2,0 8,6

2 or more, . . . . . . . . . . . . . . . . . . . . . . . 2,716 61.9 23.0 7.1 8.1

Help of another person received

1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,052 78.6 11.6 2,2 7.7

2 or more . . . . . . . . . . . . . . . . . . . . . . . . 2,999 62.7 22.7 6.7 8.0

‘Includes persons hospitalized at time of recontact,

2Excludes persons discharged from nursing homes prior to recontact.

31ncludes persons not located in 1986.

4Excludes those for whom information was missing on all IADL’s,

NOTES: Persons reported as not performing an instrumental activity of daily living (IADL) were not classified with those reported

as having difficulty with that IADL. IADL’s include meal preparation, shopping, managing money, using the telephone, light

housework, and heavy housework.

SOURCE: National Center for Health Statistics: Data from the National Health Interview Survey 1984 Supplement on Aging and

1986 Longitudinal Study on Aging.

50
TabIe 4. Percent distribution of persons 70 years of age and over in 1984 by outcome at 1986 recontact, according to sex, age,

and extent of difficulty with performing activities of daily living reported in 1984: United States

[Data are based on 1986 telephone followup of 1984 household interviews of the civilian noninstitutionalized population]

Outcome at 1986 recontact

Extent of difficulty with ADL’s reported for

persons alive and living in the commurrityl

Some

No help of Help of In

Sex, age, and extent of difficulty Total another another nursing

with ADL’s reported in 1984 in 1984 None Total person received person received Deceased hom~ Unknowr$

Both sexes, 70 years and over

Number in

thousands Percent distribution

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

No difficulty . . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty . . . . . . . . . . . . . . . . . . . . . .

No help of another person received. . .

Help of another person received . . . . .

Both sexes, 70-79 years

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

No difficulty . . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty . . . . . . . . . . . . . . . . . . . . . .

No help of another person received. . .

Help of another person received . . . . .

Both sexes, 80 years and over

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

No difficulty . . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty . . . . . . . . . . . . . . . . . . . . . .

No help of another person received. . .

Help of another person received . . . . .

Male, 70 years and over

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

Nodifliculty . . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty . . . . . . . . . . . . . . . . . . . . . .

No help of another person received. . .

m Helpher person received. . . . . . . . . . . .

17,166

12,643

4,523

3,416

1,108

12,393

9,794

2,599

2,043

556

4,773

2,849

1,924

1,373

552

6,649

5,277

1,372

1,021

351

49.5

62.1

14.4

16.5

7.9

55.8

65.6

18.8

20.7

11.9

33.2

49.9

8.4

10.2

*4.O

50.7

59.7

16,4

18.2

*11.3

29.0

21.0

51.2

51.7

49.5

26.5

19.5

52.8

53.1

51.4

35.3

26.1

49.0

49.6

47.5

25.9

21.1

44.9

47.1

38.2

24.5

18.4

41.3

44.8

30.2

23.3

17.9

43.5

47.1

30.1

27.5

20.3

38.3

41.5

30.3

22.3

19.0

35.2

39.6

22.3

4.5

2.6

9.9

6.9

19.3

3.2

1.6

9.3

6.0

21.3

7.8

5.8

10.7

8.1

17.2

3.6

2.1

9.7

7.5

15.9

10.5

7.3

19.4

16.2

29.4

7.9

5.8

15.7

13.6

23.3

17.2

12.3

24,4

20.0

35.4

13.9

10.3

27.5

23.0

40.4

2.2

1.1

5.3

4.9

6.4

1.1

0.6

2.7

1.7

*6.2

5.3

2.9

8.8

9.7

6.6

1.4

0.8

3.9

4.2

*3.1

8.8

8.5

9.8

10.7

6.8

8.8

8.4

10.0

10.8

7,2

9.0

8.8

9.4

10.6

6.5

8.1

8.2

7.3

7.5

*6.9
H Table 4. Percent distribution of persons 70 years of age and over in 1984 by outcome at 1986 recontact, according to sex, age,

and extent of difficulty with performing activities of daily living reported in 1984: United States —Con.

[Data are based on 1986 telephone followup of 1984 household interviews of the civilian noninstitutionalized population]

Outcome at 1986 recontact

Extent of difficulty with ADL’s reported for

persons alive and living in the community~

Some

No help of Help of In

Sex, age, and extent of difficulty Total another another nursing

with ADL’s reported in 1984 in 1984 None Total person received person received Deceased homr$ Unknown4

Male, 70–79 years

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

Nodifficulty . . . . . . . . . . . . . . . . . . . . . .

Some difficulty. . . . . . . . . . . . . . . . . . . .

No help of another person received.

Help of another person received . . .

Male, 80 years and over

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

Nocfifficulty . . . . . . . . . . . . . . . . . . . . . .

Some difficulty. . . . . . . . . . . . . . . . . . . .

No help of another person received.

Help of another person received ., .

Female, 70 years and over

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

No difficulty . . . . . . . . . . . . . . . . . . . . . .

Some difficulty. . . . . . . . . . . . . . . . . . . .

No help of another person received.

Help of another person received . . .

Female, 70-79 years

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

Nodifficuky. . . . . . . . . . . . . . . . . . . . . .

Some difficulty. . . . . . . . . . . . . . . . . . . .

No help of another person received.

Help of another person received . . .

. .

. .

. .

. .

. .

. .

. .

. .

. .

. .

. .

. .

. .

. .

. .

. .

. .

. .

. .

. .

Number in

thousands Percent distribution

5,087

4,222

865

643

222

1,562

1,055

507

378

129

10,517

7,366

3,151

2,395

756

7,306

5,571

1,734

1,401

334

55.9

62.8

22.1

24.3

*15.8

33.9

47.0

6.7

7.7

*3.7

48.8

63.8

13.5

15,8

6.4

55.8

67.8

17.2

19.1

*9.3

24.2

20.1

44.5

46.5

38.8

31.7

25.0

45.4

48.3

37.2

30.9

21.1

53.9

53.7

54.7

28.1

19.2

56.9

56.2

59.8

21.6

18.5

36.6

40.4

25.8

24.8

20.9

32.7

38.4

16.3

25.8

18.1

43.9

47.1

33.9

24.4

17.5

46.9

50.2

33.0

2.6

*1.6

7.9

*6.1

*13.O

6.9

4.1

12.7

9.9

20.9

5.1

3.0

10.0

6.6

20.8

3.7

1.7

10.0

6.0

26.8

11.0

8.1

25.0

20.6

37.5

23.2

19.1

31.7

27.0

45.5

8.3

5.1

15.8

13.3

24.2

5.7

4.0

11.1

10.4

13.9

0.7

*0.5

*2.O

*2.1

*2.O

3.6

*2.O

7.1

*7.8

*5.O

2.7

1.4

5.9

5.2

8.0

1.3

0.7

3.0

*1.6

*9.O

8.2

8.6

6.3

*6.5

*5.8

7.7

7.0

9.1

9.2

*8.7

9.3

8.7

10.8

12.1

6.8

9.2

8.3

11.9

12.8

*8.1
Female, 80 years and over

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,211 32.8 37.2 28.9 8.3 14.3 6.1 9.7

Nodticuky. . . . . . . . . . . . . . . . . . . . . . . . 1,794 51.6 26.8 19.9 6.9 8.3 3.4 9.9

Some difficulty . . . . . . . . . . . . . . . . . . . . . . 1,417 9.0 50.3 40.3 10.0 21.8 9.4 9.5

No help ofanother person received . . . 994 11.1 50.1 42.7 7.4 17.3 10.4 11.1

Help of another person received . . . . . 423 *4.1 50.7 34.6 16.1 32.3 7.1 5.8

I[nc[udes persons hospitalized attime Ofreccmtact.

‘Excludes persons for whom status of difficultyin 1984 was unknown.

3Excludes persons discharged from nursing homes prior to recontact.

41ncIudes persons not located in 1986.

NOTES: Persons reported as not performing an activity of daily living (ADL) were classified with those reported as having difficulty with that ADL. ADL’s include eating,

toileting, dressing, bathing, walking, getting in and out of a bed or chair, and getting outside.

SOURCE: National Center for Health Statistics: Data from the 1986 Longitudinal Study on Aging.
Table 5. Percent distribution of persons 70 years of age and over in 1984 by outcome at 1986 recontact, according to sex, age,

and extent of difficulty with bathing reported in 1984: United States

[Data are based on 1986 telephone followup of 1984 household interviews of the civilian noninstitutionalized population]

Outcome at 1986 recontact

Extent of difficulty with bathing reported for persons

alive and living in the communityl

Some

No help of Help of In

Sex, age, and extent of difficulty with Total another another

bathing reported in 19842

nursing

in 1984 None Total person received person received Deceased hom~ Unknown4

Both sexes, 70 years and over

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

No difficulty. . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty. . . . . . . . . . . . . . . . . . . . . .

No help of another person received. . . .

Help of another person received . . . . . .

Both sexes, 70–79 years

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

No difficulty . . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty. . . . . . . . . . . . . . . . . . . . . .

No help of another person received. . . .

Help of another person received . . . . . .

Both sexes, 80 years and over

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

No difficulty . . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty. . . . . . . . . . . . . . . . . . . . . .

No help of another person received. . . .

Help of another person received . . . . . .

Mate, 70 years and over

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

No difficulty . . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty. . . . . . . . . . . . . . . . . . . . . .

No help of another person received. . . .

Help of another person received . . . . . .

Number in

thousands Percent distribution

17,221

15,187

2,034

775

1,259

12,427

11,409

1,019

470

548

4,794

3,778

1,016

305

711

6,662

6,114

549

169

380

66.4

72.6

19.7

33.2

11.4

72.7

77.0

24.7

37.1

14.0

50.0

59.4

14.8

27.2

9.4

66.8

71.1

18.6

29.4

13.8

12.4

8.9

37.9

36.0

39.2

10.0

7.2

42.1

40.0

43.9

18.5

14.4

33.8

29.8

35.6

10.3

8.3

32.1

32.0

32.1

5.0

4.2

10.9

23.4

3.3

4.8

3.8

16.3

29.9

*4.7

5.5

5.5

5.5

13.4

2.2

4.3

3.8

9.4

*20.1

*4.7

7.4

4.7

27.0

12.6

35.9

5.2

3.4

25.8

10.1

39.2

13.0

8.9

28.3

16.4

33.4

6.0

4.5

22.7

*11.9

27.4

10.5

8.5

25.0

12.8

32.5

7.9

6.9

19.2

11.0

26.2

17.2

13.6

30.9

15.7

37.4

13.9

11.6

39.2

30.5

43.0

2.2

1.6

6.6

4.5

7.8

1.1

0.9

*3.2

*6.O

5.2

4.0

9.9

11.5

9.2

1.4

1.2

*3.6

*2.6

*4.O

8.6

8.3

10.8

13.5

9.1

8.4

8.2

10.9

12.0

9.9

9.1

8.7

10.7

15.8

8.5

7.7

7.8

6.6

*5.5

*7.2
Male, 70-79 years and over

Tofaf. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nod%iculty . . . . . . . . . . . . . . . . . . . . . . . .

Some d.ficulty . . . . . . . . . . . . . . . . . . . . . .

No help ofanother person received. . . .

Help of another person received . . . . . .

Male, 80years and over

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

No difficulty . . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty. . . . . . . . . . . . . . . . . . . . . .

No help of another person received. . . .

Help of another person received . . . . . .

Female, 70years andover

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

No difficulty . . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty. . . . . . . . . . . . . . . . . . . . . .

No help of another person received. . . .

Help of another person received . . . . . .

Female, 70-79 years

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

No difficulty . . . . . . . . . . . . . . . . . . . . . . . .

Some diticulty.. . . . . . . . . . . . . . . . . . . . .

No help of her person received . . . . . . .

Help of another person received . . . . . .

Female, 80years andover

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

No difficulty . . . . . . . . . . . . . . . . . . . . . . . .

Some difficuky.. . . . . . . . . . . . . . . . . . . . .

No help of another person received. . . .

Help of another person received . . . . . .

5,096

4,798

297

110

187

1,567

1,315

251

58

193

10,559

9,073

1,485

606

879

7,331

6,610

721

360

361

3,227

2,463

764

246

518

72.0

75.1

22.3

*32.4

*1 6.3

49.8

56.6

14.2

*23.7

*11.4

66.1

73.6

20.1

34.2

10.4

73.1

78.3

25.6

38.5

12.8

50.1

61.0

14.9

28.0

8.7

8.6

7.0

34.2

*32.7

35.3

15.6

12.9

29.5

*30.7

29.1

13.7

9.4

40.2

37.1

42.2

11.0

7.3

45.3

42.2

48.4

19.9

15.2

35.2

29,5

37.9

3.8

3.3

*12.1

*24.8

*4.7

5.7

5.6

*6.2

*1 1.2

*4.7

5,5

4.5

11.5

24.3

*2.6

5.5

4.2

18.0

31.4

*4.7

5.4

5.5

5.3

13.9

*1 .2

4.8

3.7

22.1

*7.9

30.6

9.9

7.3

23.3

*19.5

24.4

8.2

4.9

28.7

12.8

39.6

5.5

3.1

27.3

*10.8

43.7

14.5

9.7

29.9

15.6

36.7

11.0

9.4

36.7

*28.6

41.6

23.3

19.7

42.0

34.3

44.3

8.3

6.5

19.8

7.9

28.0

5.7

5.0

11.9

*5.5

18.3

14.3

10.3

27.2

11.3

34.8

*0.7

*0.7

*1.5

*2.4

3.6

3.2

*6.1

*7.6

*5.6

2.7

1.9

7.6

5.1

9.4

1.3

1.0

*3.9

*7.9

6.0

4.4

11.1

12.4

10.5

7.7

7.8

*5.3

*6.4

*4.6

7.8

7.7

*8.3

*3.8

*9.7

9.1

8.6

12.3

15.7

9.9

8.9

8.4

13.2

13.7

12.6

9.8

9.2

11.4

18.7

8.0

‘Includes persons hospitalized at time of recontact.

2Excludes persons for whom status ofdifficultyin 1984 was unknown.

3Excludes persons discharged from nursing homes prior to recontact.

41ncludespersons not located in 1986.

NOTE: Persons reported as notperforming an activity were classified with those reported as having difficulty with that activity.

SOURCE: National Center for Health Statistics: Datafromthe 1986 Longitudinal Study on Aging.

u’!

(n
8 Table 6. Percent distribution of persons 70 years of age and over in 1984 by outcome at 1986 recontact, according to sex, age,

and extent of difficulty with dressing reported in 1984: United States

[Data are based on 1986 telephone followup of 1984 household interviews of the civilian noninstitutionalized population]

Outcome at 1986 recontact

Extent of difficulty with dressing reported for

persons alive and living in the communityl

Some

No help of Help of in

Sex, age, and extent of difficulty with Total another person another

dressing reported in 19842 in 1984 None Total

nursing

received person received Deceased hom~ Unknowr#

Both sexes, 70 years and over

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

No difficulty . . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty. . . . . . . . . . . . . . . . . . . . . .

No help of another person received. . . .

Help of another person received . . . . . .

Both sexes, 70–79 years

TotaL . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nodifficulty . . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty. . . . . . . . . . . . . . . . . . . . . .

No help of another person received. . . .

Help of another person received . . . . . .

Both sexes, 80 years and over

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

No difficulty . . . . . . . . . . . . . . . . . . . . . . . .

Some difficuky.. . . . . . . . . . . . . . . . . . . . .

No help of another person received. . . .

Help of another person received . . . . . .

Male, 70 years and over

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

Nodifficuky. . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty . . . . . . . . . . . . . . . . . . . . . .

No help of another person received. . . .

Help of another person received . . . . . .

Number in

thousands Percent distribution

17,214

15,988

1,226

337

889

12,427

11,791

636

181

455

4,786

4,197

589

156

434

6,667

6,260

407

70

336

71.4

75.1

23.4

40.5

17.0

76.4

79.0

28.3

46.1

21.2

58.6

64.2

18.2

34.0

12.5

70.3

73.1

27.5

49.0

23.1

7.5

5.6

32.2

17.8

37.7

6.4

4.7

38.3

16.0

47.0

10.2

8.1

25.7

19.7

27.9

6.9

5.6

27.1

*13.7

29.9

2.8

2.5

7.0

12.2

5.0

2.5

2.2

9.4

*14.8

*7.2

3.5

3.4

4.4

*9.1

*2.7

2.6

2.3

*7.1

*6.7

*7.2

4.7

3.1

25.2

*5.6

32.7

3.9

2.5

28.9

*1 .2

39.8

6.7

4.7

21.3

*1 0.6

25.2

4.3

3.3

20.0

*7.O

22.7

10.5

9.1

28.5

13.6

34.2

7.9

7.3

19.0

*8.7

23.1

17.2

14.2

38.8

19.2

45.8

13.8

12.4

36.9

*1 8.6

40.7

2.2

1.8

6.9

10.5

5.5

1.1

0.9

*4.1

*3.9

*4.2

5.1

4.5

9.9

18.3

6.9

1.4

1.3

*3.2

*9.3

*2.O

8.5

8.4

9.0

17.7

5.7

8.3

8.2

10.4

25.3

*4.5

8.9

9.1

7.4

*8.8

6.9

7.6

7.7

*5.3

*9.5

*4.4
Male, 70-79 years

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

Nodifficulty . . . . . . . . . . . . . . . . . . . . . . . .

Some d-ficulty . . . . . . . . . . . . . . . . . . . . . .

No help ofanother person received. . . .

Help of another person received . . . . . .

Male, 80years and over

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

No difficulty . . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty. . . . . . . . . . . . . . . . . . . . . .

No help ofanother person received. . . .

Help of another person received . . . . . .

Female, 70 yearsand over

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

No difficulty . . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty. . . . . . . . . . . . . . . . . . . . . .

No help ofanother person received.. . .

Help of another person received . . . . . .

Female, 70–79 years

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

No difficulty . . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty. . . . . . . . . . . . . . . . . . . . . .

No help ofanother person received. . . .

Help of another person received . . . . . .

Female, 80years andover

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

No difficulty . . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty. . . . . . . . . . . . . . . . . . . . . .

No help ofanother person received. . . .

Help of another person received . . . . . .

5,100

4,856

244

41

204

1,567

1,404

162

29

133

10,547

9,728

819

267

552

7,327

6,935

392

140

251

3,220

2,792

427

126

301

74.5

76.5

34.4

67.2

27.8

56.9

61.4

17.2

*23.7

*1 5.8

72.1

76.4

21.4

38.3

13.2

77.7

80.8

24.4

39.9

*1 5.8

59.4

65.7

18.6

36.4

11.1

6.3

5.0

31.5

*6.1

36.5

8.6

7.2

20.6

24.1

19.8

7.9

5.6

34.8

18.8

42.4

6.5

4.4

42.5

18.9

55.5

11.0

8.5

27.6

18.7

31.5

2.5

2.1

*10.O

*6.1

*10.7

2.8

2.8

*2.9

*7.5

*1.9

3.0

2.6

6.9

13.6

*3.6

2.6

2.2

*9.O

*17.3

*4.3

3.8

3.7

*4.9

*9.5

*3.1

3.8

2.9

21.5

25.8

5.8

4.4

17.7

*16.6

17.9

4.9

3.0

27.9

*5.2

38.8

3.9

2.2

33.5

*1.6

51.2

7.2

4.8

22.7

*9.2

28.4

11.0

10.1

27.7

*16.O

30.0

23.3

20.1

50.7

*22.3

57.0

8.3

7.0

24.4

12.3

30.2

5.7

5.3

13.6

*6.6

17.5

14.3

11.2

34.3

18.5

40.9

*0.7

*0.7

*1.8

*2.2

3.6

3.4

*5.4

*22.3

*1.6

2.7

2.2

8.7

10.8

7.7

1.3

1.0

*5.6

*5.O

*5.9

5.9

5.0

11.6

*17.3

9.2

7.6

7.7

*4.7

*10.8

*3.5

7.6

7.8

*6.2

*7.6

*5.8

9.0

8.9

10.8

19.8

*6.4

8.8

8.5

14.0

*29.5

*5.3

9.5

9.7

7.9

*9.1

*7.4

‘Includes persons hospitalized at time of recontact.

2Excludes persons for whom status of difficultyin 1984 was unknown.

3Excludes persons discharged from nursing homes prior to recontact.

41ncludes persons not located in 1986.

NOTE: Persons reported as notperforming an activity were classified with those reported as having difficulty with that activity.

SOURCE: National Center for Health Statistics: Data from the 1986 Longitudinal Study on Aging.

m

-1
(n

w Table 7. Percent distribution of persons 70 years of age and over in 1984 by outcome at 1986 recontact, according to sex, age,

and extent of difficulty with walking reported in 1984: United States

[Data are based on 1986 telephone followup of 1984 household interviews of the civilian noninstitutionalized population]

Outcome at 1986 recontact

Extent of difficulty with walking reported for

persons alive and living in the communityl

Some

No help “of Help of In

Sex, age, and extent of difficulty with Total another person another nursing

walking reported in 1984 in 1984 None Total received person received Deceased hom~ Unknown4

Both sexes, 70 years and over

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

No difficulty . . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty . . . . . . . . . . . . . . . . . . . . . .

No help of another person received. . . .

Help of another person received . . . . . .

Both sexes, 70–79 years

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

No difficulty . . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty . . . . . . . . . . . . . . . . . . . . . .

No help of another person received. . . .

Help of another person received . . . . . .

Both sexes, 80 years and over

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

No difficulty . . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty . . . . . . . . . . . . . . . . . . . . . .

No help of another person received. . . .

Help of another person received . . . . . .

Male, 70 years and over

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

No difficulty . . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty . . . . . . . . . . . . . . . . . . . . . .

No help of another person received. . . .

Help of another person received . . . . . .

Number in

thousands Percent distribution

17,176

13,414

3,763

2,787

975

12,403

10,231

2,172

1,712

460

4,773

3,182

1,591

1,076

515

6,651

5,504

1,147

878

269

55.3

65.0

20.8

24.7

9.8

61.2

68.6

26.1

29.8

*12.2

40.0

53.2

13.7

16.7

7.6

55.7

62.4

23.1

27.8

*7.6

23,3

17.2

45.0

44.7

46.0

21,4

16.1

45.7

44.5

50.7

28.4

20.6

44.0

45.1

41.8

21.1

17.5

38.5

39.6

35.3

17.9

14.4

30.1

33.7

19.8

17.5

14.3

32.3

34.9

22.9

18.9

14.8

27.1

31.9

17.0

17.8

15.7

27.8

30.6

19.0

5.4

2.8

14.9

11.0

26.2

3.9

1.8

13.4

9.6

27.8

9.5

5.8

16.9

13.2

24.8

3.3

1.8

10.7

9.0

16.3

10.5

8.3

18.2

14.7

28.2

7.8

6.5

14.1

12.1

21.4

17.3

14.0

23.8

18.8

34.2

13.9

11.3

26.0

20.2

44.7

2.2

1.3

5.2

4.6

7.0

1.0

0.7

2.7

*1.9

*5.8

5.2

3.6

8.5

8.8

8.0

1.4

0.9

3.9

4.1

*3.2

8.8

8.2

10.8

11.3

9.1

8.7

8.1

11.4

11.8

10.0

9.1

8.7

9.9

10.7

8.4

8.0

7.9

8.6

8.3

*9.3
Male, 70-79 years

Total . . . . . . . . . . . . . . . . . ..--... . . . .

No dficulty . . . . . . . . . . . . . . . . . ..- . .

Some difficulty. . . . . . . . . . . . . . . . . . . .

No help ofanother person received..

Help ofanother person received . . . .

60.6

65.8

29.2

35.0

*9.4

39.7

49.7

12.5

15.1

*4.6

55.1

66.7

19.9

23.3

10.6

61.6

70.7

24.5

27.2

*1 3.7

40.2

55.1

14.2

17.3

8.4

19.8

16.8

38.3

37.4

41.1

17.1

15.1

29.6

30.4

*26.8

2.7

1.7

8.7

‘7.0

*14.3

10.9

8.9

23.2

18.5

39.0

*0.7

*0.4

*2.4

*2.4

*2.7

8.0

8.2

7.0

*6.7

*7.9

5,089

4,363

726

561

165

1,562

1,141

421

317

104

10,526

7,910

2,616

1,909

706

7,314

5,868

1,446

1,151

295

3,212

2,042

1,170

759

411

Male, 80years and over

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

No difficulty . . . . . . . . . . . . . . . . . . . . . .

Some difficulty. . . . . . . . . . . . . . . . . . . .

No help ofanother person received. .

Help ofanother person received . . . .

8.1

6.9

11.3

11.3

*11.6

5.4

*2.1

*14.2

12.4

*19.5

23.3

20.6

30.8

23.3

53.6

3.6

2.6

*6.4

*7.2

*4.1

25.3

20.2

39.0

43.2

26.1

19.9

18.1

24.8

30.8

*6.6

Female, 70years andover

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

No difficulty . . . . . . . . . . . . . . . . . . . . . .

Some difficulty. . . . . . . . . . . . . . . . . . . .

No help ofanother person received. .

Help of another person received . . . .

2.7

1.7

5.7

4.8

8.4

9.3

8.4

11.7

12.7

9.1

24.7

17.1

47.9

47.1

50.1

17.9

13.6

31.1

35.2

20.1

6.8

3.5

16.8

11.9

30.0

8.3

6.2

14.8

12.2

21.9

Female,70-79years

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

No difficulty . . . . . . . . . . . . . . . . . . . . . .

Some difficulty. . . . . . . . . . . . . . . . . . . .

No help of another person received. .

Help ofanother person received . . . .

5.7

4.7

9.5

9.0

*11.5

1.2

0.8

*2.9

*1 .7

*7.5

9.1

8.0

13.6

14.3

*11.2

22.4

15.8

49.5

47.9

56.1

17.7

13.8

33.7

37.1

20.7

4.7

2.0

15.8

10.8

35.4

Female 80 years and over

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

No difficulty . . . . . . . . . . . . . . . . . . . . . .

Some difficulty . . . . . . . . . . . . . . . . . . . .

No help of another person received. .

Help ofanother person received . . . .

11.6

7.9

17.9

13.5

26.1

18.4

12.9

27.9

32.4

19.6

14.3

10.3

21.3

17.0

29.3

6.0

4.1

9.3

9.4

9.0

9.6

9.7

9.4

10.4

7.6

30.0

20.8

45.8

45.9

45.7

‘Includes persons hospitalized at time of recontact.

2Excludes persons for whom status of difficulty in 1984 was unknown.

3Excludes persons discharged from nursing homes prior to recontact.

41ncludes persons not located in 1986.

NOTE: Persons reported as not performing an activity were classified with those reported as having difficulty with that activity.

SOURCE: National Center for Health Statistics: Data from the 1986 Longitudinal Study on Aging.
8 Table 8. Percent distribution of persons 70 years of age and over in 1984 by outcome at 1986 recontact, according to sex, age,

and extent of difficulty with transferring reported in 1984: United States

[Data are based on 1986 telephone followup of 1984 household interviews of the civilian noninstitutionalized population]

Outcome at 1986 recontact

Extent of difficulty with transferring reported for

persons alive and living in the community

Some

No help of Help of

Sex, age, and extent of difficulty with Total

In

another another

transferring reported in 19842

nursing

in 1984 None Total person received person received Deceased hom$ Unknown4

Both sexes, 70 years and over

Total. . . . . . . . . . . . . . . . . . . . . . . . . . . . .,

No difficulty. . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty. . . . . . . . . . . . . . . . . . . . . .

No help of another person received. . . .

Help of another person received . . . . . .

Both sexes, 70–79 years

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

No difficulty . . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty . . . . . . . . . . . . . . . . . . . . . .

No help of another person received. . . .

Help of another person received . . . . . .

Both sexes, 80 years and over

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

No difficulty . . . . . . . . . . . . . . . . . . . . . . . .

Some diffkulty.. . . . . . . . . . . . . . . . . . . . .

No help of another person received. . . .

Help of another person received . . . . . .

Male, 70 years and over

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

Nodifficulty . . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty . . . . . . . . . . . . . . . . . . . . . .

No help of another person received. . . .

Help of another person received . . . . . .

Number in

thousands Percent distribution

17,204

15,578

1,625

1,021

604

12,412

11,513

899

601

298

4,791

4,065

727

420

307

6,662

6,264

398

217

181

66.3

70.7

23.6

28.8

14.7

71.4

74.8

28.6

34.1

17.6

52.8

59.2

17.3

21.2

11.9

66.8

69.6

23.0

31.3

*13.1

12.5

10.1

35.9

37.6

33.1

11.2

9.1

38.9

39.0

38.5

15.9

12.9

32.3

35.6

27.7

10.1

8.8

30.8

35.6

25.0

8.6

7.5

19.9

29.3

*4.1

8.1

6.9

23.3

32.6

*4.4

10.0

8.9

15.8

24.6

*3.7

7.2

6.5

17.6

30.1

*2.5

3.9

2.6

16.0

8.3

29.0

3.1

2.2

15.6

*6.4

34.1

5.9

4.0

16.5

11.0

24.0

2.9

2.3

13.2

*5.5

22.5

10.4

9.2

22.7

15.3

35.2

7.8

7.1

17.1

12.8

25.7

17.2

15.0

29.6

18.8

44.4

13.8

12.4

35.6

24.0

49.5

2.2

1.8

6.6

5.6

8.4

1.1

0.9

*2.7

*8.O

5.3

4.1

11.5

13.6

8.7

1.4

1.2

*5.O

*5.2

*4.8

8.6

8.3

11.2

12.7

8.7

8.5

8.1

12.8

14.0

*1 0.2

8.9

8.8

9.4

10.9

*7.3

7.9

8.0

*5.7

*4.O

*7.7
Male, 70-79 years

9.7

8.6

32.2

*30. I

35.0

7.1

6.5

*18.8

*30. I

*4.3

2.6

2.1

*1 3.4

—

*30.7

10.9

10.1

27.9

*19.8

38.4

*0.7

*0.7

*1.8

*4.2

7.9

8.0

*5.5

*6.5

*4.2

5,098

4,858

240

135

105

1,564

1,407

158

82

76

10,541

9,314

1,227

804

423

7,314

6,656

658

466

193

3,227

2,658

569

338

231

70.9

72.8

32.6

43.7

*18.3

53.6

58.7

*8.4

*1O.7

*6. O

65.9

71.5

23.7

28.1

15.4

71.9

76.3

27.2

31.3

*17.2

52.4

59.4

19.7

23.7

13.9

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

No difficulty . . . . . . . . . . . . . . . . . . . . . . . .

Some dfilculty . . . . . . . . . . . . . . . . . . . . . .

No help of another person received. . . .

Help of another person received . . . . . .

Male, 80 years andover

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

No difficulty . . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty . . . . . . . . . . . . . . . . . . . . . .

No help ofanother person received.. . .

Help of another person received . . . . . .

7.8

8.0

*6.1

7.6

6.7

15.7

30.2

—

4.1

3.1

*12.9

*1 4.5

*11 .1

23.3

20.6

47.3

30.9

64.8

3.6

3.0

*9.8

*13.7

*5.6

11.7

9.8

28.6

44.7

*11.1 *1 2.6

Female, 70years andover

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

No difficulty . . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty . . . . . . . . . . . . . . . . . . . . . .

No help ofanother person received . . . .

Help of another person received . . . . . .

8.3

6.9

18.5

12.9

29.1

2.7

2.2

7.1

5.7

9.9

14.0 9.0

11.0

37.6

38.2

36.6

9.5

8.1

20.7

29.1

*4.8

4.5

2.9

16.9

9.1

31.8

8.5

13.0

15.1

9.2

Female, 70–79 years

Total, . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

No difficulty . . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty . . . . . . . . . . . . . . . . . . . . . .

No help of another person received . . . .

Help of another person received . . . . . .

5.7

4.9

13.1

10.8

*18.8

1.3

1.1

*3.O

—

*10.1

12.3 8.9

9.5

41.3

41.7

40.5

8.8

7.2

24.9

33.4

*4.5

3.5

2.3

16.4

*8.3

36.0

8.2

15.4

16.2

*13.5

Female, 80 years andover

11.1

10.1

15.8

23.3

*5.O

6.7

4.4

17.5

10.1

28.2

14.3

12.0

24.7

15.8

37.7

6.0

4.8

12.0

13.5

9.7

9.5

9.3

10.3

13.5

*5.6

17.8

14.5

33.3

33.4

33.2

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

No difficulty . . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty . . . . . . . . . . . . . . . . . . . . . .

No help of another person received . . . .

Help of another person received . . . . . .

‘Includes persons hospitalized at time of recontact.

LExcludes.persons for”whom status of difficultyin 1984was unknown.

3Excludes persons discharged from nursing homes priorto recontact.

41ncludes persons not locatedin 1986.

NOTES: Persons reported as not performing an activity were classified with those reported as having difficulty with that activity. Transferring means getting inand outof

abed or chair.

SOURCE: National Center for Health Statistics: Data from the 1986 Longitudinal Study on Aging.

a
0)

N Table 9. Percent distribution of persons 70 years of age and over in 1984 by outcome at 1986 recontact, according to sex, age,

and extent of difficulty with performing instrumental activities of daily living reported in 1984: United States

[Data are based on 1986 telephone followup of 1984 household interviews of the civilian noninstitutionalized population]

Outcome at 1986 recontact

Extent of difficulty with IADL’s reported for

persons alive and living in the community~

Some

No help of Help of

Sex, age, and extent of difficulty with Total

In

another another

IADL’s repotted in 198@ in 1984 None Total

nursing

person received person received Deceased homd Unknowrf

Both sexes, 70 years and over

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

No difficulty. . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty. . . . . . . . . . . . . . . . . . . . . .

No help of another person received. . . .

Help of another person received . . . . . .

Both sexes, 70–79 years

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

No difficulty. . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty. . . . . . . . . . . . . . . . . . . . . .

No help of another person received. . . .

Help of another person received . . . . . .

Bothsexes, 80 years and over

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

Nodificul~ . . . . . . . . . . . . ..o. .c. aocc.

Some difficulty. . . . . . . . . . . . . . . . . . . . . .

No help of another person received. . . .

Help of another person received . . . . . .

Male, 70 years and over

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

No difficulty . . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty . . . . . . . . . . . . . . . . . . . . . .

No help of another person received. . . .

Help of another person received . . . . . .

Number in

thousands Percent distribution

17,140

11,794

5,346

1,426

3,919

12,373

9,236

3,137

882

2,256

4,767

2,558

2,208

545

1,663

6,631

5,178

1,454

398

1,056

42.1

56.2

11.0

13.9

9.9

48.8

60.6

13.8

16.6

12.7

24.8

40.3

7.0

9.5

6.1

45.7

55.6

10.5

10.9

10.4

36.2

26.2

58.2

54.6

59.4

13.6

11.3

18.5

24.3

16.3

22.6

14.9

39.7

30.3

43.1

10.5

7.5

17.0

14.0

18.1

2.2

1.2

4.5

5.2

4.2

9.1

8.9

9.5

12.4

8.5

33.6

23.8

62.1

59.0

63.4

13.0

10.7

19.5

23.5

18.0

20.6

13.1

42.6

35.5

45.4

7.8

6.1

12.8

11.1

13.5

1.0

0.7

2.0

*0.5

2.6

8.9

8.8

9.2

12.8

7.8

42.9

34.8

52.3

47.4

54.0

15.1

13.6

16.9

25.6

14.1

27.8

21.2

35.4

21.8

39.9

17.3

12.5

22.9

18.5

24.3

5.2

2.9

7.9

12.8

6.3

9.7

9,5

10.0

11.8

9.3

12.6

11.1

18.3

25.2

15.7

30.6

23.9

54.7

54.7

54.7

18.0

12.8

36.4

29.5

39.0

13.8

10.8

24.6

21.8

25.6

1.3

1.1

2.2

*3.9

*1.5

8.5

8.6

8.0

*8.7

7.7
Male, 70-79 years

Total . . . . . . . . . . . . . . . . . . . . ..-. . . . . . .

No ditlicuky.. . . . . . . . . . . . . . . . . . . . . . .

Some difficulty. . . . . . . . . . . . . . . . . . . . . .

No help ofanother person received. . . .

Help ofanother person received . . . . . .

Male, 80 years and over

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

No difficulty . . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty. . . . . . . . . . . . . . . . . . . . . .

No help ofanother person received. . . .

Help ofanother person received . . . . . .

Female, 70years andover

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

No difficulty . . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty. . . . . . . . . . . . . . . . . . . . . .

No help ofanother person received.

Help of another person received . . .

Female, 70–79years

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

No difficulty . . . . . . . . . . . . . . . . . . . . .

Some difficulty. . . . . . . . . . . . . . . . . . .

No help of another person received.

Help of another person received . . .

Female, 80years andover

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

No difficultv. . . . . . . . . . . . . . . . . . . .

,..

,..

. . .

. . .

. . .

. . .

.,.

. . .

. . .

Some diffi&lV . . . . . . . . . . . . . . . . . . . . . .

No help ofanother person received. . . .

Help of another person received . . . . . .

5,069

4,149

920

243

677

1,562

1,029

534

155

379

10,508

6,616

3,892

1,028

2,863

7,304

5,087

2,217

638

1,579

3,204

1,530

1,674

390

1,284

51.8

60.2

13.5

*15.1

12.9

26.1

36.8

5.4

*4.3

*5.9

39.8

56.7

11,1

15.0

9.7

46.7

61.0

13.9

17.2

12,6

24.2

42.6

7.4

11.5

6.2

28.4

21.6

59.5

57.6

60.1

37.7

33.1

46.6

50.0

45.2

39.6

28.1

59.4

54.6

61.2

37.1

25.6

63.3

59.6

64.8

45.5

36.0

54.1

46.4

56.5

12.1

10.7

18.6

*23.6

16.7

14.3

12.5

17.8

27.6

13.8

14.1

11.6

18.5

24.0

16.6

13.5

10.7

19.9

23.5

18.5

15.6

14.4

16.6

24.8

14.1

16.3

10.9

40.9

34.0

43.4

23.4

20.6

28.8

22.4

31.4

25.5

16.5

40.9

30.6

44.6

23.6

14.9

43.4

36.1

46.3

29.9

21,6

37.5

21.6

42.4

10.9

9.0

19.4

*1 5.9

20.6

23.5

18.2

33.6

31.3

34.5

8.3

4.9

14.1

10.9

15.3

5.7

3.8

10.1

9.3

10.4

14.3

8.7

19.4

13.5

21.3

*0.6

*0.7

*0.5

*0.7

3.6

2.9

5.1

*10.1

*3.1

2.7

1.2

5.3

5.7

5.2

1.3

0.7

2.7

*0.7

3.5

6.0

2.9

8.8

13.8

7.3

8.3

8.6

7.2

*11.5

5.7

9.1

9.0

9.4

*4.3

11.4

9.5

9.1

10.1

13.9

8.7

9.3

8.9

10.0

13.3

8.7

10.0

9.9

10.2

14.8

8.7

‘Includes persons hospitalized at time of recontact.

2Excludes persons for whom status ofdifficultyin 1984was unknown.

3Excludes persons discharged from nursing homes prior to recontact.

41ncludes persons not located in 1986.

NOTES: Persons reported as not performing an instrumental activity of daily living (IADL) were not classified with those reported as having difficulty with that IADL. IADL’s

include meal preparation, shopping, managing money, using the telephone, light housework, and heavy housework.

SOURCE: National Center for Health Statistics: Data from the 1986 Longitudinal Study on Aging.

mco
g Table 10. Percent distribution of persons 70 years of age and over in 1984 by outcome at 1986 recontact, according to sex, age,

and extent of difficulty with meal preparation reported in 1984: United States

[Data are based on 1986 telephone followup of 1984 household interviews of the civilian noninstitutionalized population]

Outcome at 1986 recontact

Extent of difficulty with meal preparation reported for

persons alive and living in the communityl

Some

No help of Help of

Sex, age and extent of difficulty with meal Total

In

another another nursing

preparation reported in 19842 in 1984 None Total person received person received Deceased hom$ Unknown4

Both sexes, 70 years and over

Numberin

thousands Percent distribution

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

No difficulty . . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty . . . . . . . . . . . . . . . . . . . . . .

No help of another person received. . . .

Help of another person received . . . . . .

Both sexes, 70–79 years

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

No difficulty . . . . . . . . . . . . . . . . . . . . . . . .

Some difficuky.. . . . . . . . . . . . . . . . . . . . .

No help of another person received. . . .

Help of another person received . . . . . .

Both sexes, 80 years and over

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

No difficulty . . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty . . . . . . . . . . . . . . . . . . . . . .

No help of another person received. . . .

Help of another person received . . . . . .

Ma[e, 70 years and over

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

No difficulty . . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty . . . . . . . . . . . . . . . . . . . . . .

No help of another person received. . . .

Help of her person received. . . . . . . . . .

17,206

15,757

1,450

221

1,229

12,418

11,807

611

106

505

4,788

3,950

838

114

724

6,660

6,316

344

30

314

69.0

74.0

14.5

30.2

11.6

75.2

78.1

19.4

36.5

15.8

52.8

61.7

10.8

24.4

8.7

69.9

72.9

14.2

*22.1

13.5

9.6

6.9

39.1

34.3

39.9

7.4

5.5

42.6

37.5

43.7

15.4

11.0

36.6

31.4

37.3

6.9

5.5

32.8

*44.1

31.8

1.7

1.6

3.0

*11.O

*1 .5

1.6

1.5

*2.6

*8.1

*1 .4

2,1

1.9

*3.3

*1 3.8

*1.6

0.7

*0.5

*4.8

*22.2

*3.2

7.9

5.3

36.1

23.3

38.4

5.8

4.0

40.0

*29.4

42.3

13.3

9.1

33.3

17.6

35.7

6.2

5.0

28.0

*21 .9

28.6

10.4

8.8

28.6

*11.5

31.6

7.8

7.2

21.0

*8.1

23.7

17.2

13.6

34.1

*14.8

37.2

13.8

12.2

43.1

*18.9

45.4

2.2

1.7

7.9

*8.8

7.7

1.1

0.9

*4.7

—

*5.6

5.3

4.2

10.2

*1 6.9

9.1

1.4

1.3

*3.2

*1 4.9

*2.1

8.8

8.7

10.0

15.2

9.1

8.6

8.4

12.4

*1 8.0

11.2

9.3

9.5

8.4

*1 2.5

7.7

8.0

8.1

*6.7

—

*7.3
Male, 70-79 years

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

No difficulty . . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty. . . . . . . . . . . . . . . . . . . . . .

No help ofanother person received. . . .

Help ofanother person received . . . . . .

Male, 80years and over

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

No difficulty . . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty. . . . . . . . . . . . . . . . . . . . . .

No help of another person received. . . .

Help ofanother person received . . . . . .

Female, 70years andover

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

No difficulty . . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty. . . . . . . . . . . . . . . . . . . . . .

No help of another person received. . . .

Help of another person received . . . . . .

Female, 70–79years

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

No difficulty . . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty. . . . . . . . . . . . . . . . . . . . . .

No heip of another person received. . . .

Help of another person received . . . . . .

Female, 80 years andover

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

No difficulty . . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty. . . . . . . . . . . . . . . . . . . . . .

No help of another person received. . . .

Help of another person received . . . . . .

5,093

4,932

161

17

144

1,567

1,384

183

13

170

10,547

9,441

1,106

191

915

7,325

6,875

451

89

361

3,222

2,567

655

101

554

74.6

76.4

*1 8.8

*26.8

*1 7.9

54.5

60.4

*10.2

*1 6.0

*9.7

68.4

74.7

14.5

31.5

11.0

75.7

79.3

19.6

*38.4

15.0

51.9

62.4

11.0

25,5

8.4

5.8

4.9

35.1

*52.3

33.1

10.4

7.6

30.8

*33.7

30.6

11.3

7.9

41.0

32.8

42.7

8.4

6.0

45.2

*34.7

47.9

18.0

12.8

38.1

31.1

39.4

‘Includes persons hospitalized at time of recontact.

0.7 5.1

*0.5 4.4

*7.1 28.0

*26.1 *26.2

*4.9 28.2

0.8 9.6

*0.5 7.1

*2.8 28.0

*17.3 *1 6.4

*1 .7 28.9

2.4 8.9

2.4 5.5

*2.4 38.6

*9.3 *23.5

*0.9 41.8

2.2 6.2

2.3 3.7

*0.9 44.3

*4.7 *30.O

47.9

2.8 15.2

2.6 10.2

*3.4 34.7

*13.4 *1 7.7

*1.6 37.8

10.9

9.9

40.6

*2I .0

42.9

23.4

20.5

45.3

*1 6.3

47.6

8.3

6.5

24.1

*1 0.4

26.9

5.7

5.2

14.0

*5.6

16.1

14.2

9.9

31 !0

*1 4.6

34.0

0.7

*0.7

—

3.6

3.3

*6.O

*34.O

*3.8

2.7

2.0

9.3

*7.8

9.6

1.3

0.9

*6.3

—

*7.9

6.1

4.7

11.4

*1 4.7

10.8

8.0

8.1

*5.5

*6.1

8.1

8.2

*7.7

—

*8.3

9.3

9.1

11.1

*1 7.5

9.7

9.0

8.6

14.8

*2I .4

13.2

9.9

10.2

8.5

*14.1

7.5

2Excludes”persons for whom status of difficultyin 1984 was unknown.

3Excludes persons discharged from nursing homes prior to recontact.

41ncludes persons not located in 1986.

NOTE: Persons reported as notperforming an activity were not classified with those reported as having difficulty with that activity.

SOURCE: National Center for Health Statistics: Datafromthe 1986 Longitudinal Study on Aging.
% Table 11. Percent distribution of persons 70 years of age and over in 1984 by outcome at 1986 recontact, according to sex, age,

and extent of difficulty with shopping reported in 1984: United States

[Data are based on 1986 telephone followup of 1984 household interviews of the civilian noninstitutionalized population]

Outcome at 1986 recontact

Extent of difficulty with shopping reported for

persons alive and living in the community

Some

No help of Help of

Sex, age, and extent of difficulty with Total

In

another another nursing

shopping reported in 19842 in 1984 None Total person received person received Deceased hom~ Unknowti

Both sexes, 70 years and over

Number in

thousands

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

No difficulty . . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty. . . . . . . . . . . . . . . . . . . . . .

No help of another person received. . . .

Help of another person received . . . . . .

Both sexes, 70–79 years

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

No difficulty . . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty. . . . . . . . . . . . . . . . . . . . . .

No help of another person received. . . .

Help of another person received . . . . . .

Both sexes, 80 years and over

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

No difficulty . . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty. . . . . . . . . . . . . . . . . . . . . .

No help of another person received. . . .

Help of another person received . . . . . .

Male, 70 years and over

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

Nodticulty . . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty. . . . . . . . . . . . . . . . . . . . . .

No help of another person received. . . .

Help of another person received . . . . . .

17,195

14,745

2,449

108

2,342

12,414

11,267

1,147

65

1,082

4,780

3,478

1,302

42

1,260

6,655

6%054

602

25

577

Percent distribution

64.5

72.5

16.4

52.4

14.7

71.9

77.1

20.7

65.5

18.0

45.4

57.6

12.6

*32.1

11.9

66.3

71.1

17.9

*53.6

16.4

14.2

9.3

44.0

*25.8

44.9

10.8

7.2

47.0

*1 5.2

48.8

23.0

16.1

41.6

42.1

41.5

10.7

8.0

36.6

*1 8.5

37.4

1.1 .

1.0

2.0

*9.8

1.7

1.2

1.1

*2.4

*8.6

*2.O

0.9

*0.6

1.8

*1 1.6

*1 .4

1.2

1.1

*1.8

*9.2

*1.5

13.1

8.3

42.0

*1 6.0

43.2

9.6

6.1

44.6

*6.6

46.8

22.1

15.5

39.8

*30.5

40.1

9.5

6.9

34.8

*9.3

35.9

10.4

8.3

23.6

*1 0.0

24.2

7.8

6.7

19.4

*6.4

20.2

17.2

13.4

27.3

*1 5.7

27.7

13.8

11.7

35.3

*1 8.7

36.1

2.2

1.3

7.4

*8.O

7.4

1.0

0.7

4.4

*6.7

4.3

5.3

3.5

10.1

*1O.1

10.1

1.3

1.2

*2.9

*9.2

*2.7

8.6

8.7

8.6

*3.9

8.8

8,5

8.4

8.7

*6.4

8.8

9.2

9.4

8.5

8.8

7.9

7.9

7.1

7.4
Male, 70-79 years

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

Nodifficulty . . . . . . . . . . . . . . . . .. ---- . .

Some difficulty. . . . . . . . . . . . . . . . . . . . . .

No help of another person received. . . .

Help of another person received . . . . . .

Male, 80 years and over

Toil .. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

No difficulty . . . . . . . . . . . . . . . . . . . . . . . .

Some difficult . . . . . . . . . . . . . . . . . . . . . .

No help ofanother person received. . . .

Help of another person received . . . . . .

Female, 70 years and over

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

No difficulty . . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty. . . . . . . . . . . . . . . . . . . . . .

No help of another person received. . . .

Help of another person received . . . . . .

Female, 70–79 years

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

No difficulty . . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty. . . . . . . . . . . . . . . . . . . . . .

No help of another person received. . . .

Help of another person received . . . . . .

Female, 80 years andover

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

No difficulty . . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty. . . . . . . . . . . . . . . . . . . . . .

No help of another person received. . . .

Help of another person received . . . . . .

5,091

4,780

312

13

298

1,564

1,274

290

11

279

10,539

8,691

1,848

83

1,765

7,323

6,487

836

52

784

3,216

2,204

1,012

31

981

71.8

75.1

21.1

100.0

17.7

48.5

56.2

14.5

15.1

63.4

73.5

15.8

52.0

14.1

72.0

78.7

20.5

56.8

18.1

43.8

58.4

12.0

*43 .9

11.0

8.9

6.7

42.3

44.2

16.5

13.3

30.6

*39.9

30.2

16.4

10.0

46.5

*27.9

47.3

12.1

7.4

48.6

*1 8.9

50.6

26.2

17.7

44.8

*42.9

44.8

1.2

1.1

*1 .9

*2.O

1.4

*1 .3

*1.8

*19.9

*1.O

1.0

0.8

2.1

*9.9

1.7

1.2

1.0

*2.5

*1 0.7

*2.O

0.7

*0.2

*1 .8

*8.6

*1.6

7.7

5.6

40.4

—

42.2

15.1

12.0

28.8

*20.O

29.2

15.4

9.2

44.4

*18.O

45.6

10.9

6.4

46.1

*8.2

48.6

25.5

17.5

43.0

*34.3

43.2

10.9

9.5

31.6

—

33.0

23.4

19.8

39.4

*40.4

39.4

8.3

5.9

19.8

*7.5

20.3

5.7

4.5

14.9

*8.O

15.3

14.2

9.8

23.8

*6.7

24.3

0.6

*0.7

—

3.6

3.1

6.1

*1 9.8

5.5

2.7

1.4

8.9

*7.7

8.9

1.3

0.7

6.0

*8.3

5.9

6.1

3.7

11.3

*6.6

11.4

7.8

8.0

*5.O

—

*5.2

7.9

7.6

9.4

9.8

9.1

9.2

9.1

*5.O

9.3

8.9

8.7

10.0

*8.O

10.2

9.8

10.4

8.3

—

8.5

‘Includes persons hospitalizedat time of recontact.

2Excludes persons for whom status of difficulty in 1984 was unknown.

3Excludes persons discharged from nursing homes prior to recontact.

41ncludes persons not located in 1986.

NOTE: Persons reported as not performing an activitywere not classified with those reported as having difficulty with that activity.

SOURCE: National Centerfor Health Statistics: Datafrom the 1986 Longitudinal Study on Aging.
Table 12. Percent distribution of persons 70 years of age and over in 1984 by outcome at 1986 recontact, according to sex, age,

and extent of difficulty with heavy housework reported in 1984: United States

[Data are based on 1986 telephone followup of 1984 household interviews of the civilian noninstitutionalized population]

Outcome at 1986 recontact

Extent of difficulty with heavy housework reported

for persons alive and living in the communi@l

Some

No help of Help of

Sex, age, and extent of difficulty with Total

In

heavy housework reported in 19842

another another

in 1984 None Total

nursing

person received person received Deceased hom~ Unknown4

Both sexes, 70 years and over

Total, . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

No difficulty . . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty . . . . . . . . . . . . . . . . . . . . . .

No help of another person received. , .

Help of another person received . . . . .

Both sexes, 70–79 years

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

No difficulty . . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty . . . . . . . . . . . . . . . . . . . . . .

No help of another person received. . .

Help of another person received . . . . .

Both sexes, 80 years and over

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

No difficulty . . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty . . . . . . . . . . . . . . . . . . . . . .

No help of another person received . . .

Help of another person received . . . . .

Male, 70 years and over

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

Nodiflicuity . . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty . . . . . . . . . . . . . . . . . . . . . .

No help of another person received. . .

Help of another person received . . . . .

Number in

thousands Percent distribution

17,142

12,491

4,650

822

3,828

12,375

9,608

2,767

590

2,177

4,767

2,884

1,883

232

1,652

6,631

5,573

1,058

202

856

47.7

60.1

14.2

23.3

12.2

53.9

64.5

17.1

25.4

14.8

31.5

45.6

9.9

18.0

8.8

54.8

62.3

15.7

21.7

14.3

30.5

21.6

54.3

50,1

55.1

28.3

19.8

58.0

53.3

59.3

35.9

27.6

48.8

42.0

49.8

21.3

16.7

45.7

47.5

45.3

6.8

6.0

8.9

19.2

6.6

7.1

6.1

10.7

19.2

8.4

5.9

5.8

6.2

19.1

4.4

4.9

4.4

7.6

*11 .0

6.8

23.7

15.6

45.4

30.9

48.5

21.2

13.7

47.3

34.1

50.9

30.0

21.8

42.6

22.9

45.4

16.4

12.3

38.1

36.5

38.5

10.5

7.9

17.3

11.8

18.5

7.8

6.3

13.1

10.8

13.8

17.3

13.2

23.5

14.4

24.8

13.8

11.0

28.8

23.1

30.1

2.2

1.4

4.3

*2.5

4.7

1.0

0.7

2.3

2.9

5.2

3.9

7.4

*8.9

7.1

1.3

1.3

*1.7

*1.2

*1.8

9.2

9.0

9.9

12.2

9.4

8.9

8.8

9.5

10.5

9.2

10.1

9.8

10.4

16.7

9.6

8.7

8.8

8.1

*6.6

8.5
Male, 70-79 years

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

No difficulty . . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty . . . . . . . . . . . . . . . . . . . . . .

Nohelpof another person received . . . .

Help ofanother person received . . . . . .

Male, 80 years and over

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

No difficulty . . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty . . . . . . . . . . . . . . . . . . . . . .

No help ofanother person received.. . .

Help of another person received . . . . . .

Female, 70years andover

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

No difficulty . . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty . . . . . . . . . . . . . . . . . . . . . .

No help ofanother person received. . . .

Help of another person received . . . . . .

Female, 70–79years

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

No difficulty . . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty . . . . . . . . . . . . . . . . . . . . . .

No help of another person received. . . .

Help of another person received . . . . . .

Female, 80 years andover

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

No difficulty . . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty . . . . . . . . . . . . . . . . . . . . . .

No help ofanother person received,. . .

Help of another person received . . . . . .

5,071

4,389

682

152

530

1,560

1,184

376

50

326

10,511

6,919

3,592

620

2,973

7,304

5,219

2,085

438

1,647

3,207

1,700

1,507

181

1,326

59.9

66.2

19.4

*24.O

18.0

38.4

47.7

9.1

*1 4.6

8.3

43.2

58.4

13.7

23.9

11.6

49.8

63.1

16.4

25.9

13.8

28.2

44.1

10.1

19.0

8.9

20.3 5.2 15.1

15.6 4.7 10.9

50.1 *7.9 42.2

51.3 *8.8 42.5

49.9 *7.7 42.2

24.9 4.2 20.7

20.8 3.3 17.5

37.7 7.0 30.7

36.0 *1 7.6 *1 8.4

37.9 *5.4 32.5

36.2 8.0 28.2

25.5 7.3 18.2

56.8 9.2 47.6

51.0 21.9 29.1

5.8.0 6.6 51.4

34.0 8.5 25.5

23.4 7.3 16.1

60.6 11.6 49.0

54.1 22.9 31.2

62.3 8.6 53.7

41.3 6.8 34.5

32.2 7.5 24.7

51.6 6.0 45.6

43.6 19.5 24.1

52.6 4.1 48.5

10.8

8.9

23.3

*1 8.9

24.5

23.5

18.7

38.8

35.8

39.2

8.3

5.4

14.0

8.1

15.2

5.7

4.1

9.8

*8.O

10.3

14.3

9.5

19.7

*8.5

21.2

0.6

*0.6

*0.7

—

*o.t3

3.7

3.7

*3.5

*4.9

*3.3

2.7

1,5

5.1

*2.9

5.6

1.3

0.7

2.8

3.6

6.0

4.0

8.3

*1 0.0

8.1

8.4

8.7

6.6

*5.8

*6.8

9.6

9.1

11.0

*8.8

11.3

9.6

9.2

10.4

14.1

9.6

9.3

8.9

10.4

12.1

10.0

10.3

10.3

10.3

18.9

9.1

‘Includes persons hospitalized attime of recontact.

2Excludes persons for whom status of difficultyin 1984was unknown.

sExc[udes persons discharged fromnursing homes priOrtO reCOrltZICt,

41ncludes persons not located in 1986.

NOTE: Persons reported asnotpetiorming anactivi~were notclassified with those repotied ashaving di~cul~with that activi~.

SOURCE: National Center for Health Statistics: Data from the 1986 Longitudinal Study on Aging.
2 Table 13. Percent distribution of persons 70 years of age and over in 1984 by outcome at 1986 recontact, according to sex, age,

and extent of difficulty with walking up 10 steps reported in 1984: United States

[Data are based on 1986 telephone followup of 1984 household interviews of the civilian noninstitutionalized population]

Outcome at 1986 recontact

Extent of difficulty with walking

up 10 steps reported for persons

alive and living in the community

Sex, age, and extent of difficulty with Total In nursing

walking up 10 steps repotied in 19842 in 1984 None Some Deceased hom# Unknown4

Both sexes, 70 years and over

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

No difficulty . . . . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty . . . . . . . . . . . . . . . . . . . . . . . .

Both sexes, 70–79 years

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

Nodifficuky. . . . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty . . . . . . . . . . . . . . . . . . . . . . . .

Both sexes, 80 years and over

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

No difficulty . . . . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty . . . . . . . . . . . . . . . . . . . . . . . .

Male, 70 years and over

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

No difficulty . . . . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty . . . . . . . . . . . . . . . . . . . . . . . .

Male, 70-79 years

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

No difficulty . . . . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty . . . . . . . . . . . . . . . . . . . . . . . .

Male, 80years and over

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

No difficulty . . . . . . . . . . . . . . . . . . . . . . . . . .

Some difFiculty. . . . . . . . . . . . . . . . . . . . . . . .

Numberin

thousands Percent distribution

16,970

12,084

4,886

12,291

9,389

2,902

4,679

2,695

1,983

6,611

5,133

1,478

5,065

4,098

966

1,547

1,035

512

53.4 22.5 10.4 2,2 11.6

66.8 13.1 7.4 1.2 11.6

20.3 45.8 17.9 “ 4.5 11.5

59.4 20.4 7.8 1.0 11.4

70.6 11.6 5.9 0.6 11.3

23.3 48.5 14.1 2.3 11.7

37.6 28.1 17.2 5.2 12.0

53.6 18.0 12.6 3.3 12.6

15.9 41.7 23.4 7.8 11.2

57.6 16.9 13.7 1.4 10.4

67.8 9.9 10.5 1.1 10.8

22.1 41.0 25.0 2.7 9.2

62.7

71.6

25.3

40.8

52.9

16.2

15.6 10.9 *0.7 10.1

8.9 8.5 *0.5 10.6

43.8 20.9 *1.8 8.3

21.2 23.0 3.7 11.4

14.1 18.2 3.4 11.5

35.7 32.8 *4.3 11.0
Fema!e, 70 years and over

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10,359 50.7 26.1 8.3 2.7 12.3

No difficulty . . . . . . . . . . . . . . . . . . . . . . . . . . 6,951 66.1 15.4 5.1 1.4 12.1

Some d.ficulty . . . . . . . . . . . . . . . . . . . . . . . 3,407 19.5 47.9 14.8 5.3 12.5

Female, 70-79 years

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7,227 57.1 23.7 5.7 *1.2 12.3

No difficulty . . . . . . . . . . . . . . . . . . . . . . . . . . 5,291 69.8 13.8 3.8 *0.8 11.8

Some difficulty. . . . . . . . . . . . . . . . . . . . . . . . 1,936 22.4 50.9 10.7 2.5 13.5

Female, 80years andover

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,132 36.0 31.4 14.3 5.9 12.3

No difficulty . . . . . . . . . . . . . . . . . . . . . . . . . . 1,660 54.0 20.4 9.2 3.2 13.2

Some diticulty . . . . . . . . . . . . . . . . . . . . . . . . 1,472 15.7 43.8 20.2 9.0 11.3

‘Includes persons hospitalized at time ofrecontact.

ZExcludes persons for whom status of difficultyin 1984was unknown.

3Exc[udes persons discharged from nursing homes priorto recontact.

41ncludes persons not located in 1986.

SOURCE: National Centerfor Health Statistics: Data from the 1986 Longitudinal Study on Aging.

-l
N Table 14. Percent distribution of persons 70 years of age and over in 1984 by outcome at 1986 recontact, according to sex, age,

and extent of difficulty with walking one-quarter mile without rest reported in 1984: United States

[Data are based on 1986 telephone followup of 1984 household interviews of the civilian noninstitutionalized population]

Outcome at 1986 recontact

Extent of difficulty with walking onequarter mile without rest repotied for

Sex, age, and extent of difficulty

persons alive and living in the community

with walking one-quarter mile Total /n nursing

without rest repon’ed in 19842 in 1984 None Some Deceased hom~ Unknowr#

Both sexes, 70 years and over

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

Nodficulty . . . . . . . . . . . . . . . . . . . . . . . . . .

Somedifficulty . . . . . . . . . . . . . . . . . . . . . . . .

Both sexes, 70–79 years

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

Nodficuky. . . . . . . . . . . . . . . . . . . . . . . . . .

Somedifficul& . . . . . . . . . . . . . . . . . . . . . . . .

Both sexes, 80 years and over

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

No difficulty . . . . . . . . . . . . . . . . . . . . . . . . . .

Somedifficulty . . . . . . . . . . . . . . . . . . . . . . . .

Male, 70 years and over

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

Nodifficuky. . . . . . . . . . . . . . . . . . . . . . . . . .

Somedifficulty . . . . . . . . . . . . . . . . . . . . . . . .

Male, 70–79 years

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

No difficulty . . . . . . . . . . . . . . . . . . . . . . . . . .

Somedifficulty . . . . . . . . . . . . . . . . . . . . . . . .

Number in

thousands Percent distribution

17,103

11,191

5,912

12,350

8,841

3,509

4,753

2,350

2,403

6,636

4,706

1,930

5,082

3,805

1,277

49.8 27.7 10.5 2.2 9.8

67.6 15.9 6.2 1.1 9.2

16.2 49.8 18.7 4.3 11.0

57.0 24.6 7.9 1.1 9.5

71.7 14.1 4.9 0.6 8.7

20.2 50.8 15.4 2.2 11.4

31.1

52.2

10.5

52.8

67.0

18.2

58.7

71.1

21.7

35.7

22.8

48.3

23.7

14.3

46.4

21.4

12.6

47.8

17.4

11,1

23.6

14.1

9.3

25.6

11.2

7.6

21.9

5.2

3.1

7.2

1.4

1.0

2.5

*0.7

*0.5

*1.4

10.6

10.9

10.4

8.0

8.4

7.2

8.0

8.3

7.2
Male, 80 years and over

3.7

*2.9

4.7

8.1

8.7

7.3

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

Nodficulty . . . . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty . . . . . . . . . . . . . . . . . . . . . . . .

1,554

901

653

33.7

49.9

11.4

30.9

21.6

43.8

23.6

16.9

32.8

Female, 70years andover

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

No difficulty . . . . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty . . . . . . . . . . . . . . . . . . . . . . . .

10.9

9.8

12.8

10,467

6,484

3,983

47.9

68.0

15.3

30.2

17.1

51.4

8.3

4.0

15.4

2.7

1.2

5.1

Female, 70–79years

7,268

5%035

2,233

55.9

72.1

19.2

26.7

15.3

52.6

1.3

*0.6

2.7

10.5

9.0

13.8

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

No difficulty . . . . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty . . . . . . . . . . . . . . . . . . . . . . . .

5.6

3.0

11.7

Female, 80years andover

14.4

7.4

20.1

29.9

53.6

10.2

38.0

23.5

50.0

6.0

3.3

8.2

11.8

12.2

11.5

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

No difficulty . . . . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty . . . . . . . . . . . . . . . . . . . . . . . .

3,199

1,449

1,750

‘Includes persons hospitalized at time of recontact.

‘Excludes persons for whom statusof ditlicultyin 1984was unknown.

3Exc[udes persons discharged from nursing homes prior to recontact.

41ncludes persons not located in 1986.

SOURCE: National Centerfor Health Statistics: Data from the 1986 Longitudinal Study on Aging.
X Table 15. Percent distribution of persons 70 years of age and over in 1984 by outcome at 1986 recontact, according to sex, age,

and extent of difficulty with lifting 25 pounds reported in 1984: United States

[Data are based on 1986 telephone followup of 1984 household interviews of the civilian noninstitutionalized population]

Outcome at 1986 recontact

Extent of difficulty with lifting 25 pounds reported

for persons alive and living in the community

Sex, age, and extent of diri%ulty with Total Inh:.s$g

lifting 25 pounds reported in 19842 in 1984 None Some Deceased Unknown4

Both sexes, 70 years and over

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

No difficulty . . . . . . . . . . . . . . . . . . . . . . . . . .

Some difficul& . . . . . . . . . . . . . . . . . . . . . . . .

Both sexes, 70–79 years

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

No difficulty . . . . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty . . . . . . . . . . . . . . . . . . . . . . . .

Both sexes, 80 years and over

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

No difficulty . . . . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty . . . . . . . . . . . . . . . . . . . . . . . .

Male, 70 years and over

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

Nodifficuky. . . . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty . . . . . . . . . . . . . . . . . . . . . . . .

Male, 70–79 years

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

No difficulty . . . . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty . . . . . . . . . . . . . . . . . . . . . . . .

Male, 80 years and over

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

Nodifficuky. . . . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty . . . . . . . . . . . . . . . . . . . . . . . .

Number in

thousands

16,820

9,639

7,181

12,214

7,720

4,494

4,607

1,920

2,687

6,593

4,858

1,735

5,053

3,896

1,157

1,540

962

578

Percent distribution

39.0 37.3 10.5 2.2 11.0

56.9 23.7 7.1 1.2 11.2

14.9 55.6 15.1 3.5 10.8

45.8 34.7 7.9 1.0 10.7

61.7 21.4 5.8 0.6 10.6

18.4 57.6 11.5 1.7 10.8

21.1 44.2 17.5 5.3 12.1

37.8 32.8 12.3 3.5 13.6

9.1 52.3 21.1 6.5 11.0

52.6 23.3 13.8 1.3 9.1

63.2 16.5 9.9 1.0 9.4

22.6 42.3 24.6 2.2 8.3

59.0 20.6 10.9 *0.6 8.8

68.3 14.0 8.3 *0.5 9.0

27.9 43.1 19.9 *1.1 8.0

31.3 32.0 23.1 3.6 10.1

42.8 26.7 16.5 3.2 10.9

12.0 40.8 34.1 4.2 8.9
Female, 70 years and over

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

No difficulty . . . . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty. . . . . . . . . . . . . . . . . . . . . . . .

Female, 70-79 years

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

No difficulty . . . . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty. . . . . . . . . . . . . . . . . . . . . . . .

Female, 80years andover

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

No difficulty . . . . . . . . . . . . . . . . . . . . . . . . . .

Some difficulty. . . . . . . . . . . . . . . . . . . . . . . .

10,227

4,781

5,446

7,161

3,824

3,337

3,066

958

2,109

30.3

50.5

12.5

36.4

55.0

15.1

15.9

32.7

8.3

46.3

31.0

59.9

44.7

28.9

62.7

50.3

39.0

55.4

8.4

4.2

12.1

5.7

3.2

8.6

14.6

8.1

17.6

2.7

1.3

3.9

1.2

*0.7

1.9

6.2

3.9

7.2

12.3

13.0

11.7

12.0

12.2

11.7

13.0

16.3

11.5

llncludes persons hospitalized attime of recontact.

‘Excludes persons for whom status of difficultyin 1984 was unknown.

3Excludes persons discharged from nursing homes prior to recontact.

41ncludes persons not locatedin 1986.

SOURCE: NationaI Centerfor Health Statistics: Data from the 1986 Longitudinal Study on Aging.
Chapter 4

Mortality

by Sylvia E. Furrier, Ph.D., University of Illinois

at Chicago; Jeffrey Maurer, M.S., and Harry

Rosenberg, Ph.D., National Center for Health

Statistics

Introduction

Death rates for the population 65 years of

age and over, contrary to the beliefs of many,

have continued to decline (l). Substantial declines in death rates in conjunction with dramatic increases in life expectancy, measured

either from birth or from older ages, have led to

an unprecedented growth in the percentage of

the population 65 years of age and over. This

prolonging of life of the aged population, although not totally understood, appears to be the

result in part of large declines in cardiovascular

mortality resulting from changes in lifestyle and

improved access to health care for some segments of the population. Whatever its causes,

the accelerating growth of the aged population is

putting demands on somewhat fragile social welfare and health care systems. To better prepare

our public officials for the future needs of our

society in general, and more specifically the

needs of older persons, it is important to investigate and identify the changing mortality trends.

Indepth analysis of the mortality statistics of

those persons 65 years of age and over can help

to elucidate some of the effects of aging and

causes of death on this population. It is apparent

that for each race-sex group, death rates increase with age, but this increase varies by cause

of death as well as within each race-sex group.

This variation contributes to the differences seen

in life expectancy by race-sex groups.

The authors wish to acknowledge Richard Suzman, Ph. D.,

National Institute on Aging, National Institutes of Health, for his

helpful comments on the manuscript.

Furthermore, study of the trends in death

rates over decades reveals patterns that are

fundamental to the ability to make projections

about the future needs of this segment of the

population,

Swrces of data

Mortality data are compiled by the National

Center for Health Statistics (NCHS) through the

National Vital Statistics System. This system is a

cooperative effort of the Federal Government

and the States, with the States providing information based on death certificates filed in their

respective vital statistics registration offices. For

this report, the source of some of the rates for

1960-86 is the annual volumes of Vital Statistics

of the United States; the source for others is

Health, United States, 1988. For rates for 1987

and later, the sources are Health, United States,

1991 and Monthly Vital Statistics Repoti, VOL 39,

No. 13, Population estimates, the denominators

of the death rates, are published annually by the

U.S. Bureau of the Census in Current Population

Reports, Series P-25. For census years, the population counts are based on the census enumeration on April 1 of the respective census years,

and population estimates for all other years are

estimated for July 1 of the respective years. Data

on multiple causes of death are produce annually by NCHS fl from information on all ;seases,

conditions, and injuries reported on the death

certificates (2)0

77
Results and comments

In 1986, there were 2,105,361 deaths in the

United States; 1,488,161 (71 percent) of these

deaths occurred in people aged 65 years of age

andover(3). Of the deaths occurring in this age

group,52 percentwerefemales,48 percentwere

males,90 percentwerewhite persons, and9 percent were black persons. The overall death rate

for the population 65 years of age and over was

5,102 per 100,000; for males, the corresponding

rate was 5,997 and for females, the rate was

4,492, or 25 percent lower than the rate for

males. In 1990, there were 2,162,000 deaths

(provisional data) in the United States. There

was little change in the percent distribution of

1990 deaths compared with those of 1986.

Seventy-two percent of deaths occurred in people aged 65 and over, compared with 71 percent

in 1986. Of deaths occurring in this age group,

53 percent were females, 47 percent males,

90 percent were white persons and 9 percent

were black persons. Provisional death rates for

1988–90 by age-race-sex groups are presented in

table A. For both sexes and all races, death

rates by age groups dropped between 1988 and

1990. The exceptions were for white males aged

75–84 and white females aged 65–74; death rates

for these groups increased between 1989 and

1990. (data not shown).

Declines in death rates for persons under 65

years of age have over time led to the growth in

the population aged 65 and over and, therefore,

have contributed to an increase in the percentage of deaths accounted for by the older population. To illustrate this, one can compare the

above statistics with the corresponding statistics

in 1960, At that time, there were 1,711,982

deaths in the United States; 1,010,047 (59 percent) of these deaths occurred in the 65-andover population,

1986.

Mortality trends

compared with 71 percent in

From 1960 to 1986, the death rate for the

population 65 years of age and over decreased

by 16.3 percent. The decline was greater for

males, 15.8 percent, compared with females,

14.5 percent. This trend in death rates was not

Table A. Provisional death rates for all causes, according to race, sex, and age: 1988-90

[Data are based on a 10-percent sample of death certificates from the National Vital Statistics Systems]

All races White Black

Sex and age 1988 1990 1988 1990 1988 1990

Both sexes

65–74 years . . . . . . . . . . . . . . . . . . .

75–84 years . . . . . . . . . . . . . . . . . . .

85 years and over, ,,, , ..,..,...

Male

65–74 years.......,.......,,..

75–84 years . . . . . . . . . . . . . . . . . . .

85 years and over . . . . . . . . . . . . . .

Female

65–74 years . . . . . . . . . . . . . . . . . . .

75–84 years . . . . . . . . . . . . . . . . . . .

85 years and over..,.,,,,.,,,,,

2,731.2

6,324.4

15,577,7

3,583,2

8,243.2

18,475.2

2,051.4

5,166.6

14,451.7

Deaths per 100,000 resident population

2,607.4 2,679.4 2,565.7 3,587.3

6,084.5 6,305.2 6,081.0 7,257.6

14,784.4 15,888.0 15,087.7 13,206.1

3,358.5 3,533.8 3,316.2 4,527,3

7,950.2 8,234.6 7,976.4 9,360.3

17,521.6 18,933.7 17,973.3 15,342.9

2,002.1 1,993.0 1,956.9 2,887.1

4,941.7 5,145.3 4,921.1 5,997.8

13,727.5 14,727.8 13,993,7 12,259.5

3,319.7

6,873,2

12,707.3

4,172.9

8,731.4

14,743.2

2,673,9

5,763.7

11,831,4

NOTE: Includes deaths of nonresidents of the United States,

78
shared equally by white and black people. White

males experienced a 16.2-percent decline in death

rates, while black males showed only a 3.1-

percent decline. For females, the corresponding

declines in death rates by race were 14.4 percent and 8.4 percent, respectively.

Although these declines in death rates appear to be of substantial magnitude, no correction has been made to adjust for the aging

population. A more accurate comparison is of

the age-adjusted death rates, as these rates remove the effect of the different age distribution

for each of the years being compared (table B),

by assuming a fixed age distribution (that of the

U.S. population in 1940) over time. The ageadjusted comparisons show more clearly the magnitude of the decline in death rates, free of the

effects of changes in age composition.

The decline in death rates of the elderly

population from 1960 to 1986 varied by age

(table C). The decline for males was most evident in the younger age groups (55-59, 60-64,

and 65-69 years of age); of interest was the

increase in death rates for black males 75 years

of age and over. For females, the decline in

death rates showed less variation with age and,

in contrast to males, the greatest declines occurred in the older age groups (70–74, 75–79,

and 80–84 years of age). The variation with age

was greater for black females compared with

white females, with a 44.O-percent decline for

the age group 55–59 and a 4.2-percent decline

for those 85 years or over.

Mortality patterns

From 1960 to 1986, age-specific death rates

for males were higher than the corresponding

rates for females across all age groups, for both

white and black persons (table 1). For 1980 and

1986, among the age groups 55-84 years, death

rates for black persons exceeded those for white

persons; a crossover in death rates occurred

between the groups aged 80-84 and 85 years and

over.

Life expectancy

Life expectancy at birth is defined as the

average number of years that a group of infants

born in a particular year would expect to live if

they were to experience, throughout life, the

age-specific death rates prevailing in that calendar year. In 1986, life expectancy at birth was

74.8 years. Life expectancy for females was 7.0

years longer than for males (table 2), and life

expectancy for white people was 6.0 years longer

than for black people. A comparison of sex

differences in life expectancy within race groups

reveals that black females’ life expectancy was

8.3 years greater than that of black males and

that this excess was of greater magnitude than

the corresponding difference in life expectancy

for white persons (6.8 years).

Table B. Comparison of death rates per 100,000 for persons 65 years of age and over: 1960-86

Unadjusted Age-adjusted’

Percent Percent

Sex and race 1960 1986 change 1960 1986 change

Both sexes and all races . . . . . . . . . . 6,098.9 5,102.0 –1 6.3 5,714.2 4,206.6 –26.4

Males, . . . . . . . . . . . . . . . . . . . . . . . 7,120.4 5,997.4 –1 5.8 6,902.1 5,462.1 –20.9

White male. . . . . . . . . . . . . . . . . . 7,137.3 5,979.9 –1 6.2 6,908.9 5,428.1 –21 .4

Black male . . . . . . . . . . . . . . . . . . 6,979.0 6,760.8 –3.1 6,873.4 6,359.5 –7.5

Females, . . . . . . . . . . . . . . . . . . . . . 5,253.7 4,492.1 –1 4.5 4,727.1 3,357.6 –29.0

White female, . . . . . . . . . . . . . . . 5,256.7 4,502.1 –1 4.4 4,696.6 3,313.3 –29.5

Black female . . . . . . . . . . . . . . . . . 5,287.3 4,842.7 -8.4 5,101.1 4,103,7 –1 9.6

‘Adjusted to the 1940 population distribution.

79
Table C. Percent change in death rates for persons 55 years of age and over, according to age,

sex, and race: 1960-86

Male Female

Age Total White Black Total White Black

55–59 years . . . . . . . . . . . . . . . . . . . –29.7 –31 .6 –28.4 –24.7 –21 .6 –44.0

60–64 years . . . . . . . . . . . . . . . . . . . –30.0 –29.5 –36.5 –26.4 –22.6 –41 .5

65–69 years . . . . . . . . . . . . . . . . . . . –27.7 –28.2 –28.3 –26.2 –25.4 –32.4

70–74 years . . . . . . . . . . . . . . . . . . . –22.1 –22.1 –11 .5 –29.2 –29.2 –27,3

75–79 years . . . . . . . . . . . . . . . . . . . –1 8,2 –1 9.7 + 5.0 –32.9 –34.3 –15.2

80–84 years. . . . . . . . . . . . . .. . . . ,. –1 9.8 –20.1 +10.2 -35.6 –36.2 –3.2

85 years and over . . . . . . . . . . . . . . –1 4.2 –1 4.6 + 4.3 –24.8 –25.5 -4.2

The overall decline in death rates for the

total population has resulted in an increase in

life expectancy at birth and at other ages, including 65,75, and85 (table 2). For life expectancy

at birth, the increase from 1960 to 1986 was

evident for all race and sex groups (table 2).

However, the increases were not the same for

each race-sex group. Between 1960 and 1986,

males and females experienced increases in life

expectancy of4.7 and 5.2 years, respectively. For

white persons, the increase in life expectancy

was4.6 years for males and4.7years for females;

for black persons, the increase was4.5 years for

males and 7.6 years for females. Although life

expectancy at birth for black persons increased

from 1960 to 1986, it actually declined from 1984

to 1986 (3),

Changes in life expectancy between 1960 and

1986 at older ages were also evident, with each

race-sex group experiencing increases in life expectancy atage65 (table 2); thelargest increase

was for white females (2.8 years). At age 75, with

the exception of black males, each race-sex group

showed an increase in life expectancy, with the

largest increase appearing for white females (2.5

years). At age 85, life expectancy for white

females increased 1.5 years between 1960 and

1986, but the trends for the other three race-sex

groups were not clear.

In 1986 (table 3), at each age from 65 to 85,

life expectancy for females exceeded that of

males. This sex differential was evident for both

80

black and white people. For both sexes combined, white people had a longer life expectancy

than black people until ages 83, 84, and 85. This

crossover occurred at age 81 for males and at

age 83 for females. Provisional data for life

expectancy at age 65 shows small, steady increases for each race-sex group between 1988

and 1990 (table D). Increases were largest for

black males; next largest were increases for

black females.

Causes of death

Table 4 shows the leading causes of death in

the older population by 5-year age groups, Although the rankings varied with age, the top

three diseases for each of the age groups remained the same; diseases of the heart, malignant neoplasms, and cerebrovascular disease,

The ranking of pneumonia and influenza was

seventh for those 65-69, compared with fourth

for the population aged 85 years of age and over,

Death rates for diseases of the heart (table 5) continued their previously documented

decline (4). From 1980 to 1986, death rates

declined in virtually all of the race-sex groups

(table E). Large declines in death rates for

heart disease were experienced by males 65-69

years of age (an 18.2-percent decline), with white

males experiencing the greatest change in rates,

Similar patterns of decline were noted for females (a 13.3-percent decline) in the group aged
Table D. Life expectancy at 65 years of age, according to race and sex: 1986-90

[Data are based on the National Vital Statistics System]

All races White Black

Both Both Both

Year sexes Male Female sexes Male Female sexes Male Female

Remaining life expectancy in years

1986, . . . . . . . . . . . . . . . . . . . . 16.8 14.7 18.6 16.9 14.8 18.7 15.4 13.4 17.0

1987. .................... 16.9 14.8 18.7 17.0 14.9 18.8 15.4 13.5 17.1

1988, .,, ,., .,, ........... 16.9 14.9 18.6 17.0 14.9 18.7 15.4 13.4 16.9

1989. . . . . . . . . . . . . . . . . . . . . 17.2 15.2 18.8 17.3 15.2 19.0 15.5 13.6 17.0

Provisional data

1988 i ,.. . . . , . . . . . . . . . . . . 16.9 14.8 18.6 17.0 14.9 18.7 15.5 13.6 17.1

19891, ,. ,. .,.,.. . . . . . . . . 17.2 15.2 18.8 17.3 15.2 18.9 15.8 13.8 17.4

19901, ., ,, ..,... . . . . . . . . 17.3 15.3 19.0 17.3 15.3 19.0 16.1 14.2 17.6

‘Includes deaths of nonresidents of the United States.

Table E. Percent change in death rates for diseases of the heart for persons 55years ofage and

over, according toage, sex,and race: 1980-86

Male Female

Age Total White Black Total White Black

55-59 years. . . . . . . . . . . . . . . . . . . –18.9 –19.1 –1 6.9 –13.8 -14.2 -15.0

60-64 years, . . . . . . . . . . . . . . . . . . –16.5 –1 6.4 –1 0.0 –1 0.7 –11 .5 –7.1

65-69 years . . . . . . . . . . . . . . . . . . . –18.2 –1 8.8 –1 0.9 –13.3 –13.6 –9.1

70-74 years. . . . . . . . . . . . . . . . . . . –14.9 –15.3 –8.0 –1 2.7 -13.0 -9.0

75-79 years, . . . . . . . . . . . . . . . . . . –13.0 –13.3 –6.5 –1 2.8 –13.3 –5.4

80-84 years . . . . . . . . . . . . . . . . . . . –10.3 –1 0.7 –2.4 –11 .4 –1 2.0 –1 .4

85 years and over, ,,, . . . . . . . . . . –9.6 -9.1 -8.1 -6.3 –6.4 –1.7

65-69, with white females having the greatest

change.

The sex differential immortality due to diseases of the heart was evidentin all age groups

(table 5); rates formaleswere consistently higher

than rates for females for both black and white

persons. Comparing the rates for black people

and white people, it is interesting to note the

crossover in rates. The rates for black males

were higher until ages 80–84, when the rates for

white males surpassed them. For females, this

corresponding crossover did not occur until ages

85 and over.

As with overall death rates, the long-term

trends of cause-specific death rates should be

assessed with age-adjusted rates. Although these

age-adjusted comparisons are difficult for some

causes of death because of the periodic revisions

in the International Classification of Diseases

(ICD), thedifficulty is not great for the major

causes of death. In assessing the change in

cause-specific death rates from 1960 to 1986, it is

necessary to account for two revisions of the

ICD: the seventh revision (used 1958 to 1967) to

the eighth revision (used 1968 to 1978), and the

eighth revision to the ninth revision (used since

1979). To assess these changes, ratios of the

number of deaths for two revisions are constructed. These ratios, called comparability ratios, provide indications of the amount of

81
Table F. Comparison of age-adjusted death rates per 100,000 for diseases of the heart for persons

65 years of age and over: 1960-86

Percent

Sex and race 1960 1986 change

Both sexes and all races . . . . . . . . . . . 2,640.2 1,693.9 –35.8

White male,......,.....,,. . . . . . 3,257.0 2,207.9 –32.2

Black male . . . . . . . . . . . . . . . . . . . . . . 2,749.5 2,297.0 –1 6.5

White female . . . . . . . . . . . . . . . . . . . . 2,161.5 1,325.1 -38.7

Black female . . . . . . . . . . . . . . . . . . . . 2,155.8 1,677.3 –22.2

NOTES: Adjusted to the 1940 population distribution. For diseases of the heart the comparability ratio for seventh to eighth

revisions =“l.0045and foreighth to ninth revisions = 1.0126.

discontinuity between revisions (5,6). Ratios close

to the value of one clearly indicate comparability.

Comparison of the age-adjusted death rates

for diseases of the heart for 1960–86 in persons

65 years of age and over reveal large declines for

both sexes and for both white and black persons

(table F). The greatest declines in these rates

were for white females and white males.

Deaths due to malignant neoplasms, including neoplasms of lymphatic and hematopoietic

tissues (hereinafter called “cancer”), increased

during the period 1980-86 (table 6). Although

this increase was not evident for all the age-racesex groups, higher cancer death rates for older

persons can be seen. The groups with the largest

increase in cancer death rates were those at the

upper end of the age spectrum: namely, males

aged 80–84 years, with a 5.9-percent increase in

rates (5.8 percent for white males and 10.6 percent for black males) (table G). For females,

the largest increases were for those aged 70-74,

The differential by race showed greater increases in death rates for black people in all

age-sex groups except females 70–74 years of

age.

Comparison of the age-adjusted death rates

for cancer for the population 65 years of age and

over for 1960 and 1986 reveals substantial increases for both sexes and for both white and

black persons (table H).

A large part of the increase in cancer mortality was the result of substantial increases in

death rates for malignant neoplasms of the respiratory and intrathoracic organs (hereinafter

called “respiratory cancer”) (table 7). With few

exceptions, each age-race-sex group showed increases in rates (table J). For males, the changes

in rates between 1980 and 1986 ranged from a

1.3-percent decrease for those aged 65–69 to a

22.4-percent increase for those 85 years and

Table G. Percent change in death rates for cancer for persons 55 years of age and over, according

to age, sex, and race: 1980-86

Male Female

Age Total White Black Total White Black

55-59 years . . . . . . . . . . . . . . . . . . . -2.0 –0.3 –12.4 –1.2 -0.5 -6.1

60–64 years . . . . . . . . . . . . . . . . . . . + 0.4 + 0.3 + 0.8 +5.0 +5.3 + 4.8

65–69 years . . . . . . . . . . . . . . . . . . . –2.4 –2.2 –1.1 + 6.8 + 6.9 +11.6

70–74 years. . . . . . . . . . . . . . . . . . . + 0.9 + 0.4 + 6.9 + 9,4 + 10.3 +4,2

75–79years.,,, . . . . . . . . . . . . . . . +1.4 + 0.8 +11.0 + 6.6 + 6.9 +7.8

80–84 years . . . . . . . . . . . . . . . . . . . + 5.9 + 5.8 +10.6 + 4.5 +4.1 +13.0

85 years and over . . . . . . . . . . . . . . +3.8 +3.6 + 9.5 +1.7 +1.3 + 8,2

82
Table H. Comparison of age-adjusted death rates per 100,000 for cancer for persons 65 years of

age and over: 1960-86

Percent

Sex and race 1960 1986 chanae

Both sexes and all races . . . . . . . . . . . . . . . 848.2 989.2 +16.6

White male . . . . . . . . . . . . . . . . . . . . . . . . . 1,056.8 1,312.7 + 24.2

Black male. . . . . . . . . . . . . . . . . . . . . . . . . . 976.4 1,702.8 + 74.4

White female . . . . . . . . . . . . . . . . . . . . . . . . 687.3 759.3 + 10.5

Black female . . . . . . . . . . . . . . . . . . . . . . . . 588.3 815.1 + 38.5

NOTES: Adjusted tothe1940 population distribution. Forcancer thecomparatili~ ratio forseventh to eighth revisions= 1.0017

and foreighth to ninth revisions = 1.0026.

Table J. Percent change in death rates for respiratory cancer for persons 55 years of age and over,

according toage, sex, and race: 1980-86

Male Female

Age Total White Black Total White Black

55–59 years . . . . . . . . . . . . . . . . . . . -0.4 +1.1 -9,6 + 22.6 +23.8 +14.7

60-64 years . . . . . . . . . . . . . . . . . . . + 2.4 + 2.0 + 5.3 + 27.9 +28.5 + 28.9

65–69 years . . . . . . . . . . . . . . . . . . . –1.3 –1.9 + 5.9 +36.0 +36.3 + 42.4

70–74 years . . . . . . . . . . . . . . . . . . . +1.7 +1.0 +12.2 +51.7 +53.6 + 42.6

75-79 years . . . . . . . . . . . . . . . . . . . + 8.6 +8.1 +18.1 + 48.9 + 49.3 + 50.0

80–84 years . . . . . . . . . . . . . . . . . . . +15.7 +15.2 + 28.7 + 50.2 +51.5 -!-55.8

85 years and over . . . . . . . . . . . . . . + 22.4 + 22.0 +35.2 + 17.3 +17.6 +12.8

over.Whitemales experienced rangeofchanges

from a 1.9-percent decline to a 22.O-percent

increase; black males experienced changes from

a 5,9-percent increase toa35 .2-percent increase.

The largest increases in respiratory cancer mortality, however, were forwomen, witha rangeof

17,3-51.7 percent; in black women, the range

was 12.8-55.8 percent, and in white women, the

rates increasedfrom 17.6 percentto53.6 percent.

Although the respiratory cancer death rates

have clearly increased from 1980 to 1986, the

long-term trends from 1960 to 1986 are even

more dramatic (table K). The greatest increases—more than 400 percent—have been experienced by females. The increase was more than

200 percent for black males, compared with

100 percent forwhite males. Although the percent increases are larger for females than for

males, the death rate in 1986 for white males is

three times that forwhite females, and the rate

for black males is 4,3 times that for black females.

Death rates for cerebrovascular diseases have

declined rapidly inthis country since 1973 (7);

this decline was evident in the comparisons

made here (table 8). The declines between 1980

and 1986 existed for all the age-race-sex groupings ranging from 17.2 percent to 29,5 percent

(table L). The long-term trends between 1960

and 1986 in cerebrovascular disease death rates

for the population 65 years of age and over

revealed substantial declines for both sexes and

for both white and black people (table M).

Diabetes mellitus, which ranked as the sixth

or seventh leading cause of mortality among

older persons, depending on the age group, is a

disease for which death rates have declined

(table 9). For 1980 to 1986, for those persons 65

years of age and over, the rates were consistently

lower for each age group for all males and all

females (table N). Although the decline in rates

was evident for both sexes, the same did not

hold true for both white and black persons.

83
Table K. Comparison of age-adjusted death rates per 100,000 for respiratory cancer for persons 65

years of age and over: 1960-86

Percent

Sex and race 1960 1986 change

Both sexes and all races . . . . . . . . . . . 112.2 277.7 +147.7

White male . . . . . . . . . . . . . . . . . . . . . 213.0 458.1 +115,1

Black male, . . . . . . . . . . . . . . . . . . . . . 167.0 555.0 + 232,3

White female . . . . . . . . . . . . . . . . . . . . 29.8 152.6 +412.3

Black female . . . . . . . . . . . . . . . . . . . . 24.7 127.9 +418.4

NOTES: Adjusted to the 1940 population distribution. For respiratory cancer the comparability ratio for seventh to eighth

revisions = 1.0316 and for eighth to ninth revisions = 1.0007,

Table L. Percent change in death rates for cerebrovascular disease for persons 55 years of age

and over, according to age, sex, and race: 1980-86

Male Female

Age Total White Black Total White Black

55–59 years . . . . . . . . . . . . . . . . . . . –18.5 –20.0 –19.4 –18.8 –17.2 –27.3

60–64 years . . . . . . . . . . . . . . . . . . . –22.7 –22.1 –28.2 –18.9 –20.1 -17.8

65–69 years . . . . . . . . . . . . . . . . . . . –28.6 –28.9 –28.1 –21.8 –20,1 -28.4

70–74 years, . . . . . . . . . . . . . . . . . . –29.1 –29,1 –29.1 –22.6 –22,4 –25.0

75–79 years, . . . . . . . . . . . . . . . . . . –29.2 -29.5 –25.5 –27.2 –27.3 -25.6

80–84 years. . . . . . . . . . . . . . . . . . . –25.3 -25.5 –22.2 –27.0 -27.4 -19,9

85 years and over. . . . . . . . . . . . . . –24.7 –24.1 –27.9 –22.5 –22.4 –20.7

Table M. Comparison of age-adjusted death rates per 100,000 for cerebrovascular disease for

persons 65 years of age and over: 1960-86

Percent

Sex and race 1960 1986 change

Both sexes and all races . . . . . . . . 857,1 332.3 –61.2

White male, . . . . . . . . . . . . . . . . . 900.6 345.7 -61,6

Black male, . . . . . . . . . . . . . . . . . . 1,117.5 498.0 -55,4

White female 789.4 304.7 -61,4

Black female . . . . . . . . . . . . . . . . . 1,048.3 430.2 –59,0

NOTES: Adjusted to the 1940 population distribution. For cerebrovascular disease the comparability ratio for seventh to eighth

revisions = 0.9905 and foreighth to ninth revisions = 1.0049,

Table N. Percent change in death rates for diabetes mellitus for persons 55 years of age and over,

according toage, sex, and race: 1980-86

Male Female

Age Total White Black Total White Black

“55–59 years . . . . . . . . . . . . . . . . . . . . . . +2.2 –12,7 –5.1 –9.4 –0.4

60–64 years. . . . . . . . . . . . . . . . . . . . . . –5.0 –7.7 +3.9 –4.4 –5.0 -2,4

65–69 years. . .,, ,, . . . . . . . . . . . . . . . –6.7 –7.0 –9.3 –10.6 –8.8 -14.6

70–74 years . . . . . . . . . . . . . . . . . . . . . . –6.8 –8!6 + 8,0 –10.6 –12.1 –2,9

75–79 years, , . . . . . . . . . . . . . . . . . . . . –9.0 –8.9 –11.1 –9.2 –10.5 -0.9

80–84 years. ., . . . . . . . . . . . . . . . . . . . -4.4 –5.1 +13.5 -4.3 –6.8 -I-13,3

85 years and over. ., ..,,,.... . . . . . -4.0 –5,3 + 6.9 –3.5 –5.6 +12,8

84
Black people

for diabetes

experienced increased death rates

for a few age groups, with the

largest increases being experienced by males and

females aged 80-84. These same trends were

evident when death rates for diabetes mellitus

for 1960 were compared with the rates for 1986.

As the population ages, there are obvious

shifts in the leading causes of death. Pneumonia

and influenza, as a group, have shown increased

importance in the older age groups. In 1986, the

rate for males 85 years of age and over was 24

times the rate for males 65–69; in the corresponding comparison for females, the rate for women

aged 85 and over was 32 times the rate for the

group aged 65-69 (table 10).

Concern has emerged regarding suicide deaths

among the older population. Table 11 shows

that the death rates for males were approximately 3–13 times the rates for females for the

various age groups. These ratios mostly reflect

the high rates for white males compared with

white females, ratios that clearly increased with

age. The death rates for suicide for persons 65

years of age and over during the period 1980-86

increased from 9,3 percent to 33.8 percent for

men of all races; increasing trends also were

observed for women, especially for those 70–84

years of age (table O).

The data in tables

terms of an underlying

1–11 are presented in

cause of death. As the

age at death increases, the number of chronic

diseases increases. Therefore, it has become

important to use multiple cause-of-death data

because they can augment the picture of mortality among the elderly. Multiple cause-of-death

data provide useful information on concurrent

conditions and on contributory causes (8). Table 12 compares the number of deaths reported

when multiple causes of death are considered

with the number of deaths reported as the underlying cause. Many of the diseases that have

the larger ratios of reported cause to underlying

cause are those that by themselves may not be

fatal, but when present with other conditions,

may add to the risk of mortali~. Large ratios of

reported cause to underlying cause also occur

for diseases that may complicate another disease

that actually leads to death. The data in table 12

indicate that septicemia, nephritis and nephrosis, pneumonia, diabetes mellitus, arteriosclerosis, chronic obstructive pulmonary diseases and

allied conditions, and accidents and adverse effects are conditions that generally have ratios of

reported to underlying cause of two or more.

These ratios appear to be similar in magnitude

for males and females and for different age

groups. These conditions clearly are ones that

may exacerbate another condition and lead to

death. Four other causes of death

generally less than two: diseases of

Table 0. Percent change in death rates for suicide for persons 55 years of age and over,

to age, sex, and race: 1980-86

had ratios

the heart,

according

Male Female

Age Total White Black Total White Black

55–59 years . . . . . . . . . . . . . . . . . . . +6.0 + 9.2 –22.1 –2.3 –3.2 + 90.5

60-64 years . . . . . . . . . . . . . . . . . . . +12.6 +13.4 –7.2 + 2.4 +1.1 + 76.0

65–69 years . . . . . . . . . . . . . . . . . . . + 9.3 + 7.7 + 39.5 + 4.5 + 2.8 + 27.8

70-74 years . . . . . . . . . . . . . . . . . . . + 24.8 + 24.0 + 52.3 + 20.3 + 17.4 +126.7

75-79 years . . . . . . . . . . . . . . . . . . . + 27.2 + 26.9 + 54.3 +33.9 +35.5 + 70.6

80-84 years . . . . . . . . . . . . . . . . . . . +33.8 +34.2 + 48.9 + 46.8 + 49.0 +150.0

85years and over . . . . . . . . . . . . . . +21.7 i- 25.6 –5.3 –1 4.5 –13.8 _——

85
malignant neoplasms, cerebrovascular disease,

and chronic liver disease and cirrhosis. From an

epidemiologic point of view, these ratios of reported to underlying cause are important for

generating hypotheses concerning the etiology of

disease and death.

References

1!

2,

3.

Verbrugge LA. The dynamics of population aging and health. In: Aging and health: linking

research and public policy. Chelsea, Michigan:

Lewis Publishers, Inc. 1989.

National Center for Health Statistics. Multiple

causes of death in the United States. Monthly

vital statistics report; vol 32 no 10, suppl 2.

Hyattsville, Maryland: Public Health Service. 1984.

National Center for Health Statistics. Advance

report of final mortality statistics, 1986. Monthly

vital statistics report; vol 37 no 6. Hyattsville,

Maryland: Public Health Service. 1988.

4. Fingerhut LA. Changes in mortality among the

5<

6.

7.

8.

elderly, United States, 1940–78, supplement to

1980. Vital Health Stat. 3(22a). Washington: National Center for Health Statistics. 1984,

National Center for Health Statistics. Comparability of mortality statistics for the seventh and

eighth revisions of the International Classification of Diseases, United States. Hyattsville, Maryland: Health Resources Administration. 1975.

National Center for Health Statistics. Estimates

of selected comparability ratios based on dual

coding of 1976 death certificates by the eighth

and ninth revisions of the International Classification of Diseases. Hyattsville, Maryland: Public

Health Service. 1980.

Whelpton PK. Declining mortality from hypertension and stroke. Southern Med Jrnl 75(1):33-8,

1982.

Israel RA, Rosenberg HM, Curtin LR. Analytical potential for multiple cause-of-death data,

Am J Epidemiol 124(2):161-79. 1986.

86
Table 1. Death rates for all causes among persons 55 years of age and over, by sex, race, and age:

United States, selected years 1960-86

[Data are based on the National Vital Statistics System]

Sex, race, and age 1960 ‘ 1970 1980 1986

Male, all races2

55-59 years, . . . . . . . . . . . . . . . . . .

60–64 years, . . . . . . . . . . . . . . . . . .

65–69 years, . . . . . . . . . . . . . . . . . .

70-74 years. . . . . . . . . . . . . . . . . . .

75–79 years. .,, ,,, . . . . . . . . . . . .

80-84 years. , . . . . . . . . . . . . . . . . .

65 years and over, . .,, ,. ..,... .

75 years and over . . . . . . . . . . . . . .

85 years and over . . . . . . . . . . . . . .

White male

55-59 yearsu, . . . . . . . . . . . . . . . . .

60-64 years, ,,, . . . . . . . . . . . . . . .

65-69 years . . . . . . . . . . . . . . . . . . .

70–74 years, ,,, . .,, ,, ..,,.... ,

75–79 years, . . . . . . . . . . . . . . . . . .

80-84 years. . . . . . . . . . . . . . . . . ,.

65 years and over . . . . . . . . . . . . . .

75 years and over...,,....,.. . .

85 yearsand over. . . . . . . . . . . . . .

Black male

55-59 years . . . . . . . . . . . . . . . . . . .

60-64 years. . . . . . . . . . . . . . . . . . .

65-69 years.,,,,,,,...,,,,.,..

70–74 years, . . . . . . . . . . . . . . . . . .

75-79 years. ,,, . . . . . . . . . . . . . . .

80-84 years . . . . . . . . . . . . . . . . . . .

65 years and over. , . . ...,...,. .

75 years and over........,.. . . .

85 years and over....,....,.. ,.

Female, allracesz

55–59 years, . . . . . . . . . . . . . . . . . .

60-64 years. . . . . . . . . . . . . . . . . . .

65-69 years. ,,, , . .,, ,, ...,,...

70-74 years. . . . . . . . . . . . . . . . . . .

75-79 years, . . . . . . . . . . . . . . . . . .

80–84 years.,.,,..,...,....,..

65 years and over..,...,,,,.,,,

75 years and over . . . . . . . . . . . . . .

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

White female

55-59 years, ,,, ., ., ., .,,...,, ,

60-64 years. . . . . . . . . . . . . . . . . . .

65-69 years.,.,.,,,.....,,.. . .

70-74 years . . . . . . . . . . . . . . . . . . .

75-79 years, . . . . . . . . . . . . . . . . . .

80–84 years. . . . . . . . . . . . . . . . . . .

65 years and over, , ., . . . . . . . . . .

75 years and over.,.,.......,,.

85 years and over . . . . . . . . . . .,,.

1,837.0

2,893.2

4,129.9

5,986.1

8,573.8

13,508.7

7,120,4

11,849.2

21,186.3

1,784.6

2,751.4

4,050.7

5,909.2

8,698.7

13,544.3

7,137.3

12,017.6

21,750.0

2,664.5

4,199.6

5,226.5

6,664.5

7,653.7

10,757.1

6,979.0

9,695.2

14,844.8

924.2

1,518.3

2,257.6

3,676.1

6,039.1

10,629.1

5,253.7

9,663.9

19,008.4

829.7

1,362.2

2,154.9

3,583.2

6,084.2

10,654.3

5,256.7

9,787.2

19,477.7

Number ofdeaths per 100,000 resident population

1,857.2

2,786.3

4,117.9

5,893.4

8,676.8

12,386.8

7,200.8

11,448.4

17,821.5

1,774.6

2,708.4

4,046.1

5,828.0

8,693.4

12,606.8

7,237.0

11,606.5

18,551,7

2,825.8

3,778.7

5,051.3

6,936.6

8,827.8

10,629.9

7,151.7

10,047.9

12,222.2

907.0

1,316.7

2,042.4

3,244.2

5,380.1

8,772.3

4,950.8

8,518.4

15,518.0

830.8

1,222.9

1,924.5

3,134.1

5,349.8

8,869.4

4,952.8

8,611,0

15,980.2

1,460.7

2,231.0

3,393.8

5,078.3

7,480.2

11,239.6

6,387.9

10,734.3

18,801.1

1,375.6

2,140.6

3,312,1

5,022.8

7,468.5

11,267.0

6,377.3

10,808.5

19,097.3

2,457.2

3,377.1

4,484.0

6,047.7

8,092.2

11,554.2

6,919.8

10,530.5

16,098.8

749.0

1,144.0

1,717,7

2,672.8

4,256.6

7,260.1

4,484.1

7,699.3

14,746.9

695.9

1,079.2

1,642.9

2,565.1

4,188.7

7,236.4

4)482.6

7,740,4

14,979.6

1,291.0

2,023.8

2,984.1

4,661.6

7,012.9

10,838.7

5,997.4

10,205.8

18,187.4

1,221.5

1,939.8

2,908.7

4,602.1

6,988.1

10,825.7

5,979.9

10,259.3

18,576.1

2,075.4

3,075.6

4,074.1

5,797.0

8,038.1

11,854.7

6,760.8

10,552.9

15,488.1

695.7

1,118.0

1,665.8

2,601.3

4,049.9

6,846.2

4,492.1

7,526.6

14,297.5

650.4

1,055.0

1,608.2

2,536.7

3,995.0

6,794.5

4,502.1

7,561,0

14,502.9

87
Table 1. Death rates for all causes among persons 55 years of age and over, by sex, race, and age:

United States, selected years 1960-86- Con.

[Data are based on the National Vital Statistics System]

Sex,race,and age 19601 1970 1980 1986

Black female Number of deaths per 100,000 resident population

55–59 years . . . . . . . . . . . . . . . . . . . 2,051.1 1,688.5 1,305.8 1,148,2

60–64 years . . . . . . . . . . . . . . . . . . . 3,113.2 2,335.8 1,860.7 1,822,3

65–69 years, . . . . . . . . . . . . . . . . . . 3,551.9 3,285.3 2,538.4 2,402.1

70–74 years . . . . . . . . . . . . . . . . . . . 4,832.6 4,728.5 3,759.6 3,514,8

75–79 years . . . . . . . . . . . . . . . . . . . 5,931.2 6,059.7 5,243.8 5,032.1

80-84 years, . . . . . . . . . . . . . . . . . . 8,437.3 7,761.0 8,030.1 8,170,6

65 years And over . . . . . . . . . . . . . . 5,287.3 5,151.1 4,766.7 4,842.7

75 years And over . . . . . . . . . . . . . . 7,943.4 7,642.8 7,612.3 7,753.0

85 years And over . . . . . . . . . . . . . . 13,052.6 10,706.6 12,367.2 12,510.3

‘Includes deaths of nonresidents of the United States.

21ncludes races otherthan white and black.

SOURCE: National Center for Health Statistics. Mtalstatistics of the United States, volll, mortality, part A. Washington: Public

Health Service, Selected years.

88
Table 2. Life expectancy at specified ages, by race and sex: United States, selected years 1960-86

[Data are based on the National Vital Statistics System]

All races’ White Black

Both Both Both

Age and year sexes Male Female sexes Male Female sexes Male Female

At birth

19602 . . . . . . . . . . . . . . . . . .

1970. , .,, ,,, ,,, ,. ..,...

1980. . . . . . . . . . . . . . . . . . .

1986. , . . . . . . . . . . . . . . . . .

At65 years

19602.. . . . . . . . . . . . . . . . .

1970,, .,, .,, ,,, ,. . . . . . .

1980,,,, ,,, .,,.,,.,,,..

1986,. . . . . . . . . . . . . . . . . .

At75 years

19602. . . . . . . . . . . . . . . . . .

1970.. . . . . . . . . . . . . . . . . .

1980.. . . . . . . . . . . . . . . . . .

1986,,,, ,, . .,, ,, ...,...

At85years

19602. . . . . . . . . . . . . . . . . .

1970, ,,, ,,, ,, . .,,,...,,

1980. . . . . . . . . . . . . . . . . . .

1986, , . . . . . . . . . . . . . . . . .

69.7

70.8

73.7

74.8

14.3

15.2

16.4

16.8

8.7

9.6

10.4

10.7

4.8

5.8

5.9

6.0

66.6

67.1

70.0

71.3

12.8

13.1

14.1

14.7

7.9

8.3

8.8

9.1

4.5

5.3

5.0

5.2

73.1

74.7

77.4

78.3

15.8

17,0

18,3

18.6

9.4

10,5

11.5

11.7

5.0

6.1

6.4

6.4

Remaining life expectancy inyears

70.6

71.7

74.4

75.4

14.4

15.2

16.5

16.9

8.7

9.5

10.4

10<7

4.7

5.6

5.9

6.0

67.4

68.0

70.7

72.0

12.9

13.1

14.2

14.8

7.9

8.3

8.8

9.1

4.4

5.2

5.0

5.1

74.1

75.6

78.1

78.8

15.9

17.1

18.4

18.7

9.3

10.4

11.5

11.8

4.9

5.9

6.3

6.4

63.2

64.1

68.1

69.4

13.9

14.2

15.1

15.4

9.8

9.9

9.7

10.1

6.0

6.6

5.5

6.3

60.7

60.0

63.8

65.2

12.7

12.5

13.0

13.4

9.1

8.8

8.3

8.7

5.7

5.9

4.5

5.5

65.9

68.3

72.5

73.5

15.1

15.7

16.8

17.0

10.4

10.9

10,7

11.1

6.2

7,0

6.1

6.7

‘Includes races other than white and black.

21ncludes deaths of nonresidents of the United States.

SOURCE: National Centerfor Health Statistics. Vital statistics of the United States, vol 11,mortality, part A. Washington: Public

Health Service. Selected years.

,‘,

89
Table 3. Life expectancy at individual ages 65-85 years, by race and sex: United States, 1986

[Data are based on the National Vital Statistics System]

All races’ White Black

Both Both Both

Age sexes Male Female sexes Male Female sexes Male Female

65 years. . . . . . . . . . . . . . . .

66 years . . . . . . . . . . . . . . . .

67years . . . . . . . . . . . . . . . .

68 years, . .,, ., ..,,,,.,.

69 years. . . . . . . . . . . . . . . .

70 years. . . . . . . . . . . . . . . .

71 years . . . ..o . . .. o.....

72 years . . . . . . . . . . . . . . . .

73 years . . . . . . . . . . . . . . . .

74 years . . . . . . . . . . . . . . . .

75 years . . . . . . . . . . . . . . . .

76 years . . . . . . . . . . . . . . . .

77 years.,..........,,..

78 years. . . . . . . . . . . . . . . .

79 years . . . . . . . . . . . . . . . .

80 years . . . . . . . . . . . . . . . .

81 years. ,, .,, . . . . . . . . . .

82 years, . . . . . . . . . . . . . . .

83 years . . . . . . . . . . . . . . . .

84 years . . . . . . . . . . . . . . . .

85 years . . . . . . . . . . . . . . . .

16.8

16.2

15.5

14,8

14.2

13.6

12.9

12.4

11.8

11.2

10.7

10.1

9.6

9,1

8.6

8.1

7.7

7.2

6.8

6.4

6.0

14.7

14.1

13.4

12.8

12.2

11.7

11.1

10.6

10.1

9.6

9.1

8.6

8.2

7.7

7.3

6.9

6.5

6.1

5.8

5.5

5.2

18.6

17.9

17.1

16.4

15.7

15.0

14.3

13.7

13.0

12.4

11.7

11.1

10.5

9.9

9.4

8.8

8.3

7,8

7.3

6.8

6.4

Remaining life expectancy inyears

16.9

16.2

15.6

14.9

14.2

13.6

13.0

12.4

11.8

11.2

10.7

10.1

9.6

9!1

8.6

8.1

7.6

7.2

6.8

6.4

6.0

14.8

14.1

13.5

12.9

12.3

11.7

11.1

10.6

10.1

9.6

9.1

8.6

8.1

7.7

7.3

6.9

6.5

6.1

5.7

5.4

5.1

18.7

18.0

17.2

16.5

15.8

15.1

14.4

13.7

13.0

12.4

11.8

11.1

10.5

9.9

9.4

8.8

8,3

7.8

7.3

6.8

6.4

15.4

14.8

14.2

13.6

13.1

12.5

12.0

11.5

11,0

10.5

10.1

9.6

9,1

8.7

8.3

7.9

7.5

7.1

6.8

6.5

6.3

13,4

12,9

12.3

11.8

11.3

10,8

10.4

9.9

9.5

9.1

8.7

8.3

7.9

7.5

7.2

6.8

6.5

6.2

5.9

5.7

5.5

17,0

16.4

15,7

15,1

14.5

13.9

13,3

12,7

12.1

11.6

11.1

10.5

10,0

9.5

9.0

8,5

8,1

7.7

7.3

7.0

6.7

llncludes races other than white and black.

SOURCE: National Center for Health Statistics, Vital statistics of the United States, volll, mortality, part A. Washington: Public

Health Service. 1986.

90
Table 4. Death rates for the 10 leading causes of death in rank order among persons 55 years of

age and over: United States, 1986

[Data are based on the National Vital Statistics System]

Number of

deaths per

700,000

Rank

resident

Age, cause of death and ICD–9 code 1 population

1

2

3

4

5

6

7

8

9

10

1

2

3

4

5

6

7

6

9

10

1

2

3

4

5

6

7

8

9

10

1

2

3

4

5

6

7

8

9

10

55–59 years

All causes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Malignant neoplasms, including neoplasms of lymphatic and hematopoietic tissues . . . . ..140–208

Diseases of heart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..390–398.402.404-429

Cerebrovascular diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...430-438

Accidents and adverse effects.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..E8E949949

Chronic obstructive pulmonary disease and allied conditions . . . . . . . . . . . . . . . . . . . . . . ...490-496

Chronic liver disease and cirrhosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . .,,...................571

Diabetes mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , ..,...............,......250

Suicide, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,, . . . . . . . . . . . . . . ..E95o–E959

Pneumonia and influenza . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..480–487

Septicemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...38

60–64years

Al lcause s. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Malignant neoplasms, including neoplasms of lymphatic and hematopoietic tissues . . . . ..140–208

Diseases of heart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . ..390–398.402.404-429

Cerebrovascular diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...430-438

Chronic obstructive pulmonary disease and allied conditions . . . . . . . . . . . . . . . . . . . . . . ...490-496

Accidents and adverse effects.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..E8OO–E949

Chronic liver disease and cirrhosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...571

Diabetes mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...250

Pneumonia and influenza . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...480-487

Suicide, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..E95O–E959

Nephritis, nephritic syndrome, andnephrosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..580–589

65–69years

All causes, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diseases of heart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,, ... .,,390–398,402,404-429

Malignant neoplasms, including neoplasms of lymphatic and hematopoietic tissues . . . ...140-208

Cerebrovascular diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., . . . . . . . . . . . . . . . . ...430-438

Chronic obstructive pulmonary disease and allied conditions . . . . . . . . . . . . . . . . . . . . . . ...490-496

Diabetes mellitus, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...250

Accidents and adverse effects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..E800–E949

Pneumonia and influenza . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..480–487

Chronic liver disease and cirrhosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...571

Nephritis, nephritic syndrome, andnephrosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..580–589

Septicemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .38

70–74 years

All causes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diseases of heart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..390–398.402.404429

Malignant neoplasms, including neoplasms of lymphatic and hematopoietic tissues . . . ...140-208

Cerebrovascular diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...430438

Chronic obstructive pulmonary disease and allied conditions . . . . . . . . . . . . . . . . . . . . . . ...490-496

Pneumonia and influenza, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...480487

Diabetes mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .,, . . . . . . . . . . . . . . . . . . ...250

Accidents and adverse effects.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..E8OO–E949

Chronic liver disease and cirrhosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...571

Nephritis, nephritic syndrome, and nephrosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..580–589

Septicemia, , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...38

978.8

352.7

318.9

39.4

32.5

31.3

29.5

19.8

17.0

13.4

6.8

1,539.1

538.7

532.5

67.0

63.4

37.1

35.0

32.4

24.0

17.0

12.7

2,263.0

820.4

736.2

116.3

113.6

48.3

41.4

41.0

36.9

20.0

17.8

3,479.7

1,323.4

986.6

224.4

194,1

80.8

73.1

58.6

37.7

35.4

28.6

91
Table 4. Death rates for the 10 leading causes of death in rank order among persons 55 years of

age and over: United States, 1986– Con.

[Data are based on the National Vital Statistics System]

Number of

deaths per

1001000

Rank

resident

Age, cause of death and ICD–9 code 1 population

1

2

3

4

5

6

7

8

9

10

1

2

3

4

5

6

7

8

9

10

1

2

3

4

5

6

7

8

9

10

75–79 years

All causes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diseases of heart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..390–398.402.404-429

Malignant neoplasms, including neoplasms of lymphatic and hematopoietic tissues . . . ...140-208

Cerebrovascular diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., . . . . . . . . . . . . . . . . . . ..430–438

Chronic obstructive pulmonary disease and allied conditions . . . . . . . . . . . . . . . . . . . . . . ...490-496

Pneumonia and influenza . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .,..........,...,.,..480-487

Diabetes mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..250

Accidents and adverse effects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..E800–E949

Nephritis, nephritic syndrome, andnephrosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...580-589

Septicemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...38

Atherosclerosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...440

80–84years

All causes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diseases of heart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..390–398.402.404–429

Malignant neoplasms, including neoplasms of lymphatic and hematopoietic tissues .,. ..,140–208

Cerebrovascular diseases ..,..., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,., . . . . . . . . . . . . ..430–438

Pneumonia and influenza . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..480–487

Chronic obstructive pulmonary disease and allied conditions . . . . . . . . . . . . . . . . .,...,...490-496

Diabetes mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..250

Accidents and adverse effects . . . . . . . . . . . . . . . . . . . . . . . . . ,., . . . . . . . . . . . . . . . . . ..E8OO–E949

Atherosclerosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..440

Nephritis, nephritic syndrome, and nephrosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..580–589

Septicemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...38

85 years andover

All causes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diseases of heart..,.,......,.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..390–398.402.404–429

Cerebrovascular diseases, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..430–438

Malignant neoplasms, including neoplasms of lymphatic and hematopoietic tissues . . . . ..140–208

Pneumonia and influenza . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,480–487

Atherosclerosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . ...440

Chronic obstructive pulmonary disease and allied conditions . . . . . . . . . . . . . . . ., . . . . . . ..490–496

Accidents and adverse effects.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..E8OO–E949

Nephritis, nephritic syndrome, and nephrosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...580-589

Diabetes mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...250

Septicemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...38

5,206.1

2,098.1

1,188,4

422.0

271,2

172.7

103,9

86.5

62.0

50.3

49.3

8,230.0

3,526.1

1,450,3

823,7

358.3

333,7

151,7

139,0

116.9

108.1

88.3

15,398.9

7,178,7

1,762,6

1,612.0

1,032,1

432,6

362,9

252,2

216,4

213,9

181,9

‘Coded according to the International Classification of Diseases, Ninth Revision.

SOURCE: National Center for Health Statistics. Vital statistics of the United States, vol 11,mortality, part A, Washington: Public

Health Service. 1986.

92
Table 5. Death rates for diseases of the heart among persons 55 years of age and over, by sex,

race, and age: United States, selected years 1980-86

[Data are based on the National Vital Statistics System]

Sex, race, and age 1980 1982 1984 1986

Male, all races’

55-59 yt3ars. . . . . . . . . . . . . . . . . . .

60–64 years, . . . . . . . . . . . . . . . . . .

65-69 years, ,, ., . . . . . . . . . . . . . .

70-74 years,,,...,,,,,,,,,,,..

75–79 years, . . . . . . . . . . . . . . . . . .

80-84 years. . . . . . . . . . . . . . . . . . .

65 years and over. . . . . . . . . . . . . .

75 years and over, ,,, .,.....,. .

85 years and over, . . . . . . . . . . . . .

White male

55–59 years, ,, .,, . . . . . . . . . . . . .

60-64 years,,,,,,....,.,.,.. . .

65-69 years . . . . . . . . . . . . . . . . . . .

70-74 years . . . . . . . . . . . . . . . . . . .

75-79 years,,..,,.....,...,.. .

80-84 years, . . . . . . . . . . . . . . . . . .

65 years and over . . . . . . . . . . . . . .

75 years and over . . . . . . . . . . . . . .

85 years and over . . . . . . . . . . . . . .

Black male

55–59 years, . . . . . . . . . . . . . . . . . .

60–64 years, . . . . . . . . . . . . . . . . . .

65-69 years, ,,, . . . . . . . . . . . . . . .

70–74 years, . . . . . . . . . . . . . . . . . .

75-79 years. . .,, . . . . . . . . . . . . . .

80-84 years,,,...,,......,.. . .

65 years and over, . . . . . . . . . . . . .

75 years and over, ,,, ,,, ,..,. . .

85 years and over, . . . . . . . . . . . . .

Female, all races!

55-59 years. , .,, , . .,, ..,.,... .

60–64 years, . . . . . . . . . . . . . . . . . .

65-69 years, . . . . . . . . . . . . . . . . . .

70-74 years, ,,, ,,, , . . . . . . . . . . .

75–79 years. . . . . . . . . . . . . . . . . . .

80-84 years. . . . . . . . . . . . . . . . . . .

65 years and over . . . . . . . . . . . . ,.

75 years and over. . . . . . . . . . . . ,.

85 years and over, , .,, ,, .,,,..,

White female

55–59 years. ,,, . . . . . . . . . . . . . ,.

60-64 years, ,,, .,, ,, . . . . . . . . . .

65–69 years, . . . . . . . . . . . . . . . . . .

70-74 years. . . . . . . . . . . . . . . . . . .

75-79 years. . . . . . . . . . . . . . . . . . .

80-84 years. .,, , . ., .,.,...., ,.

65 years and over . . . . . . . . . . . . . .

75 years and over, . . . . . . . . . . . . .

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

596.1

923.6

1,418.9

2,150.8

3,213.8

4,959.2

2,778.3

4,778.2

8,752.7

579.4

907.2

1,413.7

2,160.8

3,249.6

5,017.6

2,812.4

4,861,6

8,958.0

824.5

1,184.4

1,593.7

2,206.3

3,084.7

4,586.2

2,623.6

4,190.0

6,819.5

196.7

357.5

621.4

1,084.6

1,893.8

3,424.6

2,027.4

3,674.8

7,350.5

175.5

329.8

588.8

1,051.0

1,873.3

3,432.0

2,040.0

3,716.4

7,501.6

Number of deaths per 100,000 resident population

553.8

874.1

1,350.0

2,020.8

3,051.4

4,629.7

2,638,8

4,495.5

8,221.3

537.3

858.0

1,339.9

2,029,1

3,098.1

4,716.2

2,671.7

4,592.4

8,442,2

787.0

1,141,9

1,586.5

2,123.6

2,790,1

4,109.4

2,517.5

3,826.8

6,378.6

187.4

339,8

588.3

1,021.3

1,771.4

3,171,5

1,945.4

3,478.1

6,970.8

167.3

312,8

560.8

994.7

1,765.3

3,186.4

1,964.4

3,530.1

7,118.6

520.4

831.3

1,242.1

1,927.4

2,940.8

4,635.6

2,546.9

4,416.6

8,154.8

506.2

813.6

1,235.6

1,924,8

2,985.9

4,664.6

2,576.1

4,499.9

8,416.4

709.9

1,110.9

1,426.6

2,161.2

2,785.7

4,569.9

2,474.0

3,905.4

6,015.9

183.0

330.5

566.0

1,000.4

1,719.6

3,155.5

1,945.2

3,472.0

6,885.9

161.1

304.0

538.9

967.0

1,705.5

3,138.3

1,957.0

3,505.6

7$044.7

483.7

777.9

1,160.5

1,829.8

2,796.5

4,450.5

2,429.3

4,230.3

7,911.5

468.5

758.2

1,148.4

1,830.6

2,818.2

4,482.4

2,450.2

4,292.0

8,138.4

685.5

1,067.1

1,420.3

2,028.9

2,885.2

4,475.6

2$465.5

3,990.0

6,268.7

169.5

319.3

538.6

947.2

1,651.3

3,035.8

1,913.0

3,415.3

6,889.3

150.6

291.8

508.6

914.7

1,624.2

3,021.8

1,922.5

3,444.0

7,021.3

93
Table 5. Death rates for diseases of the heart among persons 55 years of age and over, by sex,

race, and age: United States, selected years 1980-86- Con.

[Data are based on the National Vital Statistics System]

Sex, race, and age 1980 1982 1984 1986

Black female Number of deaths per 100,000 resident population

55–59 years. . . . . . . . . . . . . . . . . . . 416.8 387.2 391.0 354.1

60–64 years . . . . . . . . . . . . . . . . . . . 663.1 635.0 621.6 616.0

65–69 years . . . . . . . . . . . . . . . . . . . 983.1 916.5 881.1 893.5

70–74 years. . . . . . . . . . . . . . . . . . . 1,517.8 1,374.6 1,438.0 1,381.0

75–79 years, . . . . . . . . . . . . . . . . . . 2,241.2 1,980.3 2,040.3 2,120.9

80–84 years . . . . . . . . . . . . . . . . . . . 3,582.0 3,253.4 3,668.3 3,533,3

65 years and over . . . . . . . . . . . . . . 2,036.2 1,909.1 1,975.5 2,027.4

75 years and over . . . . . . . . . . . . . . 3,411.2 3,125.2 3,281.7 3,399,0

85 years and over. . . . . . . . . . . . . . 5,796.5 5,491.3 5,315.0 5,698.6

‘Includes races otherthan white and black,

NOTE: Diseasesof the heart comprise codes 390-398,402, and404-4290fth e/nternationalC/ossification ofDiseases, Ninth

Revision.

SOURCE: National Center for HeaIth Statistics. Mtalstatistics of the United States, volll, motiality, pafi A. Washington: Public

Health Service. Selected years.

94
Table 6. Death rates formaiignant neoplasms, including neoplasmsof Lymphatic and hematopoietic

tissues, among persons 55 years of age and over, by sex, race, and age: United States, selected

years 1980-86

[Data are based on the National Vital Statistics System]

Sex, race, and age 1980 1982 1984 1986

Male, all racesl

55-59 years . . . . . . . . . . . . . . . . . . .

60-64 years. ,,, . . . . . . . . . . . . . . .

65-69 years. , . ., . . . . . . . . . . . . . .

70–74 years. ,, . . . . . . . . . . . . . . . .

75–79 years.,,,........,.. . . . .

80-84 years, , . . . . . . . . . . . . . . . . .

65 years and over. . . . . . . . . . . . . .

75 years and over . . . . . . . . . . . . . .

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

White male

55–59 years.,,,,.........,.. . .

60-64 years, ,,, . . . . . . . . . . . . . ,.

65-69 years, ,,, . . . . . . . . . . . . . . .

70-74 years, , . . . . . . . . . . . . . . . . .

75-79 years. . . . . . . . . . . . . . . . . . .

80–84 years, . . . . . . . . . . . . . . . . . .

65 years and over,.,,,,...,.. . .

75 years and over.......,.,.. .,

85 years and over.........,.. . .

Black male

55-59 years. . . . . . . . . . . . . . . . . . .

60-64 years . . . . . . . . . . . . . . . . . . .

65–69 years. . . . . . . . . . . . . . . . . . .

70-74 years, . . . . . . . . . . . . . . . . .,

75-79 years. . . . . . . . . . . . . . . . . . .

80-84 years. . . . . . . . . . . . . . . . . . .

65 years and over. , . .,,,,.... . .

75 years and over, ., .,.....,, ,.

85 years and over . . . . . . . . . . . . . .

Female, all races’

55-59 years, ,,, ,,, ,,, ,,, .,.., .

60–64 years, ,,, . . . . . . . . . . . . . ,.

65–69 years. . . . . . . . . . . . . . . . . . .

70-74 years...,...,,,...,,,. . .

75-79 years, ,,, . . . . . . . . . . . . . . .

80–84 years. . . . . . . . . . . . . . . . . ,.

65 years and over . . . . . . . . . . . . . .

75 years And over . . . . . . . . . . . . . .

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

White female

55-59 years,,,,,,,,,,.,,.,,,,.

60–64 years. ,,, . . . . . . . . . . . . . .,

65-69 years . . . . . . . . . . . . . . . . . . .

70–74 years . . . . . . . . . . . . . . . . . . .

75-79 years. . . . . . . . . . . . . . . . . .,

80-84 years,,,,,,.,..,,...,,, .

65 years and over. . . . . . . . . . . . . .

75 years and over . . . . . . . . . . . . . .

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

414.8

645.2

947,5

1,292,5

1,656.2

2,033.9

1,371.4

1,901.4

2,369.5

391.9

620.7

921.5

1,274.3

1,648.5

2,014.5

1,355.5

1,894.7

2,375.6

688.8

962.4

1,287.7

1,600.7

1,862.7

2,369.8

1,642.9

2,098,2

2,393.9

307.5

423,0

542.9

686.5

820.5

1,030.2

767.8

988.6

1,255.7

301.1

416.6

542.4

681.9

822.3

1,031.3

770,6

993.6

1,266.8

Number of deaths per 100,000 resident population

412.7

644.2

954.2

1,276,7

1,671.1

2,027.1

1,380.8

1,914.9

2,409.7

389.4

616.0

927.9

1,253,3

1,664.6

2,016.5

1,332.0

1,822.1

2,413.4

695.1

1,006.0

1,332.0

1,662.8

1,900.0

2,329,4

1,708.6

2,144.4

2,566.1

310.6

428.0

564.9

683,7

840,9

1,017.3

781.7

996.5

1,256.5

304.5

421.9

563.5

683.2

843.8

1,017.5

785,4

1,002.5

1,270.6

424.4

644.3

929.5

1,297.7

1,673.8

2,109.6

1,387.2

1,941.2

2,427.2

400.6

614.6

907.5

1,270.5

1,660.0

2,075.6

1,367.5

1,927.1

2,438.6

690.3

1,016.7

1,248.7

1,716.5

2,007.7

2,668.7

1,727.8

2,275.5

2,471.4

313.5

440.0

573,7

714.8

860.7

1,073.4

808.3

1,028.3

1,271.5

307.6

434.1

574.5

714.4

864.4

1,065.7

812.1

1,032.0

1,284.3

406.7

647.7

925.0

1,303.8

1,678.9

2,154.9

1,395.6

1,961.3

2,459.5

390.8

622.6

900.9

1,279.6

1,661.6

2,130.6

1,375.8

1,946.0

2,462.3

603.6

970.5

1,273.5

1,710.6

2,067.6

2,620.9

1,752.6

2,324.9

2,620.9

303.8

444.0

579.9

750.8

874.6

1,076.5

825.6

1,038.0

1,277.2

299.7

438.7

580.0

752.4

879.0

1,073.5

829.9

1,041.8

1,283.6

95
Table 6. Death rates for malignant neoplasms, including neoplasms of lymphatic and hematopoietic

tissues, among persons 55 years of age and over, by sex, race, and age: United States, selected

years 1980-86- Con.

[Data are based on the National Vital Statistics System]

Sex, race, and age 1980 1982 1984 1986

Black female

55-59 years . . . . . . . . . . . . . . . . . . .

60–64 years . . . . . . . . . . . . . . . . . . .

65–69 years . . . . . . . . . . . . . . . . . . .

70-74 years, . . . . . . . . . . . . . . . . . .

75-79 years . . . . . . . . . . . . . . . . . . .

80-84 years . . . . . . . . . . . . . . . . . . .

65 years and over . . . . . . . . . . . . . .

75years and over, . . . . . . . . . . . . .

85 years and over . . . . . . . . . . . . . .

394.4

516.1

578.1

776.5

842.3

1,077.1

780.8

977.9

1,159.9

Number of deaths per 100,000 resident population

394.6

526.0

622,7

737,8

862.2

1,087.0

796.8

985.6

1,129,6

396.3

536.2

613.3

777.4

892.4

1,233.8

828.6

1,048.4

1,154.9

370.2

540,8

645,2

809.3

907,6

1,217.6

862,0

1,077.6

1,254.5

‘Includes races other than white and black,

NOTE: Malignant neoplasms, including neoplasms of lymphatic and hematopoietic tissues, comprise codes 140-208 of the

International Classification of Diseases, Ninth Revision.

SOURCE: National Center for Health Statistics. Vital statistics of the United States, VOI11,mortality, part A. Washington: Public

Health Service. Selected years.

96
Table 7. Death rates for malignant neoplasms of the

persons 55 years of age and over, by sex, race, and

1980-86

[Data are based on the National Vital Statistics System]

respiratory and intrathoracic organs among

age: United States, selected years

Sex, race, and age 1980 1982 1984 1986

Male, all races’

55–59years. .,. .,q . . . .. q......

60–64 years. . . . . . . . . . . . . . . . . . .

65-69 years. ,,, . . . . . . . . . . . . . . .

70–74 years, . . . . . . . . . . . . . . . . . .

75–79years. ,,, ..o, . . .. i..... .

80-84 years. . . . . . . . . . . . . . . . . . .

65 years and over, . . . . . . . . . . . . .

75 years and over . . . . . . . . . . . . .,

85 years and over. .,, ...,..... .

White male

55–59 years. ,,, , ., . . . . . . . . . . . .

60–64 years, . . . . . . . . . . . . . . . . ,.

65–69 years. . . . . . . . . . . . . . . . . . .

70–74 years, . . . . . . . . . . . . . . . . . .

75-79 years, , ., . . . . . . . . . . . . . . .

80–84 years. . . . . . . . . . . . . . . . . . .

65 years and over . . . . . . . . . . . . . .

75 years and over . . . . . . . . . . . . . .

85 years and over.........,.. . .

Black male

55–59 years. ,,, . . ...,..... . . . .

60-64 years, . .,, ,, . . . . . . . . . . . .

65–69 years, , . . . . . . . . . . . . . . . . .

70-74 years.,,,,,......,.,,. ,.

75–79 years..,,....,.....,.. . .

80–84 years,,....,.......,.. ,.

65 years and over, . . . . . . . . . . . . ,

75 years and over. . . . . . . . . . . . . .

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

Female, all racesl

55-59 years . . . . . . . . . . . . . . . . . . .

60–64 years . . . . . . . . . . . . . . . . . . .

65–69 years. , . .,, ., . . . . . . . . . . .

70-74 years. .,, , ., . . . . . . . . . . ,,

75-79 years . . . . . . . . . . . . . . . . . .,

80–84 years . . . . . . . . . . . . . . . . . . .

65 years and over . . . . . . . . . . . . . .

75 years And over. ..,,.,.., . . . .

85 years and over. ., ..,,,..,, . .

White female

55-59 years,..,..,+,,,,,,,.. .,

60–64 years. ,,, . . . . . . . . . . . . . . .

65–69 years . . . . . . . . . . . . . . . . . . .

70–74 years. ,,, . .,, ,,, .,.... ,.

75–79 years.. ,,, . . . . . . . . . . . . . . .

80–84 years,,,,.,......,.,.. .,

65 years and over . . . . . . . . . . . . . .

75 years and over, . . . . . . . . . . . . .

85 years and over, ,, ..,,...,. ,.

179.7

275.6

382.3

476.4

517.7

500.3

444.5

487.4

386.3

170.8

266.7

375.5

477.0

522.3

505.0

443.9

492.1

391.5

292.8

397.9

490.4

512.3

516.5

465.2

489.4

469.0

337.7

63,7

86.6

104.1

108.5

102.7

90.6

102.5

97.6

96.3

62.9

87.0

106.4

110.1

105.0

90.5

104.1

98.7

96.8

Numberofdeaths per 100,000 resident population

181,1

278.5

391.4

480.2

535.9

510,8

457.4

508.9

432.6

171.1

267.0

384.0

477.3

543.3

517.5

456.3

515.8

439.1

310.2

434.9

516.9

570.8

514.9

488,2

520.8

483.4

385.7

70.8

97.7

118,9

121.9

112.1

103.9

114.0

105.7

96.2

70.6

98.0

121,5

126.0

114.7

103,3

116.2

106.7

96.1

187.2

278.3

380.9

486.9

550.7

559.4

463.7

532.6

442.8

177,2

265.4

373.3

484.4

554.4

560.5

461.5

535.7

446.8

307.0

449.3

502.0

567.1

571.4

586.7

534.9

545.9

423.8

75.9

104.0

131.4

139.6

132.3

121.4

129.0

121.1

101.0

76.0

104.2

135.2

144.0

134.8

122.3

132.0

122.8

102.5

178.9

282.1

377.2

484.7

562.0

578.8

468.0

550.0

472.9

172.6

272.1

368.5

481.6

564.7

581.9

465.2

553.3

477.5

264.7

419.2

519.2

574,9

610.2

598.8

553.8

576.0

456.7

78.1

110.8

141.6

164.6

152.9

136.1

145.7

137.6

113.0

77.9

111.8

145.0

169.1

156.8

137.1

148.8

139.8

113.8

97
Table 7. Death rates for malignant neoplasms of the respiratory and intrathoracic organs among

persons 55 years of age and over, by sex, race, and age: United States, selected years

1980-86- Con.

[Data are based on the National Vital Statistics System]

Sex, race, and age 1980 1982 1984 1986

Black female Number of deaths per 100,000 resident population

55–59 years . . . . . . . . . . . . . . . . . . . 79.0 82.3 85.1 90.6

60–64 years. . . . . . . . . . . . . . . . . . . 89.5 104.9 113.3 115,4

65–69 years...,,,,...,,..,,,.. 89.0 105,7 106,0 126.7

70–74 years . . . . . . . . . . . . . . . . . . . 95.5 88.7 106.3 136.2

75–79 years. . . . . . . . . . . . . . . . . . . 79.2 90.6 113.7 118.8

80–84 years . . . . . . . . . . . . . . . . . . . 84.7 112,3 109.7 132,0

65 years and over. ., . . . . . . . . . . , 88,6 97.3 106.0 125.8

75 years and over . . . . .. A..... . . 83.3 96.3 105.9 118.1

85 years and over . . . . .. l..... . . 90.5 88.7 86,5 102.1

‘Includes races otherthan white and black.

NOTE: Malignant neoplasms of the respiratory and intrathoracic organs comprise codes 160–1650f the/ntemationa/

Classificationof Diseases, Ninth Revision,

SOURCE: National Center for Health Statistics. Vital statistics of the United States, VOI11,mortality, part A. Washington: Public

Health Service. Selected years,

98
Table 8. Death rates for cerebrovascular diseases among persons 55 years of age and over, by

sex, race, and age: United States, selected years 1980-86

[Data are based on the National Vital Statistics System]

Sex, race, and age 1980 1982 1984 1986

Male, all racesi

55–59 years.,..............,..

60-64 years,...,,,.........,,.

65-69 years,...,....,......,..

70–74 years. . . . . . . . . . . . . . . . . . .

75-79 years, . . . . . . . . . . . . . . . . . .

80-84 years, ,,, ,,, , . .,, ..,...,

65 years and over. . . . . . . . . . . . . .

75 years and over. . .,,....,. . . .

85 years and over . . . . . . . . . . . . . .

White male

55-59 years,,.,.,.,,..,,.,.,..

60–64 years, . . . . . . . . . . . . . . . . . .

65-69 years, .,, . . . . . . . . . . . . . . .

70-74 years.,,,...,....,.,.,..

75–79 years, , ., ., . . . . . . . . . . . . .

80-84 years, . . . . . . . . . . . . . . . . . .

65 years and over, . . . . . . . . . . . . .

75 years and over, . . . . . . . . . . . . .

85 years and over. . . . . . . . . . . . . .

Black male

55-59 years. . . . . . . . . . . . . . . . . . .

60-64 years...,...........,.. .

65-69 years. .,, . . . . . . . . . . . . . . .

70-74 years. , ., . . . . . . . . . . . . . . .

75-79 years, . . . . . . . . . . . . . . . . ,.

80-84 years, . . . . . . . . . . . . . . . . . .

65 years and over,,.......,.. . .

75 years and over . . . . . . . . . . . . . .

85 years and over . . . . . . . . . . . . .

Female, all racesl

55–59 years. . . . . . . . . . . . . . . . . . .

60-64 years. . . . . . . . . . . . . . . . . . .

65-69 years, . . . . . . . . . . . . . . . . . .

70-74 years. . . . . . . . . . . . . . . . . . ,

75-79 years. ,,, . . . . . ..a. .a . . . .

80-84 years,.......,......,.. .

65 years and over. ,, . . . . . . . . . . .

75 years and over . . . . . . . . . . . . . .

85 years and over.....,....,.. .

White female

55–59 years, , . . . . . . . . . . . . . . . . .

60-64 years, . . . . . . . . . . . . . . . . . ,

65–69 years, . . . . . . . . . . . . . . . . . .

70-74 years, . . . . . . . . . . . . . . . . . .

75-79 years. ,, .,, ,,, . . . . . . . . . .

80–84 years. . . . . . . . . . . . . . . . . . .

65 years and over. . . . . . . . . . . . . .

75 years and over. ,, . . . . . . . . . ,,

85 years and over.,,....,,,.. . .

54.1

99.0

184.7

361.2

675.9

1,217,1

556.9

1,123.7

2,199.2

45.5

86.0

167.3

340.1

657,4

1,208.1

544,9

1,121.2

2,236.9

145.1

244.0

376.4

609,4

908.1

1,392.8

720.3

1,219.6

1,873.2

43.2

72.4

132.1

259.4

530,0

1,067.1

583.9

1,126.6

2,328.2

36.1

62.8

117.1

241.0

512.4

1,060.0

580.5

1,130.1

2,367.8

Numberofdeaths per 100,000 resident population

51.2 47.5

85.1 80.8

164,1 146.6

312.8 283.2

580.6 519.0

1,019,7 977.1

484.7 447.7

961.1 892.8

1,908.0 1,797.0

42.7

73.4

148,6

294.9

565.3

1,020.0

474.3

961.6

1,944.7

139.6

215.0

347.6

530.8

770.8

1,091.8

634.0

1,021.9

1,637.5

38.5

65.6

117.3

225.9

456.2

918.0

519.9

986.6

2,039.9

32.5

56.3

104.9

212.5

441.7

911.4

518.0

990.8

2,074.5

39.1

70.5

133.2

265.8

510.3

965.2

438.0

894.8

1,846.4

128.8

194.0

296.0

495.7

644.6

1,173.5

568.9

935.0

1,395.2

36.1

61.9

106.0

213.2

423.1

860.1

495.1

934.9

1,918.9

30.6

53.6

94.1

196.1

408.2

844.2

492.3

937.7

1,962.5

44.1

76.5

131.9

256.1

478.5

906.8

410.1

822.7

1,656.4

36.4

67.0

119.0

241.3

463.2

900.0

400.9

819.6

1,697.0

116.9

175.2

270.5

432.3

676.1

1,083.7

536.9

920.1

1,350.7

35.1

58.7

103.3

200.9

385.9

778,6

466.2

868.9

1,804.6

29.9

50.2

93.6

187.1

372.7

769.8

464.9

871.8

1,837.3

99
Table 8. Death rates for cerebrovascular diseases among persons 55 years of age and over, by

sex, race, and age: United States, selected years 1980–86 – Con.

[Data are based on the National Vital Statistics System]

Sex, race, and age 1980 1982 1984 1986

Black female

55–59 years . . . . . . . . . . . . . . . . . . .

60–64 years . . . . . . . . . . . . . . . . . . .

65–69 years . . . . . . . . . . . . . . . . . . .

70–74 years..............,.. . .

75–79 years . . . . . . . . . . . . . . . . . . .

80–84 years . . . . . . . . . . . . . . . . . . .

65 years and over . . . . . . . . . . . . ,.

75 years And over. . . . . . . . . . . . . .

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

111.5

170.6

283.5

468.7

759.3

1,217.7

654.6

1,141.4

1,896.3

Numberofdeaths per 100,000 resident population

97.1

162.8

247,0

375.4

643.7

1,074.0

577,5

999,2

1,689.6

84.9

143,5

223.9

406,5

620.5

1,135.2

565.6

967.5

1,470.7

81.1

140,3

203.1

35106

564.6

975.2

526.2

910.8

1,504,1

llncludes races otherthan white and black.

NOTE: Cerebrovascular diseases comprise codes 430–4380f the international Classificationof Diseases, Ninth Revision,

SOURCE: National Center for Health Statistics. Vital statistics ofthe United States, volll, mortality, part A. Washington: Public

Health Service. Selected years.

100
Table 9. Death rates for diabetes mellitus among persons 55 years of age and over, by sex, race,

and age: United States, selected years 1980-86

[Data are based on the National Vital Statistics System]

Sex, race, and age 1980 1982 1984 1986

Male, all races’

55–59 years. . . . . . . . . . . . . . . . . . .

60-64 years . . . . . . . . . . . . . . . . . . .

65-69 years, .,, . . . . . . . . . . . . . . .

70-74 years. .,, ,, ., ., ...,,..,,

75-79 years,,..,,..,,,.,...,.,

80-84 years. . . . . . . . . . . . . . . . . . .

65 years and over. . . . . . . . . . . . . .

75 years and over,,,,,,...,,,,.

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

White male

55-59 years,,,.,,,,,.,,,,,.,,.

60-64 years, . . . . . . . . . . . . . . . . . .

65–69 years . . . . . . . . . . . . . . . . . . .

70-74 years. , . . . . . . . . . . . . . . . . .

75-79 years,,.,..,.,.,,...,,, .

80-84 years...,........,.,.. ,.

65 years and over. .,....... . . . .

75 years And over, . . . . . . . . . . . . .

85 years and over. . ., . ...,,..,,

Black male

55–59 years. .,, ,, . . . . . . . . . . . . .

60-64 years,.,...,...,..,,.,,.

65–69 years, ,, . . . . . . . . . . . . . . . ,

70–74 years . . . . . . . . . . . . . . . . . . .

75–79 years, . ., . .,, . . . . . . . . . . .

80–84 years,,...,,...,,.,,,,,.

65 years and over, . ., ...,,..., .

75 years and over. . . . . . . . . . . . ,.

85 years and over . . . . . . . . . . . . . .

Female, all races’

55-59 years.,.,.....,..,,.. . . .

60–64 years, . . . . . . . . . . . . . . . . ,.

65-69 years. . . . . . . . . . . . . . . . . . .

70-74 years. ,,, ,, . . . . . . . . . . . . .

75–79 years. ,, . . . . . . . . . . . . . . . .

80–84 years,........,...,,.,..

65 years and over, . . . . . . . . . . . . .

75 years and over . . . . . . . . . . . . . .

85 years and over . . . . . . . . . . . . . .

White female

55–59 years, . . . . . . . . . . . . . . . . . .

60-64 years. ., . . . . . . . . . . . . . . . .

65–69 years, . . . . . . . . . . . . . . . . . .

70–74 years, . . . . . . . . . . . . . . . . . .

75–79 years . . . . . . . . . . . . . . . . . . .

80-84 years, .,, , ., .,.,...., . . .

65 years and over, ,, . . . . . . . . . . .

75 years and over. . ., .,.,..,. . .

85 years and over. ..,,..... . . . .

21.2

34.0

52.2

79.9

115.4

160.0

92.8

147.8

217.3

18.3

31.2

48.6

76.5

110.8

157.3

89.7

145.1

219.2

51.1

64.8

90.6

117.6

171.3

203.9

130.1

187.2

209.4

19.6

33.9

53.7

80.5

113.7

157.6

102.7

153.6

223.9

15.9

28.0

45.5

72.5

106.2

149.8

95.5

146.6

217.9

Number ofdeaths per 100,000 resident population

20.5

32.0

50.5

74.5

109,9

154.0

87.9

138.3

191.8

18.5

29.5

47.6

72.3

106.9

151.0

85.5

136.0

191.9

41.9

59.4

85.6

100.8

143.5

187.1

118.0

166.6

201.8

18.8

31.9

48.5

72.8

104.1

157.6

98.1

149.0

220.7

15.3

26.1

42.2

66.3

98.3

149.8

92.4

143.3

216.7

18.8

31.5

48.6

73.2

112.3

161.0

89.4

145.5

213.6

16.8

27.7

44.1

69,7

108.5

158.0

86.1

143.1

215.9

37.6

69.3

94.1

113.3

160.1

209.6

128.1

178.3

185.7

17.0

31.9

46.9

74.6

105.5

153.1

98.2

148.3

218.1

13.6

26,6

40.3

65.2

97,9

143.3

91.2

141.2

213.9

21.2

32.3

48.6

74.5

105.0

153.0

87.4

138.2

208.7

18.7

28.8

45.2

69.9

100.9

146.3

83.4

133.9

207.6

44.6

67.3

82.2

127.0

152.3

231.4

130.5

187.5

223.9

18.6

32.4

48.0

72.0

103.2

150.9

97.6

146.4

216.0

14.4

26.6

41.5

63.7

95.0

139.6

89.8

136.9

205.6

101
Table 9. Death rates for diabetes mellitus among persons 55 years of age and over, by sex, race,

and age: United States, selected years 1980-86- Con.

[Data are based on the National Vital Statistics System]

Sex, race, and age 1980 1982 1984 1986

Black female

55–59 years . . . . . . . . . . . . . . . . . . .

60–64 years........,......,,..

65–69 years..............,.,..

70–74years . . . . . . . . . . . . . . .. a..

75-79 years . . . . . . . . . . . . . . . . . . .

80–64 years . . . . . . . . . . . . . . . . . . .

65 years and over . . . . . . . . . . . . . .

75 years And over . . . . . . . . . . . . . .

85 years and over . . . . . . . . . . . . . .

53.7

88.7

131.8

168.3

200.5

267.7

183.5

243.7

311.2

Number ofdeaths per 100,000 resident population

50.4 47.5

90.4 84.6

114.0 111.4

140.3 174.2

170.1 195,1

262,3 290.3

163.1 178.6

220,8 239.9

280,0 273,7

53.5

86.6

112,5

163.5

198.6

303,3

187.1

264,9

351,0

Ilncludes races otherthan white and black.

NOTE: Diabetes mellitus comprises code2500fthe/nternationa/ C/assificationof Diseases, Ninth Revision,

SOURCE: National Center for Health Statistics. Vital statistics of the United States, VOI11,mortality, part A. Washington: Public

Health Service. Selected years.

102
Table 10. Death rates for pneumonia and influenza among persons 55 years of age and over, by

sex, race, and age: United States, selected years 1980-86

[Data are based on the National Vital Statistics System]

Sex, race, and age 1980 1982 1984 1986

Male, all races’

55–59 years................,..

60–64 years . . . . . . . . . . . . . . . . . . .

65-69 years. . . . . . . . . . . . . . . . . . .

70-74 years, ,, . .,, . .,, ,, .,..,.

75–79 years.........,....,.. . .

80–84 years . . . . . . . . . . . . . . . . . . .

65 years and over. . . . . . . . . . . . . .

75 years and over . . . . . . . . . . . . . .

85 years and over. .,, . . . . . . . . . .

White male

55-59 years . . . . . . . . . . . . . . . . . . .

60-64 years. .,, . . . . . . . . . . . . . . .

65-69 years. . . . . . . . . . . . . . . . . . .

70-74 years, . . . . . . . . . . . . . . . . . .

75–79 years. , ., . . . . . . . . . . . . . . .

80-84 years, . . . . . . . . . . . . . . . . . .

65 years and over,.,......,.. .,

75 years and over . . . . . . . . . . . . . .

85 years and over . . . . . . . . . . . . . .

Black male

55-59 years, . . . . . . . . . . . . . . . . . .

60-64 years . . . . . . . . . . . . . . . . . ,.

65–69 years. . . . . . . . . . . . . . . . . . .

70-74 years, ,, ., .,, , . . . . . . . . . .

75-79 years . . . . . . . . . . . . . . . . . . .

80-84 years, . . . . . . . . . . . . . . . . . .

65 years and over . . . . . . . . . . . . . .

75 years and over,...,..,.,.. . .

85 years and over, ,, ..,,,.... . .

Female, all racesi

55–59 years, ,,, . . . . . . . . . . . . . .,

60-64 years. . . . . . . . . . . . . . . . . ,.

65-69 years. . . . . . . . . . . . . . . . . . .

70-74 years . . . . . . . . . . . . . . . . . . .

75-79 years, ,,, ,,, ,, ...,,..., .

80-84 years, ,,, . . . . . . . . . . . . . . .

65 years and over, , ., ...,,.... ,

75 years and over . . . . . . . . . . . ,,.

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

White female

55–59 years . . . . . . . . . . . . . . . . . . .

60-64 years, , . .,, . . . . . . . . . . . . .

65-69 years, ,, ., .,, , .,, ,,,..,,

70-74 years, ,,, . . . . . . . . . . . . . ,.

75-79 years . . . . . . . . . . . . . . . . . . .

80-84 years . . . . . . . . . . . . . . . . . . .

65 years and over. ,,, . ...,,,.,,

75 years and over,,,,,,,,,,.,,,

85 years and over

19.5

32.8

58.4

107.4

216.3

465.7

212.5

466,3

1,145.4

16.4

29,2

53.3

104,4

212.2

471.8

212.4

472.4

1,172.7

53.9

74.4

112.8

144.5

249.8

399.8

215.7

396.8

816,8

10.2

15.0

26.9

51.0

111.0

260.5

154.9

316.1

772.2

8.9

14.4

25,5

49.5

109,9

264.7

158,9

324.2

796.7

Number ofdeaths per 100,000 resident population

17.9

28.1

49.0

95.0

195.1

401.4

189.0

412.1

1,018.4

15.4

24.9

46.4

90.9

197.7

409.2

190.7

422.9

1,051.6

44.3

63.6

79.3

143.2

173.9

341.2

176.9

307.9

642.9

8.3

13.5

21.6

42.7

87.6

203.8

128.7

257.7

633.7

7.1

12.6

20.8

41.9

88.3

206.9

132.7

265.5

654.6

17.4

30.6

50.9

109.6

222.8

461.4

214.9

471.7

1,172.1

15.0

27,3

47.6

105.9

220.7

464.7

215.9

479.8

1,215.3

41.6

63.5

86.4

154.9

255.4

425.3

211.5

398.1

742.9

8.1

13.3

24.2

50.3

106.8

248.4

158.9

317,6

766.6

7.3

12.6

23.0

49.2

107.4

249.8

163.5

326.4

793.1

17.8

33.5

56.8

115.0

250.3

512.8

241.4

534.2

1,360.9

15,4

30.5

53.5

111.6

249.4

514.7

242.3

541.5

1,402.7

42.7

67.3

98.1

163.5

272.7

511.6

245.4

476.6

967.2

9.4

15.7

27.9

55.3

123.0

276.3

186.0

370.1

902.3

8.6

14.3

26.6

54.6

123.3

278.4

191.8

380.5

933.7

103
Table 10. Death rates for pneumonia and influenza among persons 55 years of age and over, by

sex, race, and age: United States, selected years 1980-86- Con.

[Data are based on the National Vital Statistics System]

Sex, race, and age 1980 1982 1984 1986

Black female Number of deaths per 100,000 resident population

55–59 years, . . . . . . . . . . . . . . . . . . 24.1 18.5 15.6 17,1

60–64 years. ,, . . . . . . . . . . . . . . . . 22.2 22.3 21.2

65–69 years . . . . . . . . . . . . . . . . . . .

31,0

41.7 29,6 37.0 41.5

70–74 years . . . . . . . . . . . . . . . . . . . 66.1 51.9 63.6

75–79 years. . .,, ,,, ,,, ,, . . . . . .

66,9

121.3 81.9 107.6 128,9

80–84 years . . . . . . . . . . . . . . . . . . . 215.7 172,6 237,2 269.3

65 years and over, . . . . . . . . . . . . . 116,4 91.6 117.8 140,0

75 years and over. . . . . . . . . . . . . . 223.5 172,0 224.2 270,3

85 years And over, ,,, ..,..., .,, 459.2 370.4 440,6 541.4

Ilncludes races other than white and black.

NOTE: Pneumonia and influenza comptise codes480–4870fthe/nternationa/ C/assificationofDkeases,Ninth Revision.

SOURCE: National Center for Health Statistics. Vital statistics of the United States, VOI11,mortality, part A, Washington: Public

Health Service. Selected years.

104
Table 11. Death rates for suicide among persons 55 years of age and over, by sex, race, and age:

United States, selected years 1980-86

[Data are based on the National Vital Statistics System]

Sex, race, and age 1980 1982 1984 1986

Male, all races’

55–59 years, , . . . . . . . . . . . . . . . . .

60-64 years . . . . . . . . . . . . . . . . . . .

65–69 years . . . . . . . . . . . . . . . . . . .

70-74 years. ,, .,, . . . . . . . . . . . . .

75-79 years, , .,, . . . . . . . . . . . . . .

80-84 years. . . . . . . . . . . . . . . . . .,

65 years and over, . . . . . . . . . . . . .

75 years and over,..........,.,

85 years and over. , . . . . . . . . . . . .

White male

55-59 years . . . . . . . . . . . . . . . . . . .

60-64 years, ,,, . . . . . . . . . . . . . . .

65-69 years, ,,, ,, .,, .,,,.,... .

70-74 years, . . . . . . . . . . . . . . . . ,.

75-79 years, . . . . . . . . . . . . . . . . . .

80–84 years, ,,, . . . . . . . . . . . . . . .

65 years and over, . . . . . . . . . . . . .

75 years and over.,.......,.. ,,

85 years and over, . . . ...,...., ,

Black male

55-59 years. . .,, ,,, . . . . . . . . . . .

60–64 years. , . ., . .,, ,., ,.,... .

65-69 years. . . . . . . . . . . . . . . . . . .

70–74years, ,,, ,, ... ,. b,......

75–79 years, , . ., . .,, . . . . . . . . . .

80–84 years. . . . . . . . . . . . . . . . . . .

65 years and over . . . . . . . . . . . . . .

75 years and over, . . . . . . . . . . . . .

85 years and over.,,,.,.,..,,,.

Female, all racesl

55-59 years, .,, .,, , . . . . . . . . . . .

60–64 years, ,,, ,, . . . . . . . . . . . . ,

65–69 years...,,......,..,,.. .

70-74 years . . . . . . . . . . . . . . . . . . .

75-79 years, . . . . . . . . . . . . . . . . . .

80-84 years, .,, . ., . . . . . . . . . . . .

65 years and over, , .,, ,., .,..,,

75 years and over . . . . . . . . . . . . . .

85 years and over . . . . . . . . . . . . . .

White female

55–59 years, . . . . . . . . . . . . . . . . . .

60-64 years, , . . . . . . . . . . . . . . . . .

65-69 years, ,,, . . . . . . . . . . . . . . .

70-74 years, . . . . . . . . . . . . . . . . . .

75–79 years . . . . . . . . . . . . . . . . . . .

80-84 years . . . . . . . . . . . . . . . . . . .

65 years and over, . . . . . . . . . . . . .

75 years and over. ,, . .,,.,,... ,

85 years and over..,,,.,..,.. ,,

24.9

23.9

28.1

33.5

41.5

43.8

35.0

43.9

50.6

26.2

25.4

30.0

35.9

44.9

46.5

37.5

46.9

52.8

12.2

11.1

11.4

10.7

9.2

13.3

11.4

12.1

18.9

8.6

8.2

6.6

6.4

5.9

4.7

6.1

.5.4

5.5

9.3

8.9

7.2

6.9

6.2

4.9

6.5

5.7

5.8

Numberofdeaths per 100,000 resident population

26.1

26.4

28.3

34.9

43.7

47.8

36.4

46.1

50.2

27.7

28.2

29.9

37,4

47.2

50.8

38.9

49.5

53.9

13.4

10.2

12.9

11.2

9.3

17.6

12.4

12.9

16.1

9.5

8.0

7.3

6.4

6.3

5.1

6.2

5.3

3.9

10.3

8.7

7.8

6.9

6.7

5.2

6.6

5.6

3.9

27.5

26.8

29.1

39.3

45.2

54.7

38.9

49.1

51.7

29.2

28.4

31.0

41.7

48.3

58.6

41.6

52.7

55.8

13.3

13.5

10,5

18.4

16.7

12.0

14.0

14.3

11.1

9,2

7,8

7.6

7.1

6.3

6.3

6.7

5.9

4.9

9.9

8.3

8.1

7.5

6.9

6.7

7.2

6.3

5.1

26,4

26.9

30.7

41.8

52.8

58.6

42.7

56.1

61.6

28.6

28.8

32.3

44.5

57.0

62.4

45.6

60.3

66.3

9.5

10.3

15.9

16.3

14.2

19.8

16.2

16.4

17.9

8.4

8.4

6.9

7.7

7.9

6.9

7.0

6.8

4.7

9.0

9.0

7.4

8.1

8.4

7.3

7,5

7,2

5.0

105
Table 11. Death rates for suicide among persons 55 years of age and over, by sex, race, and age:

United States, selected years 1980-86- Con.

[Data are based on the National Vital Statistics System]

Sex, race, and age 1980 1982 1984 1986

Black female Number of deaths per 100,000 resident population

55–59 years. . . . . . . . . . . . . . . . . . . 2,1 2.4 3.2 4.0

60–64 years . . . . . . . . . . . . . . . . . . . 2.5 2.0 3.0 4.4

65–69 years . . . . . . . . . . . . . . . . . . . 1.8 2.3 2.6 2,3

70–74 years . . . . . . . . . . . . . . . . . . . 1.5 1.9 2.4 3.4

75–79 years, ,,, . . . . . . . . . . . . . . . 1.7 0.8 0.4 2,9

80–84 years....,,,.........,,. 0,8 2.1 0.7 2.0

65 years and over . . . . . . . . . . . . . . 1.4 1.8 1.8 2,4

75 years And over, .,,,..... ..,, 1.1 1.2 0.6 1.9

85 years and over. , . ., . . . . . . . . . 0.9 0.8

‘Includes races other than white and black.

NOTE: Suicide comprises codes E950–E959 ofthelnternational Classificationof Diseases, Ninth Revision.

SOURCE: National Center for Health Statistics. Vital statistics of the United States, VOI11,mortality, part A. Washington: Public

Health Service. Selected years.

106
Table 12. Number of deaths from the 10 leading causes of death in each age-sex-race group

among persons 65 years of age and over, by reported or underlying cause and ratio of reported

causes to underlying causes: United States, 1986

[Data are based on the National Vital Statistics System]

Ratio of reported

Repotted Underlying causes to

Age, sex, race, cause of death, and ICD–9 codeq cause cause underlying causes

Total, 65–74 years

Diseases of heart, . . . . . . . . . ., ., ,390–398,402,404-429

Malignant neoplasms, including neoplasms of lymphatic

and hematopoietic tissues. . . . . . . . . . . . . . . . . .140–208

Cerebrovasculardiseases. . . . . . . . . . . . . . . . . . .430-438

Chronic obstructive pulmonary diseases and allied

conditions, . . . . . . . . . . . . . . . . . . . . . . . . . . ...490-496

Diabetes mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . ...250

Pneumonia and influenza . . . . . . . . . . . . . . . . . . .480–487

Accidents and adverse effects . . . . . . . . . . . . .E800–E949

Chronic liver disease and cirrhosis. . . . . . . . . . . . . ...571

Nephritis, nephrotic syndrome, and nephrosis. . .580–589

Septicemia ,, .,,,,,.. . . ...0.... . . . . . . . . . . . . . . .038

Male, 65–74 years

Diseases of heart, , , ., , . . . . . . . . .390-398,402,404-429

Malignant neoplasms, including neoplasms of lymphatic

and hematopoietic tissues. . . . . . . . . . . . . . . ...140-208

Chronic obstructive pulmonary diseases and allied

conditions, , ., .,, .,....... . . . . . . . . . . . ...490-496

Cerebrovascular diseases. . . . . . . . . . . . . . . . ...430-438

Pneumonia and influenza . . . . . . . . . . . . . . . . . . .480–487

Accidents and adverse effects , ., ., . . . . . . . .E800–E949

Diabetes mellitu s. . . . . . . . . . . . . . . . . . . . . . . . . . ...250

Chronic liver disease and cirrhosis. . . . . . . . . . . . . ...571

Nephritis, nephrotic syndrome, and nephrosis. . .580–589

Septicemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...038

White male, 65-74 years

Diseases of heart. ., . . . . . . . . . . . ,390-398,402,404-429

Malignant neoplasms, including neoplasms of lymphatic

and hematopoietic tissues. . . . . . . . . . . . . . . . . .140–208

Chronic obstructive pulmonary diseases and allied

conditions ,,, ,. .,.,. . . . . . . . . . . . .,,.!,... 490-496

Cerebrovascular diseases. . . . . . . . . . . . . . . . . . .430–438

Pneumonia and influenza . . . . . . . . . . . . . . . . . . .480–487

Accidents and adverse effects. . . . . . . . . . . . .E800–E949

Diabetes mellitus, ,, . . . . . . . . . . . . . . . . . . . . . . . . ...250

Chronic liver disease and cirrhosis . . . . . . . . . . . . . ...571

Nephritis, nephrotic syndrome, and nephrosis. . .580–589

Septicemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...038

Black male, 65–74 years

Diseases of heart, . . . . . . . . . . . . . .390–398,402,404–429

Malignant neoplasms, including neoplasms of lymphatic

and hematopoietic tissues . . . . . . . . . . . . . . . . ..l4O–2O8

Cerebrovascular diseases. . . . . . . . . . . . . . . . ...430-438

Chronic obstructive pulmonary diseases and allied

conditions, .,, .,, .,, .,.,... . . . . . . . . . . ...490-496

Pneumonia and influenza , . . . . . . . . . . . . . . . ...480-487

Septicemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...038

Diabetes mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . ...250

Accidents and adverse effects . . . . . . . . . . . ..E800–E949

Numberofdeaths

285,815

164,080

51,225

58,442

44,218

34,899

21,937

10,391

26,801

22,003

170,711

93,820

38,184

26,637

22,125

12,910

21,506

6,570

15,148

12,030

150,955

82,677

35,375

22,541

19,485

11,364

18,746

5,964

12,855

9,919

18,090

10,265

3,710

2,566

2,388

1,958

2,439

1,387

180,772

146,803

28,444

25,866

10,269

10,154

8,499

6,455

4,649

3,915

110,630

83,119

16,137

14,147

6,247

5,094

4,564

3,972

2,538

2,135

99,076

73,112

14,894

11,788

5,390

4,384

3,835

3,637

2,035

1,718

10,591

9,211

2,138

1,127

793

709

638

633

1.6

1.1

1.8

2.3

4.3

3.4

2.6

1.6

5.8

5.6

1.5

1.1

2.4

1.9

3.5

2.5

4.7

1.7

6.0

5.6

1,5

1.1

2.4

1.9

3.6

2.6

4.9

1.6

6.3

5.8

1.7

1.1

1.7

2.3

3.0

2.8

3.8

2.2

107
Table 12. Number of deaths from the 10 leading causes of death in each age-sex-race group

among persons 65 years of age and over, by reported or underlying cause and ratio of reported

causes to underlying causes: United States, 1986 – Con.

[Data are based on the National Vital Statistics System]

Ratio of reported

Repotied Underlying causes to

Age, sex, race, cause of death, and ICD–9 codel cause cause underlying causes

Black male, 65–74 years– Con.

Nephritis, nephrotic syndrome, and nephrosis. . .580–589

Chronic liver disease and cirrhosis, ., . . . , . . . . . . . ..571

Female, 65–74 years

Diseases of heart. . . . . . . . . . . . . . .390–398,402,404-429

Malignant neoplasms, including neoplasms of lymphatic

and hematopoietic tissues. . . . . . . . . . . . . . . . . .140–208

Cerebrovascular diseases, . . . . . . . . . . , . . . . ...430-438

Chronic obstructive pulmonary diseases and allied

conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..490–496

Diabetes mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . ...250

Pneumonia and influenza , . . . . . . . . . . . ., , . . . .480–487

Accidents and adverse effects , , . . . . . . . . . . .E800–E949

Chronic liver disease and cirrhosis, , . . . . . . . . , . . . ..571”

Nephritis, nephrotic syndrome, and nephrosis. . .580–589

Septicemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...038

White female, 65–74 years

Diseases of heart. , . . . . . . . . . . , . .390-398,402,404-429

Malignant neoplasms, including neoplasms of lymphatic

and hematopoietic tissues. . . . . . . . . . . . . . . . . ,140–208

Cerebrovascular diseases. . . . . . . . . . . . . . . . . . .430–438

Chronic obstructive pulmonary diseases and allied

conditions . . . . . . . . . . . . . . . . . . , . . . . . . . . . ..490–496

Diabetes mellitu s. . . . . . . . . . . . . . . . . . . . . . . . . . ...250

Pneumonia and influenza , . . . . . . . . . . . . . . . . . .480–487

Accidents and adverse effects . . . . . . . . . . . . .E800–E949

Chronic liver disease and cirrhosis. . . . . . . . . . . . . ...571

Nephritis, nephritic syndrome, andnephrosis. ..5858989

Septicemia ..,................,., . . . . . . . . . . ...038

Black female, 65–74 years

Diseases of heart. ., ., . . . . . . . . . .390–398,402,404-429

Malignant neoplasms, including neoplasms of lymphatic

and hematopoietic tissues.,..,.. . . . . . . . . . ..140–208

Cerebrovascular diseases. . . . . . . . . . . . . . . . . . .430–438

Diabetes mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . ...250

Nephritis, nephritic syndrome, andnephrosis. ..5858989

Pneumonia and influenza , . . . . . . ., ., . . . . . . . .480–487

Chronic obstructive pulmonary diseases and allied

conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . ...490496

Accidents and adverse effects . . . . . . . . .,. ..E8OE94949

Septicemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...038

Chronic liver disease and cirrhosis. . . . . . . . . . . . . ...571

Total, 75–84years

Diseases ofheart, ., ..,.,....,.,390-398,402,404-429

Malignant neoplasms, including neoplasms of lymphatic

and hematopoietic tissues. . . . . . . . . . . . . . . . ..140–208

Cerebrovascular diseases . . . . . . . . . . . . . . . . ...430438

Chronic obstructive pulmonary diseases and allied

conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . ...490-496

Pneumonia and influenza . . . . . . . . . . . . . . . .,, ,480–487

Numberofdeaths

2,108 476

530 302

115,104 70,142

70,260 63,684

24,588 14,297

20,258 9,729

22,712 5,705

12,774 3,907

9,027 3,405

3,821 2,483

11,653 2,111

9,973 1,780

98,163 60,073

62,852 57,022

20,309 11,797

19,138 9,234

18,425 4,471

11,317 3,407

8,010 2,990

3,436 2,242

9,352 1,591

8,212 1,441

15,941 9,509

6,840 6,156

3,985 2,304

4,018 1,158

2,148 490

1,319 452

1,027 451

918 371

1,675 323

328 207

368,329 238,956

138,783 116,632

91,616 51,982

61,204 26,708

59,506 21,995

4.4

1.8

1.6

1.1

1.7

2.1

4.0

3.3

2.7

1.5

5.5

5.6

1,6

1.1

1.7

2.1

4.1

3,3

2.7

1.5

5.9

5.7

1.7

1.1

1.7

3.5

4.4

2,9

2.3

2.5

5.2

1.6

1,5

1.2

1.8

2.3

2,7

108
Table 12. Number of deaths from the 10 leading causes of death in each age-sex-race group

among persons 65 years of age and over, by reported or underlying cause and ratio of reported

causes to underlying causes: United States, 1986-Con.

[Data are based on the National Vital Statistics System]

Ratio of reported

Reported Underlying causes to

Age, sex, race, cause of death, and ICD–9 code’ cause cause underlying causes

Total, 75-84 years – Con.

Diabetes mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . ...250

Accidents and adverse effects . . . . . . . . . . . . .E800–E949

Nephritis, nephrotic syndrome, and nephrosis. . .580–589

Atherosclerosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...440

Septlcemla. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...038

Male, 75–84 years

Diseases of heart. ., . . . . . . . . . . . .390-398,402,404-429

Malignant neoplasms, including neoplasms of lymphatic

and hematopoietic tissues. . . . . . . . . . . . . . . . . .140–208

Cerebrovascular diseases. . . . . . . . . . . . . . . . . . .430–438

Chronic obstructive pulmonary diseases and allied

conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . ...490-496

Pneumonia and influenza . . . . . . . . . . . . . . . . . . .480–487

Accidents and adverse effects . . . . . . . . . . . . .E800–E949

Diabetes mellitus, ., .,, , ..,.,.... . . . . . . . . . . . ...250

Nephritis, nephrotic syndrome, and nephrosis. . .580–589

Atherosclerosis, . . . . . . . . . . . . . . . . . . . . . . . . . . . ...440

Septicemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...038

White male, 75-84 years

Diseases ofheart. , . . . . . . . . . . ...390-398.402.404-429

Malignant neoplasms, including neoplasms oflymphatic

and hematopoietic tissues. . . . . . . . . . . . . . . . ..140–208

Cerebrovascular diseases . . . . . . . . . . . . . . . . ...430-438

Chronic obstructive pulmonary diseases and allied

conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . ...490-496

Pneumonia and influenza . . . . . . . . . . . . . . . . . ..480–487

Accidents and adverse effects . . . . . . . . . . . ..E800-E949

Diabetes mellitus, . . . . . . . . . . . . . . . . . . . . . . . . . . ...250

Nephritis, nephritic syndrome, andnephrosis. ..580–589

Atherosclerosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...440

Septicemia. ,, ...,...,......,,. . .,............038

Black male, 75–84 years

Diseases ofheart. . . . . . . . . . . . ...390-398.402.404-429

Malignant neoplasms, including neoplasms oflymphatic

and hematopoietic tissues . . . . . . . . . . . . . . . . ..140–208

Cerebrovascular diseases . . . . . . . . . . . . . . . . . ..430–438

Pneumonia and influenza . . . . . . . . . . . . . . . . . ..480–487

Chronic obstructive pulmonary diseases and allied

conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . ...490-496

Accidents and adverse effects . . . . . . . . . . . ..E800-E949

Nephritis, nephritic syndrome, andnephrosis. ..580–589

Diabetes mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . ...250

Septicemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...038

Atherosclerosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...440

Female, 75–84years

Diseases ofheart. . . . . . . . . . . . ...390-398.402.404-429

Malignant neoplasms, including neoplasms of lymphatic

and hematopoietic tissues. . . . . . . . . . . . . . . . . .140–208

Numberofdeaths

48,220

25,895

35,095

35,437

28,547

178,653

75,522

38,958

40,174

32,564

12,782

19,669

18,609

15,963

13,346

161,566

67,794

34,606

37,747

29,837

11,521

17,607

16,287

14,712

11,385

15,174

6,961

3,826

2,323

2,080

1,078

2,059

1,725

1,773

1,104

189,676

63,261

11,048

9,633

7,196

6,781

5,857

114,305

62,493

21,304

16,996

11,588

4,908

4,126

3,615

2,959

2,701

104,267

55,943

18,901

16,011

10,502

4,314

3,580

3,067

2,680

2,273

8,927

5,893

2,122

920

831

516

514

467

394

249

124,651

54,139

4.4

2.7

4.9

5.2

4.9

1.6

1.2

1.8

2.4

2.8

2.6

4.8

5.1

5.4

4.9

1.5

1.2

1.8

2.4

2.8

2,7

4.9

5.3

5,5

5.0

1.7

1.2

1.8

2.5

2.5

2.1

4.0

3.7

4.5

4.4

1.5

1.2

109
Table 12. Number of deaths from the 10 leading causes of death in each age-sex-race group

among persons 65 years of age and over, by reported or underlying cause and ratio of reported

causes to underlying causes: United States, 1986 – Con.

[Data are based on the National Vital Statistics System]

Ratio of reported

Reported Underlying causes to

Age, sex, race, cause of death, and ICD–9 codel cause cause underlying causes

Female, 75–84 years – Con.

Cerebrovascular diseases. . . . . . . . . . ., ., , ., . ,430–438

Pneumonia and influenza . . . . . . . . . . . . . . . . . . .480–487

Chronic obstructive pulmonary diseases and allied

conditions, . . . . . . . . . . . . . . . . ,., . . . . . . . . ..490–496

Diabetes mellitu s..........,,..,.. , . . . . . . . . . ...250

Accidents and adverse effects . . . . . ., . . . . . .E800–E949

Atherosclerosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..44o

Nephritis, nephrotic syndrome, and nephrosis. . .580–589

Septicemia . . . . . . . . . . . . . . . . . . . . . . , .,,.....,...038

White female, 75–84 years

Diseases of heart. . . . . . . . . . . . . . .390-398,402,404-429

Malignant neoplasms, including neoplasms of lymphatic

and hematopoietic tissues. . . . . . . . . . . , ., ., ..140–208

Cerebrovascular diseases, . . . . . . . . . . . . . . . ...430-438

Pneumonia and influenza . . . . . . . . . . . . . . . . . . ,480–487

Chronic obstructive pulmonary diseases and allied

conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . ...490-496

Diabetes mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . ...250

Accidents and adverse effects . . . . . . . . . . . . .E800–E949

Atherosclerosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..44o

Nephritis, nephrotic syndrome, and nephrosis. . ,580–589

Septicemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...038

Blackfemale,75–84 years

Diseases ofheart. ., ., . . . . . . . . ..390–398.402.404-429

Malignant neoplasms, including neoplasms of[ymphatic

and hematopoietic tissues. . . . . . . . . . . . . . . . ..140–208

Cerebrovascular diseases . . . . . . . . . . . . . . . ,., ,430–438

Diabetes mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . ...250

Pneumonia and influenza .,.... . . . . . . . . . . . ..480–487

Nephritis, nephritic syndrome, andnephrosis. ..580–589

Septicemia. . ., .,, . . . . . . . . . . . . . . . . . . . . . . . . . ...038

Accidents and adverse effects . . . . . . . . . . . ..E800–E949

Atherosclerosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..44o

Chronic obstructive pulmonary diseases and allied

conditions, ..,..,,...,,, ,., . . . . . . . . . . . ..490–496

Total, 85 years and over

Diseases ofheart. . . . . . . . . . . . . . .390–398,402,404-429

Cerebrovascular diseases . . . . . . . . . . . . . . . . . ..430–438

Malignant neopiasms, including neoplasms of lymphatic

and hematopoietic tissues. . . . . . . . . . . . . . . . ..140–208

Pneumonia and influenza . . . . . . . . . . . . . . . . ...480-487

Atherosclerosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..44o

Chronic obstructive pulmonary diseases and allied

conditions . . . . . . . . . . . . . . . ... , . . . . . . . . . ..490–496

Accidents and adverse effects . . . . . . . . . . . ..E800–E949

Nephritis, nephritic syndrome, andnephrosis. ..580–589

Diabetes mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . ...250

septicemia. .,,,,,,.......,,,, , .,.,,,,,,.,,,..038

Numberofdeaths

52,658

26,942

21,030

28,551

13,113

19,474

16,486

15,201

170,516

57,780

46,320

24,830

20,181

24,949

12,052

17,792

14,133

12,930

17,924

5,075

5,458

3,314

1,910

2,179

2,130

931

1,576

753

293,213

82,380

59,493

61,753

42,963

25,062

20,431

25,573

23,945

21,848

30,678

10,407

9,712

6,922

4,725

3,822

3,581

3,156

112,628

49,407

27,416

9,559

9,365

5,822

4,307

3,486

2,960

2,647

11,281

4,377

3,056

1,014

769

580

486

364

316

304

199,281

48,931

44,749

28,652

12,009

10,075

7,002

6,006

5,939

5,049

1,7

2.6

2.2

4.1

2.8

5.1

4.6

4.8

1.5

1.2

1.7

2.6

2,2

4.3

2.8

5.1

4.8

4,9

1.6

1.2

1.8

3.3

2.5

3.8

4,4

2.6

5.0

2.5

1.5

1.7

1.3

2.2

3,6

2.5

2.9

4.3

4,0

4,3

110
Table 12. Number of deaths from the 10 leading causes of death in each age-sex-race group

among persons 65 years of age and over, by reported or underlying cause and ratio of reported

causes to underlying causes: United States, 1986 – Con.

[Data are based on the National Vital Statistics System]

Ratio of reported

Reporfed Underlying causes to

Age, sex, race, cause of death, and ICD–9 codel cause cause underlying causes

Male, 85 years and over

Diseases of heart. , . . . . . . . . . . . . .390–398,402,404–429

Malignant neoplasms, including neoplasms of lymphatic

and hematopoietic tissues. . . . . . . . . . . . . . . ...1 40–208

Cerebrovascular diseases. . . . . . . . . . . . . . . . ...430-438

Pneumonia and influenza . . . . . . . . . . . . . . . . . . .480–487

Chronic obstructive pulmonary diseases and allied

conditions, . . . . . . . . . . . . . . . . . . . . . . . . . . ...490-496

Atherosclerosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...440

Accidents and adverse effects . . . . . . . . . . . . .E800–E949

Nephritis, nephrotic syndrome, and nephrosis. ..580-589

Septicemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...038

Diabetes mellitus, . . . . . . . . . . . . . . . . . . . . . . . . . . ...250

White male, 85 years and over

Diseases of heart. . . . . . . . . . . . . . .390-398,402,404-429

Malignant neoplasms, including neoplasms of lymphatic

and hematopoietic tissues. . . . . . . . . . . . . . . . ..140–208

Cwebrovascular diseases. . . . . . . . . . . . . . . . ...430-438

Pneumonia and influenza . . . . . . . . . . . . . . . . ...480-487

Chronic obstructive pulmonary diseases and allied

conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..490–496

Atherosclerosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...440

Accidents and adverse effects . . . . . . . . . . . . .E800–E949

Nephritis, nephrotic syndrome, and nephrosis. . .580–589

Diabetes mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . ...250

Septicemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...038

Black male, 85 years and over

Diseases of heart. ., ., . . . . . . . . ..390–398.402.404–429

Malignant neoplasms, including neoplasms oflymphatic

and hematopoietic tissues . . . . . . . . . . . . . . . . ..140–208

Cerebrovascular diseases . . . . . . . . . . . . . . . . . ..430–438

Pneumonia and influenza . . . . . . . . . . . . . . . . . ..480–487

Nephritis, nephritic syndrome, andnephrosis. ..580–589

Chronic obstructive pulmonary diseases and allied

conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..490–496

Accidents and adverse effects . . . . . . . . . . . ..E800–E949

Septicemia, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...038

Atherosclerosis ., . . . . . . . . . . . . . . . . . . . . . . . . . . ...440

Diabetes mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . ...250

Female, 85years andover

Diseases ofheart. . . . . . . . . . . . . . .390-398,402,404-429

Cerebrovascular diseases . . . . . . . . . . . . . . . . . ..430–438

Malignant neoplasms, including neoplasms oflymphatic

and hematopoietic tissues. . . . . . . . . . . . . . . . . .140–208

Pneumonia and influenza . . . . . . . . . . . . . . . . . ..480–487

Atherosclerosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...440

Diabetes mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . ...250

Chronic obstructive pulmonary diseases and allied

conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..490–496

Accidents and adverse effects . . . . . . . . . . . ..E800-E949

Nephritis, nephritic syndrome, andnephrosis. ..580-589

Septicemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...038

Numberofdeaths

95,414

26,306

22,650

23,784

14,189

12,220

7,349

11,100

7,398

6,905

87,783

23,847

20,846

22,120

13,399

11,407

6,776

9,906

6,325

6,457

6,705

2,212

1,567

1,365

1,050

635

484

835

709

494

197,799

59,730

33,187

37,969

30,763

17,040

10,873

13,082

14,473

14,450

62,184

19,332

13,019

10,697

5,858

3,267

2,786

2,494

1,661

1,640

57,457

17,384

11,981

9,903

5,531

3,051

2,528

2,186

1,466

1,424

4,200

1,756

905

648

275

267

215

212

201

150

137,097

35,912

25,417

17,955

8,742

4,299

4,217

4,216

3,512

3,388

1.5

1.4

1.7

2.2

2.4

3.7

2.6

4.5

4.5

4.2

1.5

1.4

1.7

2.2

2.4

3.7

2.7

4,5

4.3

4.5

1.6

1.3

1.7

2.1

3.8

2.4

2.3

3.9

3.5

3.3

1.4

1.7

1.3

2.1

3.5

4.0

2,6

3!1

4,1

4.3

111
Table 12. Number of deaths from the 10 leading causes of death in each age-sex-race group

among persons 65 years of age and over, by reported or underlying cause and ratio of reported

causes to underlying causes: United States, 1986-Con.

[Data are based on the National Vital Statistics System]

Ratio of reported

Repotted Underlying causes to

Age, sex, race, cause of death, and ICD–9 codel cause cause underlying causes

White female, 85 years and over Number of deaths

Diseases of heart. . . . . . . . . . . . , . .390–398,402,404–429

Cerebrovascular diseases. ., . . . . . . . . . . . . . . . ,430–438

Malignant neoplasms, including neoplasms of lymphatic

and hematopoietic tissues. , . . . . . . . . . . . . . . . .140–208

Pneumonia and influenza . . . . . . . . . . . . . . . . . . .480–487

Atherosclerosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..44o

Chronic obstructive pulmonary diseases and allied

conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..490–496

Accidents and adverse effects . . . . . . . . . . . . .E800–E949

Diabetes mellitus . . . . . . . . . . . . . . . , . . . . . . . . . . . ...250

Nephritis, nephrotic syndrome, and nephrosis. . .580–589

Septicemia, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...038

Black female, 85 years and over

Diseases of heart. . . . . . . . . , , . . . .390-398,402,404-429

Cerebrovascular diseases. . . . . . . . . . . . . . . . . . .430–438

Malignant neoplasms, including neoplasms of lymphatic

and hematopoietic tissues. . . . . . . . . . . . . . . . ..140–208

Pneumonia and influenza , . . . . . , , , , , . . . . . . . .480–487

Diabetes mellitus . . . . . . . . . . . . . . . . . , .,..,.......250

Nephritis, nephrotic syndrome, and nephrosis. . .580–589

Atherosclerosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..LMo

Septicemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...038

Accidents and adverse effects , , , , . . . . . . . . .E800–E949

Chronic obstructive pulmonary diseases and allied

conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..490–496

184,018

55,615

30,746

35,986

29,178

10,416

12,322

15,443

12)879

12,720

12,658

3,742

2,225

1,689

1,450

1,469

1,467

1,611

661

383

128,139

33,530

23,426

17,040

8,302

4,064

3,917

3,752

3,058

2,959

8,263

2,181

1,819

785

509

423

407

402

262

133

1,4

1.7

1,3

2.1

3.5

2.6

3,1

4.1

4,2

4.3

1.5

1.7

1.2

2,2

2.8

3.5

3.6

4.0

2.5

2.9

Icoded according to the /nternationa/ C/ossification of Diseases, Ninth Revision.

NOTE: Causes of death are ranked according to underlying cause.

SOURCE: National Center for Health Statistics: Mortality Statistics Branch, Division of Vital Statistics,

112
Part Ill

Health care use and its costs
Chapter 5

Acute care

by Sylvia E. Furrier, Ph. D., University of Illinois

at Chicago; and Lola Jean Kozak, Ph. D.,

National Center for Health Statistics

Introduction

The focus of this chapter is on the acute

medical care of the elderly, which is examined in

both outpatient and inpatient settings. The importance of acute care is illustrated by its financial impact. In 1987, national health care

expenditures in the United States totaled $500

billion. Physician services accounted for 21 percent of these expenditures and hospital care for

39 percent (l).

According to data from the National Ambulatory Medical Care Survey (NAMCS), an estimated 636.4 million office visits were made to

nonfederally employed office-based physicians in

the United States from March 1985 to February

1986 (2), Of these, 130.5 million visits (21 percent) were made by persons 65 years of age and

over, 13 percent by females and 8 percent by

males. In 1987, 33,4 million discharges and 214.9

million hospital days were reported for patients

treated in short-stay non-Federal hospitals in

the United States, according to data from the

National Hospital Discharge Survey (3). Persons

65 years of age and over accounted for 31 percent of the discharges and 42 percent of the

days of care,

A number of factors have affected the use of

acute care services, including the introduction,

in October 1983, of a prospective payment system based on diagnosis-related groups (DRG’s)

for hospitalizations of Medicare patients. Other

factors include advances in medical technolo~,

the availability of long-term care facilities, the

emergence of home health care, and the financial

ramifications of catastrophic illness. In addition

to the ambulatory care provided in physicians’

offices, walk-in clinics, outpatient facilities, and

ambulatory surgery centers have emerged as

important sources of ambulatory services. Despite these alternatives, the number of visits to

office-based physicians increased by 60.6 million

from 1980 to 1985, and the proportion of visits

accounted for by the population 65 years of age

and over increased from 17 to 21 percent (4).

The hospital discharge rate increased throughout the 1970’s for all persons, including those 65

years of age and over (5). This increase continued until 1983, when the prospective payment

system based on DRG’s was introduced. From

1983 to 1987, the total discharge rate decreased

17 percent. Surprisingly, the rate decrease for

persons 65 years of age and over was somewhat

less than the decrease for persons under 65

years of age. Average lengths of stay in U.S.

short-stay hospitals have been declining since

the 1960’s, well before the introduction of the

prospective payment system. From 1965 to 1987,

the average length of stay decreased 1.4 days

(18 percent) for all patients and 4.4 days (43 percent) for patients 65 years of age and over.

Sources of data

The National Health Interview Surveys

(NHIS) of 1985 through 1987 are the source of

person-level data on physician visits. The NHIS

is a continuing nationwide survey of the noninstitutionalized civilian population. The 1985

NAMCS, a national probability sample of

115
office-based physicians, is the source of data on

office visits. The 1981 and 1987 National Hospital Discharge Surveys (NHDS), continuous voluntary surveys of patient discharges from a

nationally representative sample of short-stay

non-Federal hospitals, provide the data for inpatient visits.

Results

Health interview survey data

Persons 65 years of age and over who rated

their health as fair or poor had a greater number

of physician visits than those who rated their

health as good or excellent (table 1). This difference in number of physician visits by health

status was evident for both sexes and for both

white and black persons.

Within the “all health statuses” and the

“excellent and good health” categories, the number of physician visits per person per year was

significantly lower for the 65–69-year age group

than for the group 85 years of age and over. This

difference was evident for both males and females; males 70–74 years of age also had significantly fewer physician office visits per person ‘

than did males 85 years of age and over within

these health status categories, No relationship

was evident between age and number of physician visits per person in the “fair or poor health”

category. Thus, in this category, health status,

more than increasing age, appeared to dictate

the need for physician services.

Females 65 years of age and over reported

more physician visits than males for all health

statuses. When this statistically significant difference in rates of physician visits by sex was

investigated by race, it was found that this sex

difference was statistically significant only for

black persons, not for white persons, The rates

of physician visits for males and females at 85

years of age and over were not significantly

different,

Office-based physician data

Reasons that patients cited for a visit to a

physician are shown in table 2. The reasons are

classified according to the Reason for Visit Classification for Ambulatory Care (RVC). Postoperative visit, general medical examination, and

progress visit were among the most common

reasons for physician visits for all age groups 65

years of age and over. Hypertension and/or blood

pressure check were also frequently mentioned

across age groups, as was vertigo. Cough and

diabetes mellitus were common reasons for visits

for groups under 85 years of age. Diminished

vision and cataract were frequently mentioned

by older age groups.

Rankings of reasons for visits were generally

similar by sex for the age groups under 80 years

of age. For those 80 years of age and over,

however, there are some differences in rankings

between males and females, For example, diabetes mellitus ranked as the 7th leading reason for

an office visit for females 80 to 84 years of age,

but it ranked significantly lower at 39th for males

in that age group. This may suggest that women

with diabetes mellitus survive longer than men,

that men are in a more fragile state of health

than women (leading them to be institutionalized), or that there are other competing reasons

leading men to visit a physician. Hypertension

ranked as the 5th most common reason for

females aged 85 years of age and over to visit a

physician, but it ranked significantly lower, as

the 43d most common reason for visits by males

in this age group. As with diabetes mellitus,

reasons for this could be differences in survival,

institutionalization, or disease patterns.

One-half of the physician visits of persons 65

years of age and over were to physicians in

general practice (29 percent) or internal medicine (22 percent) (table 3). Visits to ophthalmologists made up 14 percent of the physician visits

of persons 65 years of age and over, but the

proportions varied with age. Persons 65-69 and

116
70-74 years of age had significantly lower proportions of visits to ophthalmologists than did

those S5 years of age and over. The same age

pattern was found for females, and males 65-69

years of age had a lower proportion of visits to

ophthalmologists than did males 85 years of age

and over, In contrast, the proportion of visits to

orthopedic surgeons was smaller for persons 85

years of age and over than for those 65–69 years

of age, This age variation was the result of

differences in proportions of visits for males;

4 percent of visits for males 65–69 years of age,

but only 1 percent of visits for males 85 years of

age and over, were to orthopedic surgeons. The

proportion of visits to cardiovascular specialists

was greater for males than for females but

showed no particular pattern by age.

The most common diagnoses rendered by

office-based physicians for patients 65 years of

age and over are shown in table 4. These diagnoses are classified by the International Classification of Diseases, Ninth Revision, Clinical

Modification (ICD–9–CM). Essential hypertension was the leading diagnosis for all age categories and for both sexes except males 85 years of

age and over. Diabetes mellitus was the second

leading diagnosis for both males and females in

each 5-year age group of those 65–79 years of

age and the fourth or fifth leading diagnosis for

groups 80 years of age and over. Essential hypertension and diabetes mellitus ranked similarly as

diagnoses for males and females, but rankings

for some conditions varied by sex. Chronic airway obstruction was a leading diagnosis for males

but ranked much lower for females; a possible

reflection of the greater rate of smoking among

men. In contrast, osteoarthritis and allied disorders and arthropathies were leading diagnoses

for females but ranked lower for males, which

reflects the known higher prevalence rates of

these conditions in females (6-8).

Table 5 illustrates the type of diagnostic procedures that the population 65 years of age and

over received in the ambulatory setting. The

most frequent diagnostic procedure for both

males and females in all age groups was the

blood pressure check. Urinalysis was the second

most frequent diagnostic test. Blood pressure

checks and urinalyses were conducted with the

same frequency for males and females and at a

consistent rate across the age groups. Rates of

certain tests did vary with age for females, including pelvic exams, breast exams, and visual

acuity tests. The number of pelvic exams per

1,000 visits was significantly lower for women 75

years of age and over– 32, compared with women

65–69 years of age – 64. The number of breast

exams per 1,000 visits was also lower for women

75 years of age and over than for women 65-69

years of age. The number of visual acuity tests

per 1,000 visits was significantly greater for females 75 years of age and over than for their

counterparts 65–69 years old.

Hospital-based data

The number of hospital discharges, the discharge rate, the number of days of care, and the

average length of stay are shown according to

first-listed diagnoses for males in table 6 and for

females in table 7. In 1987, diseases of the heart

was the most frequently listed diagnosis for both

males and females in all age groups 65 years of

age and over. For males, malignant neoplasms

was the second most frequent diagnosis, followed by cerebrovascular disease, except for the

group 85 years of age and over. For females,

there was slightly more variation in the three

leading diagnoses, but clearly, in addition to

diseases of the heart, malignant neoplasms and

cerebrovascular disease were important causes

of hospitalization. Other diagnoses that were

important causes of hospitalization for males 65

years of age and over included fractures, pneumonia, hyperplasia of the prostate, and inguinal

hernia. For females, other important diagnoses

117
included cholelithiasis, fractures, pneumonia, volume depletion (dehydration), and urinary tract

infections.

A comparison of discharge rates for selected

diagnoses for males between 1981 and 1987

(table 6) reveals a few differences. The discharge rate for diseases of the heart increased

for males 70–74 years of age but did not change

significantly for other age groups. The malignant

neoplasm discharge rate for males 65 years of

age and over decreased from 48 per 1,000 population in 1981 to 40 per 1,000 population in

1987. Discharge rates for cerebrovascular disease remained stable for males in all age groups

65 years of age and over. The pneumonia discharge rate increased for males 65 years of age

and over as a group. There were large increases

in the rates for the age groups 75–79 and 80–84

years of age but no significant changes in the

rates for the other age groups.

Discharge rates for selected conditions for

females aged 65 and over (table 7) were relatively stable from 1981 to 1987. Discharge rates

for heart disease and for cerebrovascular disease

among females did not change significantly. The

discharge rate for malignant neoplasms decreased for females 65 years of age and over,

The discharge rate for dehydration increased

among females 85 years of age and over and the

discharge rate for urinary tract infections increased for females 75 years of age and over.

In contrast to the small changes in discharge

rates, there were sfibstantial declines from 1981

to 1987in average length of stay for some of the

diagnoses in tables 6 and 7. Average stays for

heart disease and hyperplasia of the prostate

decreased for each 5-year age group of males 65

years of age and over. Males 65 years of age and

over as a group had shorter average stays in 1987

than in 1981 for cerebrovascular disease and

malignant neoplasms. For females, average stays

decreased for each 5-year age group of those 65

years of age and over for heart disease, and for

each group except females 85 years of age and

over for malignant neoplasms. The average

lengths of stay for fractures also decreased for

all the female age groups 65 years of age and

over, with the greatest decreases occurring in

the age groups 70-74 and 80–84 years of age,

Tables 8–11 present data on the number and

rate of surgical and nonsurgical procedures performed on male and female hospital patients 55

years of age and over. In 1981 and 1987, the

leading procedure for males 65 years of age and

over as a group was the prostatectomy (table 8).

In 1981, prostatectomy was also the most frequent procedure for each of the male age groups

within the group 65 years of age and over,

Procedures related to heart disease were more

common in the younger portion of this population than in the older portion. Once males

reached 80 years of age, more of the surgical

procedures they received were related to conditions other than heart disease.

Females 65 years of age and over had a

different set of surgical procedures than males

(table 9), although there was some overlap, for

example, cardiac catheterization and pacemaker

insertion. Other surgical procedures performed

with high rates for females included reduction of

fractures, cholecystectomy, hysterectomy, and arthroplasty and hip replacement. High rates of

cholecystectomy persisted across the age groups

and increased for females 85 years of age and

over from 1981 to 1987. Among females 65 years

of age and over, hysterectomy was a frequent

procedure only in the group aged 65-69. Arthroplasty and hip replacement procedures were

performed with high rates for females 70 years

of age and over. In 1981 and 1987, the rate of

these procedures was significantly higher for

females 85 years and over than for females

70–74 years of age. The 1987 rates of arthroplasty and hip replacement were significantly

higher than the 1981 rates for females 80-84

years of age.

118
Investigation of the leading nonsurgical procedures in 1981 and 1987 for patients 55 years of

age and over gives an indication of the changes

in medical technology during this period. In

1981, the radioisotope scan was the nonsurgical

procedure performed most frequently for males

65 years of age and over (table 10). Although

this procedure was performed at the same rate

in 1987, it shifted to the fourth most frequently

used nonsurgical procedure because of large

increases in other nonsurgical procedures. The

use of the computerized axial tomography or

CAT scan quadrupled between 1981 and 1987

for male patients 65 years of age and over. Rates

of most of the other leading procedures were

higher in 1987 than in 1981 for each 5-year age

group. Exceptions were the rate of radioisotope

scans, which increased only for males 80–84

years of age; the rate of intravenous pyelograms,

which did not increase for males 85 years of age

and over; and the rate of arteriography using

contrast material, which did not increase for

those 65-69 years or 85 years of age and over.

Table 11 shows numbers and rates of nonsurgical procedures for females 55 years of age

and over. In 1987, the highest rates for females

were for CAT scans and diagnostic ultrasounds.

The frequency of these procedures increased

from 1981 to 1987. The rate of radioisotope

scans did not increase significantly during this

period, and by 1987, it had dropped to the third

most frequently used procedure, with a rate less

than one-half that for CAT scans. As is the case

for males, these findings could indicate changes

in the approach to medical care for older females or increased reporting of nonsurgical procedures by hospitals providing data to NHDS

through abstract services.

In addition to changes in the approach to

medical care, these increases in nonsurgical procedures may be the result of a change in the data

collection methodology of the NHDS. Beginning

in 1985, data from commercial abstracting services

were included in the NHDS. A greater number

of nonsurgical procedures per patient were reported by hospitals whose data were obtained

from abstracting services than by hospitals in

which data were collected by the traditional

manual system.

Discharge rates and average lengths of stay

are shown in table 12 for pneumonia and influenza, diagnoses that are increasingly important

as the population ages. In 1987, the discharge

rate for pneumonia and influenza increased with

age for both males and females 65 years of age

and over. This relationship was not evident in

1981. The discharge rate for pneumonia and

influenza was higher in 1987 than in 1981 for

males 65 years of age and over, but the rate for

elderly females did not change between these

two years. The average length of stay for pneumonia and influenza was not significantly different between 1981 and 1987.

Fractures of all sites, and especially hip fractures, also increase in importance as the population ages. As seen in table 13, rates of fractures

did not change appreciably between 1981 and

1987. The fracture rates for females, for both all

fractures and hip fractures, were higher than the

rates for males in all age groups and for both

years examined.

The disposition of patients discharged from

short-stay hospitals can give an indication of

severity of illness. In 1987, 82 percent of persons

65–74 years of age were classified as routine

discharges; 6 percent were discharged to longterm care facilities; and 5 percent died while

hospitalized. In contrast, for the group 85 years

of age and over, only 53 percent were routine

discharges, while significantly more, 21 percent,

were discharged to long-term care facilities, and

10 percent died while hospitalized.

Table 14 presents the discharge disposition

by sex for the years 1981 and 1987. The percentage of both male and female patients 65 years of

age and over who died in the hospital increased

119
with age both in 1981 and 1987. Male fatality

rates exceeded female fatality rates except for

those 85 years of age and over in 1981. For

persons aged 65 years and over, the highest

fatality rates were for the diagnoses of diseases

of the heart (27.0 per 100 deaths), malignant

neoplasms (16.4 per 100 deaths), and cerebrovascular disease (9.7 per 100 deaths),

As the population ages, the percentage discharged to long-term care facilities increases.

This pattern was found in both 1981 and 1987

and for both males and females. Females had a

larger percentage of discharges to long-term

care facilities than males in both 1981 and 1987

for all age groups except those 85 years of age

and over in 1987.

References

1, National Center for Health Statistics. Health,

United States, 1989. Washington: Public Health

Service. 1990.

2. McLemore T, DeLozier J. 1985 Summary: National Ambulatory Medical Care Survey. Ad3.

4.

5.

6.

7.

8.

vance data from vital and health statistics; no

128. Hyattsville, Maryland: National Center for

Health Statistics. 1987.

Graves EJ. National Hospital Discharge Survey:

Annual Summary, 1987. Vital Health Stat 13(99),

Washington: National Center for Health Statistics. 1989.

Nelson C, McLemore T. The National Ambulatory Medical Care Survey: United States,

1975-1981 and 1985 trends. Vital Health Stat

13(93). Washington: National Center for Health

Statistics. 1988.

Pokras R, Kozak LJ, McCarthy E, Graves EJ,

Trends in hospital utilization: United States,

1965–1986. Vital Health Stat 13(101). Washington: National Center for Health Statistics, 1989,

Collins JG. Prevalence of selected chronic conditions: United States, 1979-1981. Vital Health

Stat 10(155). Washington: National Center for

Health Statistics, 1986.

Cunningham LS, Kelsey JL. Epidemiology of

musculoskeletal impairments and associated disability. Am J Public Health 74(6):574-9. 1984.

Collins JG. Prevalence of selected chronic conditions, United States, 1983-1985. Advance data

from vital and health statistics; no 155, Washington: National Center for Health Statistics. 1988.

120
Table 1. Average annual number of physician visits per person, by race, sex, respondent-assessed

health status, and age: United States, 1985-87

[Data are based on household interviews of the civilian noninstitutionalized population]

All racesl White Black

Respondent-assessed

health status and age Male Female Male Female Male Female

All health statusesz

55–59 years, . . . . . . . . . . . . . . . . . .

60-64 years. . . . . . . . . . . . . . . . . . .

65-69 years. . . . . . . . . . . . . . . . . . .

70-74 years. ,, .,, . . . . . . . . . . . . .

75–79 years, ,, .,, . . . . . . . . . . . ,.

80-84 years.,..,,.,..,,..,.,,.

65 years and over. .,, ,,, .,,.,, .

75 years and over, ,,, ,, .,.,.,, .

85 years and over. ,,, . .,,.,..,.

Good orexcellent health

55-59 years, . . . . . . . . . . . . . . . . . .

60-64 years. .,, , . . . . . . . . . . . . . .

65-69 years . . . . . . . . . . . . . . . . . . .

70-74 years. ,., of,, ..,.,.... ,.

75-79 years. . .,, ,,, ,,, . . . . . . . .

80-84 years. . . . . . . . . . . . . . . . . . .

65 years and over.,......,,,. . .

75 years and over. . . . . . . . . . . ,,.

85 years and over. . . . . . . . . . . . . .

Fairer poor health

55-59 years, ,,, ,,, , . . . . . . . . . . .

60–64 years, ,,, .,, .,, . . . . . . . . .

65-69 years, , . . . . . . . . . . . . . . . . .

70-74 years, . . . . . . . . . . . . . . . . . .

75–79 years. ,,, ., .,, ,,, . . . . . ,.

80-84 years. . . . . . . . . . . . . . . . . ,.

65 years and over. . . . . . . . . . . . . .

75 years and over . . . . . . . . . . . . . .

85 years and over . . . . . . . . . . . . . .

4.2

4.8

4.9

5.4

5.5

5.9

5.4

6.0

7.5

2.7

3.2

3.4

3.5

3.9

4.4

3.7

4.3

5.1

10,5

9,8

8.9

9.5

8.5

8.6

9.2

9.2

12.1

4.7

5.2

5.4

5.8

5.9

6.3

5.8

6.2

6,6

3.1

3.3

3.9

4.0

4.5

4.5

4.2

4.6

5.2

10.6

11.0

9.6

10.1

8.6

9.9

9.5

9.2

9.3

Number ofvisits per person peryear

4.1

4.7

4.8

5.3

5,5

5.9

5.4

6.0

7.5

2.7

3.2

3.4

3.6

3.9

4.5

3.8

4.3

5.1

10.2

9.7

8.8

9.5

8.7

8.6

9.2

9.3

12,3

4.5

5.1

5.3

5.5

5.8

6.3

5.7

6.1

6.6

3.2

3.3

3.9

4.1

4.5

4.4

4.2

4.6

5.2

10.6

11.2

9.5

9.4

886

10.0

9.3

9.2

9.4

4.8

5.9

6.0

5.7

5.5

6.5

5.9

6.1

7.7

1.9

2.9

2.7

2.9

3.6

3.8

3.1

3.9

5.6

10.6

10.0

9.7

9.8

7.3

9.3

9.2

8.2

9.9

6.2

6.5

7,0

8.4

6.6

7.4

7.4

6.9

6.9

3.0

3.6

4.5

3.6

4.7

4.8

4.3

4.8

4.9

11.1

10.4

10.0

*14.2

8.8

9.6

10.8

9.2

9.5

‘Includes races other than white and black.

‘Includes unknown respondent-assessed health status.

SOURCE: National Center for Health Statistics$’’Datafrom the National Health lntetview Survey.

121
Table 2. Number of mentions of most common patient reasons for a physician visit for ambulatory

patients 55 years of age and over and rank for males and females, by age: United States, 1985

[Data are based on reporting by a sample of office-based physicians]

Rank

Age and most common patient Number of mentions

Rank reason for a physician visit per 1,000 visits Male Female

1

2

3

4

5

6

7

8

9

10

1

2

3

4

5

6

7

8

9

10

1

2

3

4

5

6

7

8

9

10

1

2

3

4

5

6

7

8

9

10

122

55–59 years

Hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

General medical examination. . . . . . . . . . . . . . , , . . . . . .

Postoperative visit ., . . . . .. o....... . . . . . . . . . . . . . .

Blood pressure test . . . . . . . ...,,,... . . . . . . . . . . . . .

Cough . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Progress visit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Back pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Shoulder pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Headache . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

60–64years

General medical examination. ,.. . . . . . . . . . . . . . . . . . .

Postoperative visit....,,..,,.. . . . . . . . . . . . . . . . . . .

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

Blood pressure test . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Progress visit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Cough . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Back pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Anxiety .,.,,.,.,....,....,,,, . . . . . . . . . . . . . . . . .

Chest pain (excluding heart pain), . . . . . . . . . . . . . . . . .

65–69years

General medical examination. .,, . .,, , . . . . . . . . . . . . .

Postoperative visit.,,....,.,.. . . . . . . . . . . . . . . . . . .

Hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Blood pressure test . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Progress visit, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Cough . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Vertigo .,,....,,....,...,,,.. ,,, , . ., .,, .,,,.,,

Chest pain (excluding heart pain) . . . . . . . . . . . . . . . . . .

Shortness of breath, . . . . . . . . . . . . . . . . . . . . . . . . . . . .

70–74years

Postoperative visit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

General medical examination, ... . . . . . . . . . . . . . . . . . .

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

Progress visit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Blood pressure test . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Cough. . ., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diminished vision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Vertigo .,,....,....,,...,,,.. . . . . . . . . . . . . . . . . .

Back pain ., . . . . . . . . . . . . . . . . . ,,, ...,....,,.,,.,

56

50

49

41

37

27

26

22

20

20

60

55

53

39

38

37

30

25

25

24

60

54

53

40

39

30

29

28

25

21

78

60

46

39

38

33

32

26

24

23

1

4

2

3

6

5

7

9

8

21

3

1

2

5

4

6

12

10

19

8

3

1

2

5

4

6

9

8

7

13

1

2

3

4

7

6

5

10

16

9

2

1

3

4

5

12

9

11

19

7

1

2

3

4

7

6

5

9

8

15

1

3

2

4

5

7

6

8

10

11

1

2

4

5

3

6

9

7

8

12
Table 2. Number of mentions of most common patient reasons for a physician visit for ambulatory

patients 55 years of age and over and rank for males and females, by age: United States,

1985-Con.

[Data are based on reporting by a sample of office-based physicians]

Rank

Age and most common patient Number of mentions

Rank reason for a physician visit per 1,000 visits Male Female

1

2

3

4

5

6

7

8

9

10

1

2

3

4

5

6

7

8

9

10

1

2

3

4

5

6

7

8

9

10

75–79 years

Postoperative visit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

General medical examination, . . . . . . . . . . . . . . . . . . . . .

Hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Progress visit . o, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Blood pressure test . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Cataract, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Cough, , .,, , . .,, ,, . .,, ..,,,.... . . . . . . . . . . . . . . .

Vertigo ... ,,..0 ,. ..,,.. . . . . . . . . . . . . . . . . . . . ...!

Diminished vision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

80–84years

Postoperative visit .o, ..o, .,,.o.. .OO. . . . . . . . . . . . .

General medical examination . . . . . . . . . . . . . . . . . . . . . .

Progress visit . . . . . . . . ..o . . . . . . . . . . . . . . . . . . . . . . .

Diminished vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Cataract, ,., o, ., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Vertigo, ..,,,...,,,,...,,,.,,, . . . . . . . . . . . . . . . .

Shortness of breath,,,,,,.,,..,,, . . . . . . . . . . . . . . .

Diabetes mellitus . .,, . .,,.,.... . . . . . . . . . . . . . . . . .

Cough . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

85 years andover

General medical examination . . . . . . . . . . . . . . . . . . . . . .

Postoperative visit, , .,, ,, ..,,.., . . . . . . . . . . . . . . . .

Vetilgo .,, .,, .,, ,.. o. . . . . . . . . . . . . . . . . . . . . . . . . .

Diminished vision, ,, ..,.,.... . . . . . . . . . . . . . . . . . . .

Cataract, ,,, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Progress visit,,......,....,,.. . . . . . . . . . . . . . . . . .

Back pain.,........,.....,.. . . . . . . . . . . . . . . . . . .

Hypertension . ,. . . . . ! . . . . ! . . . . , . . . . . . . . . . ,. . . . ,

Leg pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Skin lesion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

74

62

51

44

37

31

29

28

27

27

82

63

52

40

34

32

31

28

27

24

64

64

44

41

40

38

35

*34

*32

*3O

1

2

4

3

9

6

10

5

17

11

1

2

3

6

10

11

24

4

39

5

1

2

16

8

5

3

28

43

13

19

1

3

2

4

5

8

6

14

7

9

1

2

3

4

6

8

5

18

7

19

3

1

2

4

7

10

6

5

8

9

SOURCE: National Centerfor Health Statistics: Data fromthe National Ambulatory Medical Care Suwey.

123
Table 3. Percent of office visits by persons 55 years of age and over to selected physician

specialists, by sex and age: United States, 1985

[Data are based on reporting by a sample of office-based physicians]

Specialty

Ortho- CardioVisits to all General Internal General Ophthal- pedic vascular Other

Sex and age physicians practice medicine surgery mology surgery specialty specialty

Both sexes

Number in

thousands Percent

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

55–59 years . . . . . . . . . . . . .

60–64 years. . . . . . . . . . . . .

65–69 years . . . . . . . . . . . . .

70–74years . . . . .. a......

75–79 years . . . . . . . . . . . . .

80–84 years . . . . . . . . . . . . .

65 years And over . . . . . . . .

75 years And over . . . . . . . .

85 years and over. . . . . . . .

Male

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

55–59 years. . . . . . . . . . . . .

60–64 years....,.,...,..

65–69 years . . . . . . . . . . . . .

70–74 years . . . . . . . . . . . . .

75–79 years . . . . . . . . . . . . .

80-84 years . . . . . . . . . . . . .

65 years And over. ..,...,

75 years Andover..,..,,,

85 years and over. . . . . . . .

Female

Total, . .,, . . . . . . . . . . . . . .

55–59 years . . . . . . . . . . . . .

60-64 years . . . . . . . . . . . . .

65-69 years . . . . . . . . . . . . .

70–74 years . . . . . . . . . . . . .

75–79 years . . . . . . . . . . . . .

80-84 years. . . . . . . . . . . . .

65 years and over. . . . . . . .

75 years And over . . . . . . . .

85years and over. . . . . . . .

205,582

37,218

37,826

39,781

35,646

29,354

16,227

130,539

55,111

9,530

82,112

15,520

15,588

16,707

14,058

11,518

5,808

51,004

20,239

2,912

123,469

21,698

22,237

23,074

21,588

17,835

10,419

79,535

34,873

6,618

29.9

29.6

33.1

28.8

28.8

28.6

29.2

29.1

29.4

32.3

28.7

28.7

30,5

28.4

26.4

28.0

30.5

28.1

29,1

30.8

30,7

30.2

34.9

29.1

30,4

29.0

28,5

29.7

29,6

32,9

20.2

16.8

16.9

22.3

22.0

22.3

21.4

22,1

22.1

22.5

19.1

15.8

16.9

20.9

21.7

21.7

18.2

20.8

20,2

18.1

20,9

17.5

16,8

23.3

22.2

22,7

23.2

23.0

23.2

24.4

6.4

6.7

6.6

6.0

6.8

7.1

4.9

6,2

6.0

4.5

6.6

5.8

6.8

5.9

8,3

6.9

6.4

6.7

6.2

3.2

6.2

7.2

6.5

6.1

5.7

7.3

4.1

5.9

5.9

5.1

11.4

7.4

8.4

10.4

12.1

14.7

19.1

13,5

16.6

18.1

10.3

7.6

8.2

9.9

10.8

12.4

16.0

11.8

14,0

16.1

12.2

7.3

8.6

10,7

12.9

16.2

20.8

14.5

18.1

19.1

4.2

6.4

5.0

4.2

2.9

3.5

2.6

3.4

3.1

2.6

4.0

7.4

5.1

4.2

2.0

2.2

1.5

2.6

1,8

1.1

4.4

5,7

4.9

4.2

3.5

4,4

3.2

3.8

3.8

3.3

3.8

3.2

4.3

4.0

3,9

4.1

3.5

3.8

3.8

3.1

5.2

4.4

6.5

5,7

4.7

4.7

4.8

5.0

4,7

4.2

2,9

2.3

2.9

2,7

3.3

3.7

2.7

3.1

3.2

2.7

10.3

12.6

10.5

10.4

10,6

9.2

8.6

9.7

8.5

6.3

10.8

13.0

10.4

10.3

11.1

10.2

8.0

10,2

9,5

10.3

10,0

12.2

10,5

10.4

10.3

8.6

8.9

9.3

7.9

4,5

SOURCE: National Center for Health Statistics: Data from the National Ambulatory Medical Care Survey.

124
Table 4. Number of mentions of most frequent all-listed diagnoses for ambulatory patients 55 years

of age and over and rank for males and females, by age: United States, 1985

[Data are based on reporting by a sample of office-based physicians]

Rank

Age, most frequent all-listed Number of mentions

Rank diagnoses, and ICD–9 – CM cod$ per 1,000 visits Male Female

1

2

3

4

5

6

7

8

9

10

1

2

3

4

5

6

7

8

9

10

1

2

3

4

5

6

7

8

9

10

1

2

3

4

5

6

7

8

9

10

55–59 years

Essential hypertension .,, . . . . . . . . . . . . . . . . . . . . . . . ...401

Diabetes mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...250

Chronic ischemic heafldisease . . . . . . . . . . . . . . . . . . . . ..4l4

Neurotic disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..3oo

Disorders of refraction and accommodation. . . . . . . . . ...367

Osteoarthritis and allied disorders. . . . . . . . . . . . . . . . . ...715

Arthropathies, other and unspecified. . . . . . . . . ., . . . . . , .716

Obesity, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...278

Bronchitis, , . . . . . . . . . . . . . . . . . . . .,. .,, ... . . . . . . . ..49o

Acute upper respiratory infections. . . . . . . . . . . . . . . . . ...465

60–64 years

Essential hypertension . . . . . . . . . . . . . ., . . . . . . . . . . . . ..4o1

Diabetes mellitus, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...250

Chronic ischemic heart disease. . . . . . . . . . . . . . . . . . . ...414

Osteoarthritis and allied disorders. . . . . . . . . . . . . . . . . ...715

Disorders of refraction and accommodation . . . . . . . . . ...367

Arthropathies, other and unspecified., . . . . . . . . . . . . . . . .716

Chronic airway obstruction, not elsewhere classified . . ...496

Neurotic disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..3oo

Angina pectoris . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...413

Cardiac dysrhythmias . . . . . . . . . . ., . . . . . . . . . . . . . . . ...427

65–69years

Essential hypertension. ..,...... . . . . . . . . . . . . . . . . . ..4ol

Diabetes mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...250

Chronic ischemic heart disease, . . . . . . . . . . . . . . . . . . ...414

Osteoarthritis and allied disorders., . . . . . . . . . . . . . . . ...715

Cataract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...366

Cardiac dysrhythmias . . . . . . . . . . . . ...,..,...........427

Angina pectoris . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...413

Chronic airway obstruction, not elsewhere classified . . ...496

Arthropathies, other and unspecified.. . . . . . . . . . . . . . ...716

Disorders ofrefraction and accommodation . . . . . . . . . ...367

70–74years

Essential hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . ..4ol

Diabetes mellitus, . . . . . . . . . . . . .,....,....,........250

Chronic ischemic heart disease.. . . . . . . . . . . . . . . . . . ...414

Cataract, , ., . . . . . . . . . . . . . . . . . . ,, ...,..,..,,....,366

Osteoarthritis and allied disorders, . . . . . . . . . . . . . . . . ...715

Cardiac dysrhythmias . . . . . . . . . . . . . . . . . . . . . . . . . . . ...427

Chronic airway obstruction, not elsewhere classified . . ...496

Heartfailure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...428

Arthropathies, other and unspecified.. . . . . . . . . . . . . . ...716

Glaucoma. , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...365

143

61

28

26

26

25

19

16

16

16

159

83

46

28

26

21

19

19

19

17

157

78

47

43

30

26

24

23

23

22

145

81

53

48

35

27

27

25

24

24

1

2

3

9

6

4

10

27

16

47

1

2

3

5

8

10

4

19

6

16

1

2

3

10

8

5

6

4

9

11

1

2

3

5

8

6

4

9

18

14

1

2

17

4

5

9

11

10

13

6

1

2

3

5

4

9

38

7

22

11

1

2

5

3

4

6

11

17

9

8

1

2

4

3

5

10

12

8

6

7

125
Table 4. Number of mentions of most frequent all-listed diagnoses for ambulatory patients 55 years

of age and over and rank for males and females, by age: United States, 1985-Con.

[Data are based on repotting by a sample of office-based physicians]

Rank

Age, most frequent all-listed Number of mentions

Rank diagnoses, and ICD–9-CM cod.& per 7,000 visits Male Female

1

2

3

4

5

6

7

8

9

10

1

2

3

4

5

6

7

8

9

10

1

2

3

4

5

6

7

8

9

10

75–79 years

Essential hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . ...401

Diabetes meilitus, . .,, . . . . . . . . . . . . . .,,...,,....,..250

Chronic ischemic heatidisease . . . . . . . . . . . . . . . . . . . . ..4l4

Cataract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...366

Osteoarthritis and allied disorders. . . . . . . . . . . , , . . . . . . . 715

Heart failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...428

Cardiac dysrhythmias. . . . . . . . . . . . . . . . . . . . . . . . . . . ...427

Glaucoma . . . . . . . . . . . . . . . . . . . . ...,..,.......,...,365

Arthropathies, other and unspecified.. . . . . . . . . . . . . . ...716

Neurotic disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...300

80-84years

Essential hypertension . . . . . . . . . , . . . . . . . . . . . . . . . . ...401

Cataract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...366

Chronic ischemic heart disease. . .,,...,.,....,...,..414

Diabetes mellitus .,, , ...,,,.,, . . . . . . . . . . . . . . . . . ...250

Heart failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...428

Osteoarthritis and allied disorders.. . . . . . . . . . . . . . . . ...715

Glaucoma, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...365

Cardiac dysrhythmias . . . . . . . . . . . . . . . . . . . . . . . . . . . ...427

Other eye disorders . . . . . . . . . . . . .,....,,...........379

Chronic airway obstruction, not elsewhere classified ,. ...496

85 years andover

Essential hypertension.,,,..,,. . ...,..,....,.,...,,401

Chronic ischemic heart disease.. . . . . . . . . . . . . . . . . . ...414

Cataract . . . . . . . . . . . . . . . . . . . . . ,, . . . . . . . . . . . . . . ...366

Heart failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...428

Diabetes mellitus ., ., ...,,... . . . . . . . . . . . . . . . . . . ...250

Osteoarthritis and allied disorders., . . . . . . . . . . . . . . . . ..715

Glaucoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...365

Cardiac dysrhythmias . . . . . . . . . . . . . . . . . . . . . . . . . . . ...427

Other disordersof urethraand urinary tract, , ...,,.... ,599

Other skin cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...173

170

91

67

61

48

37

34

32

27

21

133

74

72

56

54

54

32

30

27

27

122

77

74

66

44

37

35

*33

*31

*31

1

2

3

5

7

6

4

8

12

15

1

5

2

8

3

6

9

7

14

4

4

1

3

2

5

9

8

6

16

7

1

2

4

3

5

7

9

6

8

11

1

2

3

4

6

5

7

11

8

26

1

3

2

4

5

6

8

12

9

11

l“A1l-listed” means listed as first, second, or third diagnosis.

2Coded according to the international Classification of Diseases, Ninth Revision, Clinical Modification,

SOURCE: National Centerfor Health Statistics: Data from the National Ambulatory Medical Care Survey.

126
Table 5. Number of mentions per 1,000 visits of common diagnostic services for ambulatory patients 55 years of age and over,

according to sex and age: United States, 1985

[Data are based on reporting by a sample of office-based physicians]

Blood Other

Blood Urine Breast

pres- E/ectroPelvic Rectal Visual

radioSex and age

Urin- Hema- Pap sure cardio- Chest logic

glucose glucose exam’ exam’ exam acuity alysis tology test’ check gram x ray test

Total

55–59 years . . . . . . . . . . . . . . .

60-64 years . . . . . . . . . . . . . . .

65-69 years . . . . . . . . . . . . . . .

70–74 years . . . . . . . . . . . . . . .

75–79 years . . . . . . . . . . . . . . .

80–84 years . . . . . . . . . . . . . . .

65 years Andover......,,..

75 years And over . . . . . . . . . .

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

Male

55–59 years . . . . . . . . . . . . . . .

6G64 years . . . . . . . . . . . . . . .

65-69 years . . . . . . . . . . . . . . .

70-74 years . . . . . . . . . . . . . . .

75–79 years . . . . . . . . . . . . . . .

80–84 years . . . . . . . . . . . . . . .

65 years And over . . . . . . . . . .

75 years And over . . . . . . . . . .

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

Female

55–59 years . . . . . . . . . . . . . . .

60-64 years . . . . . . . . . . . . . . .

65-69 years . . . . . . . . . . . . . . .

70-74 years, . . . . . . . . . . . . . .

75–79 years. . . . . . . . . . . . . . .

80–84 years . . . . . . . . . . . . . . .

65 years And over . . . . . . . . . .

75 years And over . . . . . . . . . .

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

98

107

104

107

113

92

104

103

90

99

121

95

106

119

69

98

96

*62

97

98

111

108

109

105

108

106

103

84

80

80

84

84

88

82

82

64

81

87

81

92

97

98

89

93

*66

86

75

79

80

76

83

78

75

63

128

117

99

83

69

66

79

64

*47

...

...

...

...

...

...

...

...

...

128

117

99

83

69

66

79

64

*47

105

82

64

49

35

31

46

32

*28

...

...

...

...

...

...

...

...

,..

105

82

64

49

35

31

46

32

*28

77

67

73

66

53

*54

62

51

40

62

80

72

89

78

64

76

70

*54

88

57

73

52

37

49

53

40

*34

68

80

86

103

117

160

112

136

154

72

77

84

100

99

142

101

117

137

66

83

86

105

129

171

118

147

162

128

132

134

143

128

141

135

132

127

125

135

139

153

142

140

143

141

138

130

130

130

136

120

142

130

127

122

97

100

100

110

115

113

109

116

123

80

95

88

97

124

105

102

118

117

109

104

109

118

109

118

114

115

125

75

53

39

31

*18

*2O

27

17

*lo

...

...

...

...

...

...

...

...

...

75

53

39

31

*18

*2O

27

17

*lo

468

475

502

515

511

458

502

492

495

444

452

480

504

519

411

487

481

467

485

491

518

522

505

484

511

499

507

62

61

61

65

62

55

61

58

49

80

90

74

68

76

56

69

67

*54

48

41

52

64

54

55

56

53

*47

44

48

42

40

51

39

42

45

*34

52

62

35

41

65

31

45

57

32

38

38

47

39

42

32

40

37

*34

73

75

72

70

58

57

65

57

50

68

69

71

55

43

59

58

48

45

76

79

72

79

68

57

69

61

52

llncludes only visits by female patients.

SOURCE: National Center for Health Statistics: Data from the National Ambulatory Medical Care Survey.
Table 6. Number of patients discharged, rate of discharges, days of care, and average length of

stay for males 55 years of age and over, by age and selected first-listed diagnoses: United Statesj

1981 and 1987

[Discharges from non-Federal short-stay hospitals]

Average

Discharges Days of care length of stay

Age, first-listed diagnosis,

and ICD-9–CM code’ 1981 1987 1981 1987 1981 1987 1981 1987

55–59 years

Diseases of heart . . . . .391–392.0,393-398,

402,404,410-416,420-429

Malignant neoplasms . ...1 40–208,230–234

Cerebrovascular disease . . . . . ...430-438

Inguinal hernia . . . . . . . . . . . . . . . . . ., .550

Fractures, all sites. . . . . . . . . . . . . . 800–829

Hyperplasia of prostate. . . . . . . . . . . . .. 600

60–64 years

Diseases of heart . . . . .391–392.0,393-398,

402,404,410-416,420-429

Malignant neoplasms . ...1 40–208,230–234

Cerebrovascular disease . . . . . ...430438

Hyperplasia of prostate. . . . . . . . . . . ...600

Inguinal hernia . . . . . . . . . . . . . . . . . . . ,550

Pneumonia, all forms . . . . . . . . . . . 480–486

65–69 years

Diseases of heart . . . . .391–392.0,393–398,

402,404,410416,420-429

Malignant neoplasms . ...1 40–208,230–234

Cerebrovascular disease . . . . . ., .430-438

Hyperplasia of prostate. . . . . . . . . . . ...600

Pneumonia, all forms . . . . . . . . ...480486

Inguinal hernia..,.,..,.,,....,,. .. 550

70–74 years

Diseases of heart . . . . .391–392.0,393–398,

402,404,410416,420-429

Malignant neoplasms . ...1 40–208,230-234

Cerebrovascular disease . . . . . . . . 430–438

Hyperplasia of prostate . . . , , . . . , ... , .600

Pneumonia, all forms . . . . . . . . . . . 480–486

Inguinal hernia . . . . . . . . . . . . . . . . . ...550

75–79 years

Diseases of heart . . . . .391-392.0,393–398,

402,404,410-416,420429

Malignant nesms. . . . . ...140-208.230-234

Cerebrovascular disease . . . . . . . .430438

Pneumonia, all forms . . . . . . . . ...480-486

Hyperplasia of prostate. . . . . . . . . . . ...600

Fractures, all sites. . . . . . . . . . . . . . 800–829

Number in

thousands

227

91

30

37

23

24

224

117

36

40

39

19

271

153

56

53

26

38

221

145

62

58

34

31

166

106

57

27

35

14

238

76

31

25

23

21

270

118

42

39

31

26

285

131

60

59

35

24

294

145

67

54

48

21

223

111

63

47

46

20

Number per

1,000 population

41.5

16.6

5.5

6.8

4.2

4.4

46.9

24.4

7.5

8.3

8.2

4.0

68.6

38.8

14,2

13.6

6.7

9.7

75.0

49.3

20.9

19.5

11.7

10.7

87.6

55.9

30.0

14.4

18.7

7.3

44.8

14.3

5.9

4.6

4.0

3.9

53.1

23.3

8.3

7.6

6.1

5.1

63.3

29.0

13.4

13.2

7.7

5.4

88.2

43.4

20,1

16.2

14.4

6.4

98.3

49.0

27.7

20.9

20.5

9,0

Number in

thousands

1,846

954

292

179

192

154

1,864

1,207

419

288

190

206

2,506

1,959

628

454

260

205

2,169

1,815

674

513

417

193

1,683

1,366

834

326

314

226

1,407

704

366

52

154

93

1,681

1,036

376

186

66

215

1,992

1,186

537

294

334

64

2,128

1,228

607

283

479

74

1,748

1,092

587

470

263

237

Stay in days

8.1

10,5

9.6

4.8

8.3

6.4

8.3

10.3

11.7

7.2

4.8

10.8

9.3

12.8

11.2

8.5

9.9

5.4

9.8

12.5

10.9

8.9

12.1

6.1

10.1

12.9

14.7

11.9

8.9

16,5

5.9

9.3

11.7

2.1

7.4

4.5

6.2

8.8

8.9

4.8

2,2

8.4

7.0

9.1

8.9

5.0

9.6

2.6

7.2

8.5

9.1

5.3

10.0

3.5

7.9

9.8

9,4

9.9

5.7

11,7

128
Table 6. Number of patients discharged, rate of discharges, days of care, and average length of

stay for males 55 years of age and over, by age and selected first-listed diagnoses: United States,

1981 and 1987–Con.

[Discharges from non-Federal short-stay hospitals]

Average

Discharges Days of care /ength of stay

Age, first-listed diagnosis,

and ICD–9–CM code’ 1981 1987 1981 1987 1981 1987 1981 1987

80–84 years

Diseases of heart , . ...391-392.0.393-398,

402,404,410-416,420-429

Malignant neoplasms . ...1 40–208,230–234

Cerebrovascular disease . . . . . ...430-438

Pneumonia, all forms . . . . . . . .

Hyperplasia of prostate . . . . . . . . . . . . . . 600

Fractures, all sites. . . . . . . . . . . . . . 800–829

65 years and over

Diseases of heart . . ...391-392.0.393-398.

402,404,410-41 6,420–429

Malignant neoplasms . ...140-208.230-234

Cerebrovascular disease . . . . . ...430-438

Pneumonia, all forms . . . . . . . . . . . 480–486

Hyperplasia of prostate. . . . . . . . . . . ...600

Fractures, all sites. . . . . . . . . . . . . . 800–829

75 years and over

Diseasesof heart , . ...391-392.0.393-398,

402,404,410-416,420-429

Malignant neoplasms . ...1 40–208,230–234

Cerebrovascular disease . . . . . ...430-438

Pneumonia,allforms . . . . . . . . ...480-486

Hyperplasiaof prostate. . . . . . . . . . . ...600

Fractures, all sites. . . . . . . . . . . . . . 800–829

85 years and over

Diseases of heart . . . . .391–392.0,393-398,

402,404,410-416,420-429

Pneumonia, all forms ,, .,.......480-486

Malignant neoplasms . ...1 40–208,230–234

Cerebrovascular disease . . . . . . . . 430–438

Fractures, all sites. . . . . . . . . . . . . . 800–829

Hyperplasia of prostate. . . . . . . . . . . ...600

Number in

thousands

118

62

45

20

22

14

868

506

252

141

181

80

376

207

134

81

70

49

93

33

40

32

21

13

157

61

48

47

29

21

1,054

485

273

222

206

97

476

210

146

140

93

61

96

45

38

35

20

17

Number per

1,000 population

110.4

57.9

42.1

19.2

20.5

13.2

82.2

47.9

23.8

13.4

17.1

7.6

102.6

56.5

36.5

22.0

19.1

13,3

131.1

46,4

56.7

45.7

30.0

18.0

128.3

49.7

39.4

38.5

23.9

17.2

87.0

40,0

22.5

18.4

17.0

8.0

110.8

48.8

34.0

32.5

21.7

14.2

119.4

56.0

43.6

47.0

24.4

21.5

Number in

thousands

1,215

780

580

259

224

328

8,563

6,449

3,090

1,652

1,690

1,280

3,888

2,675

1,788

976

724

891

991

391

530

374

337

185

1,163

639

466

472

182

275

7,714

4,522

2,498

2,190

1,166

1,168

3,595

2,109

1,354

1,377

588

766

683

435

377

301

254

143

Stay in days

10.3

12.7

12.9

12.7

10.3

23.4

9.9

12.8

12.2

11.7

9.3

16.0

10.3

12.9

13.4

12.1

10.4

18.2

10.7

11.9

13.4

11.6

15.9

14.6

7.4

10.5

9.7

10.0

6.2

13.0

7.3

9.3

9.1

9.8

5.7

12.0

7.6

10.1

9.3

9.9

6.3

12.5

7.1

9.6

10.0

8.6

12.9

8.2

1Coded a~~ording to the /nternationa/ C/assifjcation of Diseases, Ninth Revision, clinical Modification.

SOURCE: National Center for Health Statistics: Data from the National Hospital Discharge Survey.

129
Table 7. Number of patients discharged, rate of discharges, days of care, and average length of

stay for females 55 years of age and over, by age and selected first-listed diagnoses: United

States, 1981 and 1987

[Discharges from non-Federal short-stay hospitals]

Average

Discharges Days of care /errgfh of stay

Age, first-listed diagnosis,

and ICD-9–CM code’ 1981 1987 1981 1987 1981 1987 1981 1987

55–59 years

Diseases of heart ., , . .391-392.0,393-398,

402,404,410-416,420-429

Malignant neoplasms . ...1 40–208,230–234

Cholelithiasis . . . . . . . . . . . . . . . . . . . . ..574

Cerebrovascular disease . . . . . ...430-438

Fractures, all sites. ., . . . . . . , . . . . 800–829

Pneumonia, all forms , ...,.....,480-486

60–64 years

Diseases of heart ., . ..391-392.0.393-398,

402,404,410-416,420-429

Malignant neoplasms . ...1 40–208,230–234

Cerebrovascular disease . . . . . ...430-438

Fractures, all sites. . . . , . . . . . , . . . 800–829

Cholelithiasis . . . . . . . . . . . . . . . . . . . . .. 574

Pneumonia, all forms . . . . . . . . . . . 480–486

65–69 years

Diseases of heart . . ...391 -392.0,393–398,

402,404,410-41 6,420–429

Malignant neoplasms . . ..140–208.230–234

Cerebrovascular disease . . . . . ...430-438

Fractures, all sites. . . . . . . . . . . . . . 800–829

Pneumonia, all forms , . . . . . . . . ..480–486

Cholelithiasis ., . . . . . . . . . . . . . . . . . . . .574

70–74 years

Diseases of heart , . ...391-392.0,393-398,

402,404,410-416,420-429

Malignant neoplasms . . ..140–208.230–234

Cerebrovascular disease ., . . . ...430-438

Fractures, all sites. ., , . . . . . , . . . . 800–829

Pneumonia, all forms . . . . . . . . . ..480–486

Cholelithiasis ..,.....,...,,,.,.. .. ,574

75–79 years

Diseases of heart . . . ..391 –392.0.393-398.

402,404,410-416,420-429

Malignant neoplasms . . . .140–208,230–234

Cerebrovascular disease . . . . . ...430-438

Fractures, all sites. . . . . . . . . . . . . . 800–829

Pneumonia, all forms . .,,..,,.,,480-486

Cholelithiasis . . . . . . . . . . . . . . . . . . . . ..574

Number in

thousands

126

115

28

20

28

21

152

148

32

34

31

22

198

156

58

42

29

32

228

121

68

46

27

25

244

101

71

64

32

21

118

96

28

24

24

18

179

144

40

28

27

25

225

140

47

40

32

30

271

120

81

50

37

23

265

95

87

55

43

24

Number per

1,000 population

20.6

18.8

4.6

3.3

4.5

3,4

27.4

26.7

5.8

6.2

5.5

4.0

40.1

31.6

11.8

8.5

5.8

6.4

56.0

29.6

16.8

11.3

6.6

6.1

80.8

33.3

23.5

21.2

10.5

6.9

20.3

16.4

4.9

4.1

4,1

3.1

30.7

24.8

6.8

4.9

4.7

4.2

41,8

26,0

8.7

7.3

6.0

5.6

60,9

27,0

18.2

11,2

8.2

5.2

75.4

27,0

24.6

15,7

12.2

6.7

Number in

thousands

1,113

1,214

262

228

258

171

1,467

1,570

425

397

300

226

1,944

1,819

734

494

299

349

2,288

1,607

921

689

287

301

2,401

1,298

947

108

348

253

723

687

170

245

156

116

1,306

1,098

396

238

180

210

1,571

1,194

508

435

289

208

1,970

1,152

898

460

386

196

2,102

805

880

657

389

232

Stay in days

8.8

10,5

9.2

11.3

9.3

8,3

9,6

10.6

13.1

11,5

9.7

10,1

9.8

11.7

12,6

11.8

10.4

11.0

10.0

13,3

13.5

14.9

10.7

12.1

9.9

12.9

13.4

16.9.

11,0

12.1

6.1

7.2

6.0

10.2

6.5

6,5

7.3

7.6

10.0

8,4

6,6

8.6

7.0

8,5

10.9

11.O

9,0

6,9

7.3

9.6

11,1

9,2

10.6

8.4

7.9

8.5

10.2

11.9

9.0

9.9

130
Table 7. Number of patients discharged, rate of discharges, days of care, and average length of

stay for females 55 years of age and over, by age and selected first-listed diagnoses: United

States, 1981 and 1987- Con.

[Discharges from non-Federal short-stay hospitals]

Average

Discharges Days of care length of stay

Age, frrst-listed diagnosis,

and ICD-9–CM code’ 1981 1987 1981 1987 1981 1987 1981 1987

80–84 years

Diseases of heart . . . . .391-392.0,393-398,

402,404,410-416,420-429

Cerebrovascular disease ., . . . . . . 430-438

Fractures, all sites. ., , . . . . . . . . . . 800–829

Malignant neoplasms . ...1 40–208,230–234

Pneumonia, all forms , , . . . . . . . . . 480–486

Urinary tract infection , ., , . . . ., , . ...599.0

65 years and over

Diseases of heart . . . . .391–392.0,393-398,

402,404,410-416,420-429

Malignant neoplasms . . . .140–208,230–234

Cerebrovascular disease . . . . . ...430-438

Fractures, all sites. ., . . . . . . . . . . . 800–829

Pneumonia, all forms , . . . , . . . , , . 480–486

Cholelithiasis . . . . . . . . . . . . . . . . . . . . . ,574

75 years and over

Diseases of heart ., . .,391-392.0,393-398,

402,404,410-416,420-429

Cerebrovascular disease . . . . . ...430-438

Fractures, all sites, , . . . . . . . . . . . . 800–829

Malignant neopiasms , . ..1 40–208,230–234

Pneumonia, ali forms ., . . . . . . ...480-486

Urinary tract infection . . . . . . . . . . . ...599.0

85 years and over

Diseases of heart . . . . .391–392.0,393-398,

402,404,410-416,420-429

Fractures, ail sites, , . . . , , . . . . . . . 800–829

Cerebrovascular disease . . . . . . . . 430-438

Pneumonia, aii forms ., . . . . . . , ,.480-486

Malignant neoplasms . ...1 40–208,230–234

Voiume depietion, dehydration. . . . . ..276.5

Number in

thousands

199

72

59

60

29

11

1,048

483

342

292

161

99

622

215

204

207

106

39

180

81

72

45

46

18

209

89

67

66

46

26

1,186

468

392

307

223

107

690

265

218

208

154

74

215

96

89

65

47

33

Number per

1,000 population

98.4

35.8

29.2

29.8

14.5

5.2

66.8

30.8

21.8

18.6

10.3

6.3

92.9

32.2

30.5

30.9

15.8

5.8

108.4

49.2

43.6

27.1

27.7

10.7

91.0

38.7

29.0

28.8

19.8

11.4

66.9

26.4

22.1

17.3

12.6

6.0

87.6

33.6

27.7

26.4

19.5

9.4

104.4

46,7

43.2

31.6

22.9

15.9

Number in

thousands

2,210

918

987

848

366

117

10,904

6,220

4,570

4,833

1,827

1,180

6,672

2,915

3,650

2,793

1,241

407

2,062

1,583

1,050

527

647

204

1,664

942

807

691

480

289

9,027

4,431

4,189

3,595

2,245

978

5,486

2,783

2,700

2,085

1,570

719

1,719

1,236

961

701

589

423

Stay in days

11.1

12.7

16.7

14.1

12.5

11.2

10.4

12.9

13.4

16.6

11.3

12.0

10.7

13.5

17.9

13.5

11.7

10.5

11.5

19.4

14.5

11.8

14.1

11.5

8.0

10.6

12,1

10.5

10.6

11.0

7.6

9.5

10.7

11.7

10.1

9.2

8.0

10.5

12.4

10.0

10.2

9.8

8.0

12.9

10.8

10.7

12.5

12.9

I Coded a~~ording to the /nternationa/ Classification of Diseases, Ninth Revision, clinical Modification.

SOURCE: Nationai Center for Health Statistics: Data from the National Hospitai Discharge Survey.

131
Table 8. Number and rate of surgical procedures for males 55 years of age and over discharged

from short-stay hospitals, by age and selected procedures: United States, 1981 and 1987

[Discharges from non-Federal short-stay hospitals]

Age, procedure category, and ICD–9–CM codei 1981 1987 1981 1987

55-59 years

Cardiac catheterization . . . . . . . . . . .37.21 –37.23

Direct heart revascularization. , , . . . . . . . ...36.1

Repair of inguinal hernia . . . . . . . . . . . . .53–53,1

Prostatectomy. , . . . . . . . . . . . . . . . . . .60,2–60.6

Reduction of fracturez. . . . . . . . . . . . . . ...76.70.

76.78-76 .79,79.0–79.6

60-64 years

Cardiac catheterization. . . . . . . . . . .37.21-37.23

Prostatectomy. , . . . . . . . . . . . . . . . . . .60.2–60.6

Direct heart revascularization. ., . . . . . . . . ..36,1

Repair of inguinal hernia . . . . . . . . . . . . .53–53.1

Cholecystectomy . . . . . . . . . . . . . . . . . . . ...51.2

65–69 years

Cardiac catheterization . . . . . . . . . . .37.21–37.23

Prostatectomy. . . . . . . . . . . . . . . . . . . .60.2–60.6

Direct heart revascularization. . . . . . . . . . ...36.1

Repair of inguinal hernia ., , ., . . . . . . . .53–53.1

Cholecystectomy . . . . . . . . . . . . . . . . . . . ,. .51.2

70–74 years

Prostatectomy. . . . . . . . . . . . . . , . . . . .60.2–60.6

Cardiac catheterization . . . . . , ., . . .37.21-37.23

Direct heart revascularization. ., . . . . , ., ., .36,1

Repair of inguinal hernia . . . . . . . . . . . . .53–53.1

Pacemaker insertion3 . . . . . . . . . . . . ..37.7–37.8

75–79 years

Prostatectomy . . . . . . . . . . . . . . . . . . . .60.2–60.6

Cardiac catheterization ., ., . . . , . .,37.21-37,23

Pacemaker insertion3 ,., ,., ,,. ,,, .,37,7+7,8

Repair of inguinal hernia . . . . . . . . . . . . .53–53.1

Cholecystectomy . . . . . . . . . . . . . . . . . . . ...51.2

80–84 years

Prostatectomy. ., . . . . . . . . . . . . . . . . .60,2–60.6

Pacemaker insertion3 . . . . . . . . . . . . ..37.7–37.8

Repair of inguinal hernia . . . . . . . . . . , . .53–53.1

Resection of intestine . . . . . . . . . . . ...45.6-45.8

Reduction of fracture2, ., . . . . . . . . . . . ...76.70.

76.78-76 .79,79.0-79.6

65 years and over

Prostatectomy . . . . . . . . . . . . . . . . . . . .60.2–60.6

Cardiac catheterization . . . . . . . . . . ,37.21–37.23

Direct heart revascularization. . . . . . . . . . ...36.1

Repair of inguinal hernia . . . , . . . , . . . . .53–53,1

Pacemaker insertion3 . . . . . . . . . . . ...37.7-37.8

Number of procedures

in thousands

48 84

26 40

40 26

24 24

12 15

40 89

45 56

25 44

42 32

13 18

34 87

64 79

23 48

42 28

17 19

80 85

17 53

10 39

34 26

18 21

57 77

7 30

14 26

25 20

10 16

41 47

13 18

13 13

9 12

4 10

263 318

60 182

36 105

122 96

69 95

Number of procedures

per 10,000 population

88.3

46.6

73,9

43.8

22.5

83.3

94.0

52,9

87.5

26.8

85.0

161.5

58.8

107.2

43,9

271.0

58.3

32,8

115.8

62.7

298.5

35.5

74.4

132.9

50.3

386.4

118.7

123.8

84.5

41.5

248.7

56.9

34.2

115.2

65.3

157.7

75,1

49.1

46.2

29.1

176.0

109,9

87.6

62.6

35.0

194.2

175.4

106.7

62.1

43.1

256.5

159.6

116.1

77,1

63,8

338.9

134.6

116.7

87.8

70.7

386.7

146.4

109.4

102.0

81.5

262.7

149.8

86.8

79.2

78.6

132
Table 8. Number and rate of surgical procedures for males 55 years of age and over discharged

from short-stay hospitals, byage and selected procedures: United States, 1981 and 1987-Con.

[Discharges from non-Federal short-stay hospitals]

Age, procedure category, and/CD–9–CMcodel 1981 1987 1981 1987

Number of procedures

75 years and over in thousands

Prostatectomy. . . . , . . . . . . . . . . . . . . .60.2–60.6 119 154

Pacemaker insertion3 . . . . . . . . . . . ...37.7-37.8 35 58

Repair of inguinal hernia . . . . . . . . . . . . .53–53.1 45 42

Cardiac catheterization , , ., , , . . . , .37,21-37.23 9 41

Resection of intestine ., , . . . . . . . . ...45.6-45.8 24 28

Number of procedures

per 10,000 population

324.5 358.8

95.9 135.8

123.3 98.8

25.4 95.9

66.4 65.6

85 years and over

PrOState(XOmy,,., . . . . . . . . . ., ., , . .60,2–60,6 21 30 301.1 372.5

Pacemaker insertion3 ., . . . . . . . . . . . ,37.7–37.8 8 14 119.1 173.4

Reduction of fracture2, , . . . . . . . . . . . . . ..76.70.

76.78–76.79,79.0-79.6 8 10 111,2 130.0

Repair of inguinal hernia , . . . . . . . . . . . .53–53.1 7 9 97.0 113.6

Arthroplasty and replacement of hip , .81 .5–81.6 5 7 77.0 87.8

‘Coded according to the International Classification of Diseases, Ninth Revision, Clinical Modification.

‘Excluding skull, nose, and jaw.

31ncluding replacement, removal, and repair.

SOURCE: National Center for Health Statistics: Data from the Hospital Discharge Survey.

133
Table 9. Number and rate of surgical procedures for females 55 years of age and over discharged

from short-stay hospitals, by age and selected procedures: United States, 1981 and 1987

[Discharges from non-Federal short-stay hospitals]

Age, procedure category, and ICD–9–CM codel 1981 1987 1981 1987

Number of procedures

in thousands

Number of procedures

55–59 years per 10,000 population

Cardiac catheterization. . . . . . . . . . . . .37.21–37.23

Cholecystectomy. . ., . . . . . . . . . . . . . . . . . ...51.2

Hysterectomy, . . . . . . . . . . . . . . . . . . . ..68.3–68.7

Oophorectomy and salpingooophorectomy. . . . . . . . , ., . . . . . . . . . .65.3–65.6

Reduction of fracture2. ., . . . . . . . . . . . . . ...76.70.

76.78–76.79,79.0–79.6

60–64 years

Cardiac catheterization. . . . . . . . . . . . .37.21–37.23

Cholecystectomy ...,............,.. . . ...51.2

Hysterectomy . . . . . . . . . . . . . . . . . . . . ..68.3–68.7

Mastectomy . . . . . . . . . . . . . . . . . . . . . . . . . ...85.4

Reduction of fracture2, , , ., , . . . , , . . . . . . ..76.70,

76.78–76,79,79.0–79.6

65–69 years

Cardiac catheterization. . . . . . . . . . ...37.21 –37,23

Cholecystectomy . . . . . . . . . . . . . . . . . . . ., ...51.2

Hysterectomy . . . . . . . . . . . . . . . . . . . ..,68 .3–68.7

Reduction of fracture2. . . . . . . . . . . . . . . . ...76.70.

76.78–76.79,79.0–79.6

Resection of intestine, ., . . . . . , ., . . ...45.6-45.8

70-74 years

Cardiac catheterization. . . . . . . . . . . . .37.21–37,23

Reduction of fracture2. . . . . . . . . . . . . . . . ...76.70.

76.78–76.79,79.0-79.6

Cholecystectomy . . . . . . . . . . . . . . . . . . . . . ...51.2

Resection of intestine. . . . . , . . . . . . . . . .45.6–45.8

Arthroplasty andreplacement of hip , ...81.5-81.6

75-79 years

Cardiac catheterization. . . . . . . . . . . . .37.21–37.23

Reduction of fracture2. . . . . . . . . . . . . . . . ...76.70.

76,78–76.79,79.0–79.6

Arthroplasty and replacement of hip . ...81 .5–81.6

Resection of intestine. , . . . . . . . . . . . ., .45.6-45.8

Pacemaker insertion3 . . . . . . . . . . . . . . . .37.7–37.8

17

29

27

43

31

24

27,2

47.8

44.3

73.3

53.3

41.5

23 19 38.2 33.2

17 13 27.8 21.6

22

31

26

17

51

31

25

23

39.7

55.7

47.3

30,6

87.9

52.8

43.1

40.0

19 18 33.8 31.1

20

28

22

56

32

24

40.4

57.5

45.2

103,8

59.6

44.4

25

16

24

20

50.1

31,5

43.8

37.1

12 47 28.6 106.4

19

24

16

16

29

26

26

19

47.2

59.6

38.1

39,7

64.9

58.5

57.5

43.7

7 28 24.0 80.1

31

17

13

16

27

24

19

18

101.8

56.9

41.7

51.7

75.8

67.0

53.6

51.5

80–84 years

Reduction of fracture2, , . . . . . . . . . . . , . . . , .76.70,

76.78–76.79,79,0–79.6

Arthroplasty and replacement of hip . . . .81,5-81.6

Pacemaker insertion3 . . . . . . . . . . . . . . . ,37,7–37.8

Resection of intestine. ., . . . . . . . . . . . . .45,6–45.8

Cholecystectomy . . . . . . . . . . . . . . . . . . . . . ...51.2

29

17

16

11

10

33

30

19

13

12

141.9

82.1

80.2

55.1

49.7

142.9

131.6

82.3

58.3

54.2

65 years and over

Reduction of fracture2. . . . . . . . . . . . . . . . ...76.70.

76.78–76.79,79.0–79.6

Cardiac catheterization. . , , , . . . . ., , ,37,21-37.23

Arthroplasty and replacement of hip . ...81.5-81.6

Cholecystectomy . . . . . . . . . . . . . . . . . . . . . ...51.2

Resection of intestine. . . . . . . . . . . . . ...45.6-45.8

134

41

82

86

66

169

146

115

106

92

85.2

26,1

52.5

55.0

42.2

95,2

82.5

65.1

59,8

51.8

134
Table 9. Number and rate of surgical procedures for females 55 years of age and over discharged

from short-stay hospitals, by age and selected procedures: United States, 1981 and 1987-Con.

[Discharges from non-Federal short-stay hospitals]

Age, procedure category, and ICD–9–CM codel 1981 1987 1981 1987

Number of procedures Number of procedures

75 years and over in thousands per 10,000 population

Reduction of fracture2. . . . . . . . . . . . . . . . ...76.70.

76.78–76.79,79.0–79.6 90 116 134.2 147.2

Arthroplasty and replacement of hip . ...81 .5–81.6 52 75 77.4 95.5

Pacemaker insertion3 . . . . . . . . . . . . . . . .37.7-37.8 45 53 67.5 67.4

Cholecystectomy, . . . . . . . . . . . . . . . . . . .,...51.2 34 48 50.2 60.6

Resection of intestine. . . . . . . . . . . . . ...45.6-45.8 35 46 52.6 58.5

85 years and over

Reduction of fracturez. , , . . . . , , . . . , . . . ...76.70.

76.78–76.79,79.0-79.6 30 56 184.1 273.7

Arthroplasty and replacement of hip ., ..81.5-81.6 18 21 109.2 103.8

Pacemaker insertion3 . . . , , ., , . . . , . ...37.7-37.8 13 16 80.7 77.9

Resection of intestine. . . . . . . . . . . . . ...45.6-45.8 11 14 69.4 67.2

Cholecystectomy, . . . . . . . . . . . . . . . . . . . . ...51.2 6 12 35.2 60.3

‘Coded according to the International Classification of Diseases, Ninth Revision, Clinical Modification.

2Excluding skull, nose, and jaw.

31ncluding replacement, removal, and repair.

SOURCE: National Center for Health Statistics: Data from the Hospital Discharge Survey.

135
Table 10. Number and rate of diagnostic and other nonsurgical procedures for males 55 years of

age and over discharged from short-stay hospitals, by age and selected procedures: United States,

1981 and 1987

[Discharges from non-Federal shott-stay hospitals]

Age, procedure category, and ICD–9–CM codel 1981 1987 1981 1987

55–59 years

Angiocardiography using contrast material. ., ,88.5

Computerized axial tomography

(CATscan) . . . . . . . . . . . . ..41 . . . ..87. O3.87.4l.

87.71,88.01,88.38

Diagnostic ultrasound . . . . . . . . . . . . . . . . . ...88.7

Arteriography using contrast material , . . . . ...88.4

Radioisotope scan. . . . . . . . . . . . . . . . . . . .92–92.1

Number of proceudres

in thousands

50 102

17 61

16 46

29 31

25 30

Number of procedures

per 10,000 population

92.3 192.9

30.5 115.4

29.8 86.4

52.9 58.2

45.9 57,4

60-64 years

Angiocardiography using contrast material. , , ,88.5 34 107 70.6 211,0

Computerized axial tomography

(CATscan) .,., . . . . . . . . . . . . . . . ..87. O3.87.4l.

87.71,88.01,88.38 12 72 25.8 142,6

Diagnostic ultrasound . . . . . . . . . . . . . . . . . ...88.7 13 62 26.1 122.2

Radioisotope scan. ., ., , . . . . . . . . . . . . . .92–92,1 27 36 57.1 71,8

Arteriography using contrast material. . . . . ...88.4 28 32 57.8 63.2

65-69 years

Angiocardiography using contrast material. . ..88.5 31 99 79.4 220.3

Computerized axial tomography

(CATscan) . . . . . . . . . . . . . . . . . . . ..87. O3.87.4l.

87.71,88.01,88.38 26 81 65.6 180.2

Diagnostic ultrasound . . . . . . . . . . . . . . . . . ...88.7 20 67 49.6 148.0

Radioisotope scan. . . . . . . . . . . . . . . . . ...92-92.1 42 42 106.9 94.4

Arteriography using contrast material. ., . . ...88.4 23 35 58.5 77,0

70-74 years

Computerized axial tomography

(CATscan) . . . . . . . . . . ..87.03 .87.41. O3.87.4l,

87.71,88,01,88.38 21 92 70,3 274.9

Diagnostic ultrasound . . . . . . . . . . . . . . . . . ...88.7 14 86 48.3 258.8

Angiocardiography using contrast material. . ..88.5 12 58 42.4 174.5

Radioisotope scan, ., . . . . . . . . . . . . . . ...92-92.1 33 45 112.9 136.7

Arteriography using contrast material. ., , ., .,88.4 25 42 84.2 127.2

75–79 years

Computerized axial tomography

(CATscan) . . . . . . . . . . . . . . . . . . . ..87. O3.87.4l.

87.71,88.01,88.38

Diagnostic ultrasound . . . . . . . . . . . . . . . . . ...88.7

Radioisotope scan. ., , , , ., , ., . . . , . . . . ,92-92,1

Angiocardiography using contrast material. . ..88.5

Arteriography using contrast material. . . . . ...88.4

17

10

28

3

16

69

62

32

30

26

89.4

52.1

148,3

18,1

43.8

304.0

275.1

142,7

131.8

116.3

136
Table 10. Number and rate of diagnostic and other nonsurgical procedures for males 55 years of

age and over discharged from short-stay hospitals, by age and selected procedures: United States,

1981 and 1987- Con.

[Discharges from non-Federal short-stay hospitals]

Age, procedure category, and ICD–9–CM codel 1981 1987 1981 1987

80-84 years

Computerized axial tomography

(CATscan) ., . . . . . . . . . . . . . . . . . ..87. O3.87.4l.

87.71,88.01,88.38

Diagnostic ultrasound ., . . . . . . . . , . . . . . . ...88.7

Radioisotope scan. ., , . . . . . . . . . . . . . . . .92–92.1

Arteriography using contrast material, , . . . . . .88.4

Angiocardiography using contrast material. ..88.5

Number of procedures

in thousands

Number of procedures

per 10,000 population

12 56

6 49

13 30

5 15

*z 9

111.7 460.5

59.8 396.8

124.8 241.1

50.7 119.6

*9.7 72.1

65 years and over

Computerized axial tomography

(CATscan) . . . ..87 . . . . . . . . . . . . ..87. O3.87.4l.

87.71,88.01,88.38 80 337 76.2 278.1

Diagnostic ultrasound . . . . . . . . . . . . . . . . . ...88.7 56 290 52.9 239.7

Angiocardiography using contrast material. ..88.5 49 196 46.3 162.0

Radioisotope scan. . . . . . . . . . . . . . . . . . . .92–92.1 127 167 120.4 137.9

Arteriography using contrast material. . . . . ...88.4 74 121 70.0 99.7

75 years and over

Computerized axial tomography

(CATscan) .,,,.,,,,,.,...,,,,,,803,87841,l,

87,71,88.01,88.38 34 165 92.2 383.1

Diagnostic ultrasound . . . . . . . . . . . . . . . . . ...88.7 22 138 60.2 320.8

Radioisotope scan, , , . . . . . . . . . . . . . . ...92-92.1 52 79 141.1 184.2

Arteriography using contrast material. ., . . ...88.4 26 44 71.0 102.1

Angiocardiography using contrast material, .,88.5 5 39 13.9 91.3

85 years and over

Computerized axial tomography

(CATscan),,,..., . . . . . . . . . . . . ..87. O3.87.4l.

87.71,88.01,88.38 5 39 70.7 487.9

Diagnostic ultrasound , ., ., . . . ., , , . . . , , ., .88.7 6 27 82.4 333.5

Radioisotope scan, , , , . . . . . . ., ., . . . ...92-92.1 10 17 146.0 214.5

Intravenous pyelogram , , . . . . . . . . , ., , . . . ,87,73 5 3 67.0 40.9

Arteriography using contrast material. . . . . ...88.4 5 3 67.1 35.9

‘Coded according to the International Classification of Diseases, Ninth Revision, Clinical Modification.

SOURCE: National Center for Health Statistics: Data from the Hospital Discharge Survey,

137
Table 11. Number and rate of diagnostic and other nonsurgical procedures for females 55 years of

age and over discharged from short-stay hospitals, by age and selected procedures: United States,

1981 and 1987

[Discharges from non-Federal short-stay hospitals]

Age, procedure categoty, and ICD–9–CM codel 1981 1987 1981 1987

Number of procedures Number of procedures

55–59 years in thousands per 10,000 population

Angiocardiography using contrast material . . ...88.5 13 53 20,9 91,3

Computerized axial tomography

(CAT scan). . . . . . . . .87.03.87.41.87.71,88.01,88.38 19 53 30.9 90,8

Diagnostic ultrasound . . . . . . . . . . . . . , . . . . . ...88.7 13 46 21,1 79.7

Radioisotope scan, . . . . . ..92 . . . . . . . . . . ..92–92.l 23 32 37.8 55,3

Arteriography using contrast material. , . . . . . ...88.4 18 16 29.4 26.8

60–64 years

Computerized axial tomography

(CATscan),.,,,,, . ,87,03,87.41 ,87.71,88.01,88,38 20 64 35,2 110,4

Diagnostic ultrasound . . . . . . . . . . . . . . . . . . . ...88.7 21 59 38.4 101,9

Angiocardiography using contrast material , , , , .88.5 16 54 27.9 92.6

Radioisotope scan. .,, . . . . . . . . . . . . . . . . ..92–92.l 43 37 77.3 63,3

Arteriography using contrast material. . . . . . . . ..88.4 19 30 34.8 51.3

65–69 years

Computerized axial tomography

(CAT scan) ...,.... .87.03,87.41 ,87.71,88.01,88.38

Diagnostic ultrasound . . . . . . . . . . . . . . . . . . . ...88.7

Angiocardiography using contrast material . . ...88.5

Radioisotope scan. ... . . . . . . . . . . . . . . . . ..g2–g2.l

Arteriography using contrast material. ., . . . . . ..88.4

70–74 years

Computerized axial tomography

(CAT scan), . . . . . . . .87.03,87,41 ,87.71,88.01,88,38

Diagnostic ultrasound . . . . . . . . . . . . . . . . . . . ...88.7

Angiocardiography using contrast material . . ...88.5

Radioisotope scan . . . . . . . . . . . . . . . . . . . . ..92–92.l

Arteriography using contrast material. . . . . . . . . .88.4

75–79 years

Computerized axial tomography

(CAT scan) .,...... .87.03,87.41 ,87.71,88.01,88.38

Diagnostic ultrasound . . . . . . . . . . . . . . , ...,,,,88.7

Radioisotope scan. . . . . . . . . . . . . . . . . . . . . .92–92.1

Angiocardiography using contrast material , , . ..88.5

Arteriography using contrast material. . . . . . . . , .88.4

80–84 years

Computerized axial tomography

(CAT scan)....,., . .87.03,87.41 ,87.71,88.01,88.38

Diagnostic ultrasound . . . . . . . . . . . . . . . . . . . ...88.7

Radioisotope scan. ... . . . . . ..92 .1 . . . . . ..92–92.l

Arteriography using contrast material. . . . . . . ...88.4

Angiocardiography using contrast material . . . ..88.5

65 years and over

Computerized axial tomography

(CAT scan)...,.,.. .87.03,87.41 ,87.71,88.01,88.38

Diagnostic ultrasound..,..,.....,.. . ...,,,.88.7

Radioisotope scan. .,, . . . . . . . ..92 .1 . . . ..92-92.l

Angiocardiography using contrast material . . ...88.5

Arteriography using contrast material. . . . . . . ...88.4

24

19

17

42

25

21

19

9

33

20

20

23

29

4

13

15

12

22

8

*z

93

81

143

32

72

77

75

64

54

29

95

90

56

46

29

104

79

51

35

26

92

76

38

19

9

461

387

219

169

107

47.8

38.0

35.1

85.6

50.5

52,2

46.9

23.3

80.3

50.0

67.4

75.9

96.8

13.8

43,9

73.5

60,0

110,1

40.9

1.4

59.2

51,7

91.2

20.6

46.1

142.0

138.8

119.4

100.7

53.4

213,5

202.6

126,0

103.6

65.7

295,9

224,7

144.1

98.4

73.5

400,4

328,9

164,8

83,5

40.2

259.9

218,3

123,7

95.2

60,5

138
Table 11. Number and rate of diagnostic and other nonsurgical procedures for females 55 years of

age and over discharged from short-stay hospitals, by age and selected procedures: United States,

1981 and 1987- Con.

[Discharges from non-Federal short-stay hospitals]

Age, procedure category, and ICD–9–CM code’ 1981 1987 1981 1987

Number of procedures Number of procedures

75 years and over in thousands per 10,000 population

Computerized axial tomography

(CATscan).., . . . . , .87.03,87.41 ,87.71,88.01,88.38 48 289 71.9 367.0

Diagnostic ultrasound, . . . . . . . . . . . . . . ., . . ...88.7 43 222 64.6 281.6

Radioisotope scan. ., . . . . . . . . . . . . . . . . . ..92–92.l 68 119 102.0 150.8

Arteriography using contrast material. . . . . . . ...88.4 27 49 40.4 62.5

Angiocardiography using contrast material . . ...88.5 5 48 8.1 61.2

85 years and over

Computerized axial tomography

(CAT scan), ., , , ., , .87.03,87.41,87.71,88 .01,88.38 13 93 78.4 451.0

Diagnostic ultrasound . . . . . . . . . . . . . . . . . . . ...88.7 8 67 49.8 326.0

Radioisotope scan. ,,. ,, . . . . . . . . . . . . . . ..92–92.l 17 30 101.7 146.5

Angiocardiography using contrast material . . ...88.5 1 4 6.1 21.3

Arteriography using contrast material. . . . . . . ...88.4 6 4 33.5 20.1

‘Coded according to the International Classification of Diseases, Ninth Revision, Clinical Modification.

SOURCE: National Center for Health Statistics: Data from the Hospital Discharge Survey.

139
Table 12. Number of patients discharged, rate of discharges, and average length of stay for

persons 55 years of age and over with a diagnosis of pneumonia or influenza, by sex and age:

United States, 1981 and 1987

[Discharges from non-Federal short-stay hospitals]

Average length

Discharges of stay

Sex and age 1981 1987 1981 1987 1981 1987

Both sexes Number in thousands

55–59 years................,,.

60–64 years . . . . . . . . . . . . . . . . . . .

65–69 years . . . . . . . . . . . . . . . . . . .

70–74 years, . ., . . . . . . . . . . . . . . .

75–79 years. . . . . . . . . . . . . . . . . . .

80–84 years . . . . . . . . . . . . . . . . . ,.

65 years and over, ,, . . . . . . . . . . .

75 years and over..,...,,.,.. . .

85 years and over, . . . . . . . . . . . . .

Male

55–59 years . . . . . . . . . . . . . . . . . . .

60–64 years. . . . . . . . . . . . . . . . . . .

65–69 years. . . . . . . . . . . . . . . . . ,.

70–74 years, . . . . . . . . . . . . . . . . . .

75–79 years . . . . . . . . . . . . . . . . . . .

80–84 years. . . . . . . . . . . . . . . . . . .

65 years and over,,,...,.,,,,,.

75 years And over . . . . . . . . . . . . . .

85 years and over........,,.. . .

Female

55–59 years. . . . . . . . . . . . . . . . . . .

60-64 years.,..,..,,,,,,,,.,..

65–69 years. . . . . . . . . . . . . . . . . . .

70–74 years . . . . . . . . . . . . . . . . . . .

75–79 years . . . . . . . . . . . . . . . . . . .

80–84 years,,........,,,,,,.. .

65 years and over. . . . . . . . . . . . . .

75 years andover

85 years andover

46

47

63

72

69

61

351

216

86

20

21

30

38

31

24

159

90

35

26

27

32

34

38

37

192

126

50

37

52

68

87

92

94

454

299

113

18

26

35

48

48

47

225

141

46

19

26

33

39

44

47

229

157

67

Number per

1,000 population

4.0

4.6

7,1

10.2

14.1

19.8

13.4

20.9

36.3

3.6

4.4

7.7

13,0

16.4

22.4

15.1

24.6

50.2

4.3

4,8

6.5

8.2

12.7

18,5

12.2

18.8

30.3

3.3

4.7

6.9

11.2

15.9

26.7

15.2

24.5

39.3

3.3

5.1

7.7

14.5

21.4

38.5

18.5

32.9

56.9

3.3

4.4

6.1

8.7

12.4

20.4

12.9

20.0

32.4

Stay indays

8.1

9.7

9.8

10.9

11,0

11.7

11,0

11.4

11.6

8.0

10.3

9.7

11.6

11.5

12.1

11.3

11.7

11.6

8.1

9,2

10.0

10.1

10.7

11.4

10.8

11.2

11.5

7,7

8.3

9.3

10,1

9.4

10.2

9.9

10.0

10.2

9.0

8.3

9.6

9.9

9.8

10,0

9,8

9.8

9.5

6,5

8.3

8,9

10.3

9,0

10.4

10,0

10.1

10.6

NOTE: Pneumonia or influenza comprises codes 480–4870f thelnternationa/C/ossification ofDiseases, Ninth Revision,Clinica/

Modification,

SOURCE: National Centerfor Health Statistics: Datafromthe 1981 and 1987 National Hospital Discharge Surveys,

140
Table 13. Rate of patients discharged with a diagnosis of fractures, all sites, or hip fracture

(fracture of neck of femur) for persons 55 years of age and over, by sex and age: United States,

1981 and 1987

[Discharges from non-Federal short-stay hospitals]

Fractures, all sites Hip fracture

Sex and age 1981 1987 1981 1987

Both sexes

55–59 years. . . . . . . . . . . . . . . . . . .

60-64 years. . . . . . . . . . . . . . . . . . .

65–69 years, . . . . . . . . . . . . . . . . . .

70-74 years. ,,, ,,, . . . . . . . . . . . .

75-79 years, ,, .. o. . . . . . . . . . . . .

80–84 years. . . . . . . . . . . . . . . . . . .

65 years and over, . . . . . . . . . . . . .

75 years and over . . . . . . . . . . . . . .

85 years and over . . . . . . . . . . . . . .

Male

55-59 years, . . . . . . . . . . . . . . . . . .

60-64 years . . . . . . . . . . . . . . . . . . .

65-69 years, . . . . . . . . . . . . . . . . . .

70-74 years, ,,, ,,, . . . . . . . . . . . .

75-79 years, . .,, . . %. . . . . . . . . . .

80-84 years, . . . . . . . . . . . . . . . . . .

65 years and over . . . . . . . . . . . . . .

75 years and over . . . . . . . . . . . . . .

85 years and over. . . . . . . . . . . . . .

Female

55–59 years . . . . . . . . . . . . . . . . . . .

60–64 years, ,,, . . . . . . . . . . . . . . .

65-69 years . . . . . . . . . . . . . . . . . . .

70–74 years . . . . . . . . . . . . . . . . . . .

75–79 years. . . . . . . . . . . . . . . . . . .

80–84 years, . . . . . . . . . . . . . . . . . .

65 years and over . . . . . . . . . . . . . .

75 years and over . . . . . . . . . . . . . .

85 years and over . . . . . . . . . . . . . .

4.4

5.1

6.3

9.0

15.8

23.7

14.2

24.5

43.4

4.2

3.8

3.7

5.7

7.3

13.2

7.6

13,3

30.0

4.5

6.2

8.5

11.3

21.2

29.2

18.6

30.5

49.2

Number ofdischarges per 1,000 population

4.0 0.8

4.1 0.9

5.7 1.7

8.9 3.5

13.0 7.1

24.9 12.9

13.5 6.8

22.9 13.4

40.4 27.3

4.0

3.3

3.6

5.9

9.0

17,2

8.0

14.2

24.4

4.1

4.9

7.3

11.2

15.7

29.0

17.3

27.7

46.7

0.4

0.5

0.9

2.0

4.1

5.5

3.5

7.6

20.3

1.1

1.3

2.4

4.5

9.1

16.8

9.0

16.6

30.2

0.7

0.7

1.8

3.4

7.5

15.3

7.3

14.2

26.2

0.6

0.5

1.5

2.4

5.2

11.5

4.5

9.4

18.1

0.7

0.9

2.2

4.1

9.1

17.4

9.1

16.8

29.3

NOTE: Fractures, all sites, comprise codes 800-829, and hip fracture comprises code8200fthe/rttemationa/ C/assificatior?of

Diseases, Ninth Revision, Clinical Modification.

SOURCE: National Center for Health Statistics: Datafromthe 1981 and 1987 National Hospital Discharge Surveys.

141
Table 14. Percent distribution of patients 55 years of age and over discharged from short-stay

hospitals by disposition status, according to sex and age: United States, 1981 and 1987

[Discharges from non-Federal short-stay hospitals]

Male Female

Age and disposition status 1981 1987 1981 1987

55–64 years

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

Routine discharge . . . . . . . . . . . . . . . . .

Discharged to long-term care. . . . . . . .

Died. . . . . . . . . . . . . . . . . . . . . . . . . . ,.

Other and unknown . . . . . . . . . . . . . . .

65–74years

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

Routine discharge . . . . . . . . . . . . . . . . .

Discharged to long-term care . . . . . . . .

Died . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other and unknown, . . . . . . . . . . . . . .

75–84years

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

Routine discharge . . . . . . . . . . . . . . . . .

Discharged to long-term care, ,., . . . .

Died, .,, , . . . . . . . . . . . . . . . . . . . . . .,

Other and unknown . . . . . . . . . . . . . . .

65years andover

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

Routine discharge . . . . . . . . . . . . . . . . .

Discharged to long-term care . . . . . . . .

Died . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other and unknown . . . . . . . . . . . . . . .

75 years andover

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

Routine discharge . . . . . . . . . . . . . . . . .

Discharged to long-term care, .,.....

Died . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other and unknown,........,,, ,..

85 years andover

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

Routine discharge. ., . . . . . . . . . . ,..,

Discharged to long-term care . . . . . . . .

Died, .,.,,,..,..,,,,,.,,..,,., ,.

Other and unknown.....,,,., . . . . .

100.0

82.5

1.3

3.1

13.1

100.0

78.2

2,8

6.2

12.8

100.0

71.9

7,6

8.3

12.2

100.0

73.9

6.0

7.6

12.5

100.0

68.5

10.1

9.5

11.9

100.0

57.5

18.2

13.3

11.0

Percent distribution

100.0 100.0

87.3 83.3

2.3 1.4

3.3 2,9

7.1 12.4

100.0 100.0

81,7 79.8

5.0 4.2

5.7 3,7

7.6 12,3

100.0 100.0

73.4 72.1

11,5 10,6

8.1 6,0

7.0 11.3

100.0 100.0

75.9 73.0

9.6 9.6

7.2 5.7

7.3 11.7

100.0 100,0

69.6 67.2

14.6 14.3

8.8 7.5

7.0 11.0

100.0 100.0

56.6 55.0

25.3 23.5

11.4 11,2

6.7 10.3

100.0

88.6

2.4

3.1

5.9

100,0

81.9

6.9

4.0

7.2

100,0

70.9

15.7

6.3

7,1

100.0

72.1

14,9

5.9

7.1

100,0

64.5

21.2

7.3

7.0

100,0

50.6

33.3

9.6

6,5

SOURCE: National Centerfor Health Statistics: Data from the National Hospital Discharge Survey.

142
Chapter 6

Selected issues in long-term

care: Profile of cognitive

disability of nursing home

residents and the use of

informal and formal care by

elderly in the community

by Joan F. Van Nostrand, M.P.A., National

Center for Health Statistics; Baila Miller, Ph. D.,

and Sylvia E. Furrier, Ph. D., University of

Illinois at Chicago

Introduction

Long-term care (LTC) refers to care delivered to individuals who are dependent on others

for assistance with the basic tasks necessary for

physical, mental, and social functioning over

sustained periods. The goal of such care is to

enable the recipients to function at the highest

level of autonomy possible (l). Issues about LTC

have been receiving greater attention recently,

especially from researchers and policymakers

(2,3). A major reason for this is that those at

greatest risk of needing LTC, the oldest-old

aged S5 and over, have been the most rapidly

growing segment of the older population. This

rapid growth is projected to continue so that

between 1990 and 2030, the number of oldestold is expected to more than double (4). Policymakers in particular have raised a myriad of

issues about LTC, These issues address the

interrelationships among need, use, supply, and

costs of LTC (5) from both formal and informal

care perspectives. The intent of this chapter is to

examine two of the issues ‘frequently raised about

LTC. The issues concern the health of particular

LTC subpopulations:

● Cognitively disabled nursing home residents

. the disabled elderly living in the community

and their use of informal and formal care

Profile of cognitive

home residents

Background

disability of nursing

The enactment of Medicare and Medicaid in

1965 led to the rapid growth of the nursing home

industry in the late 1960’s. Rates of use per

1,000 elderly population increased dramatically

from the mid-1960’s to the early 1970’s and have

leveled off since then (table A). Rates have

been consistently highest for those 85 and over,

especially for females. The physical health status

of nursing home residents has been well documented at the national level (6,7), with recent

trends toward more dependency in activities of

daily living (ADL’s) (8).

Less attention has been given to national

data about the cognitive functioning of nursing

home residents. Of the few reports that present

national data, the focus is on the cognitively

disabled as one group of nursing home residents

“with mental conditions” (9,10) or on dementia

versus other mental disorders (11). Reports about

the subgroup of persons with dementia, whether

they live in nursing homes or in the community,

abyJoan F. Van Nostrand, M.P.A., National Center for Health

Statistics

143
Table A. Nursing home residents 65 years of age and over per 1,000 population, according to age,

sex, and race: United States, 1963, 1973-74, 1977, and 1985

Residents per 1,000 population

Age, sex, and race 1963 1973–742 19773 1985

Age

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . .

65–74 years . . . . . . . . . . . . . . . . . . . . . .

75–84 years . . . . . . . . . . . . . . . . . . . . . .

85 years and over . . . . . . . . . . . . . . . . .

Sex

Male, . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65–74 years. . . . . . . . . . . . . . . . . . . . . .

75–84 years . . . . . . . . . . . . . . . . . . . . . .

85 years and over...,,,,,,,,, . . . . .

Female. , . . . . . . . . . . . . . . . . . . . . . . . . . .

65–74 years.....,,.....,.,.. . . . . .

75–84 years . . . . . . . . . . . . . . . . . . . . . .

85 years and over. . . . . . . . . . . . . . . . .

Race4

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

65–74 years . . . . . . . . . . . . . . . . . . . . . .

75–84 years..............,., . . . . .

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

Black, ,,, . . . . . . . . . . . . . . . . . . . . . . . . .

65–74 years, . . . . . . . . . . . . . . . . . ,..,

75–84 years . . . . . . . . . . . . . . . . . . . . . .

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

25.4

7.9

39.6

148.4

18.1

6.8

29.1

105.6

31.1

8.8

47.5

175.1

26.6

801

41.7

1.57.7

10.3

5.9

13.8

41.8

44.7

12.3

57.7

257.3

30.0

11.3

39.9

182.7

54.9

13.1

68.9

294.9

46.9

12.5

60.3

270.8

22.0

11.1

26.7

105.7

47.1

14.4

64.0

225,9

30.3

12.6

44,9

146.3

58,6

15.8

75.4

262.4

48.9

14.2

67.0

234.2

30.7

17.6

33.4

133.6

46.2

12,5

57.7

220,3

29,0

10,8

43.0

145.7

57.9

13.8

66.4

250.1

47,7

12,3

59.1

228.7

5,0

15.4

45,3

141,5

‘Residents per 1,000 population for1973–74 and 1977 differ from those presented in the original source reports because the

rates have been recomputed using revised census estimates for these years,

2Excludes residents in personal care or domiciliary care homes,

31ncludes residentsin domiciliary care homes.

4For data years 197&74,a~d 1977, al[people of Hispanic ofiginwere included in the white category.For 1963, “black” includes

all other races.

have addressed research (12) and policy (13)

concerns.

The intent ofthis section ofthe chapter isto

provide aprofile ofcognitive disability innursing

homes by specific diagnostic categories. In this

analysis, cognitive disabilities cover awide range

of conditions from dementias, psychiatric conditions, affective states, substance abus e, andmental retardation. This analysis investigates whether

nursing home residents with cognitive disabilities are a homogeneous group or not,

There are two classes of hypotheses

144

in this

section of the

residents with a

chapter: those that compare

specific cognitive disability and

residents with no cognitive disability and those

that compare characteristics of subgroups of

residents within a particular cognitive disability,

It is hypothesized that (a) there is no difference

in characteristics of residents with a specific

cognitive disability and residents with no cognitive disability, and (b) there is no difference in

characteristics of subgroups of residents within a

particular cognitive disability,
Sources of data

The source of data for this section is the 1985

National Nursing Home Survey (NNHS). The

NNHS is a national sample survey of nursing

homes, their residents, discharges, and staff in

the conterminous United States. The 1985 NNHS

included all types of nursing and related-care

homes that had three or more beds set up and

staffed for use and routinely providing care.

Facilities were either freestanding establishments or nursing care units. Residential care

facilities were excluded. Although the 1985 NNHS

included nine questionnaires, the source of data

for tables 1–11 was the Current Resident Questionnaire (CRQ), and for table 12, the Discharge Resident Questionnaire (DRQ). An

interviewer completed the CRQ and the DRQ

for each sampled resident by interviewing the

member of the nursing staff most familiar with

care provided to that resident. The nurse referred to the resident’s medical record when

responding, No resident was interviewed directly. A detailed description of survey procedures and facsimiles of the CRQ and DRQ have

been published (7).

For tables 1–11 based on the CRQ, current

residents with specific cognitive disabilities were

identified by responses to (a) a question on

primary and secondary diagnoses current at the

time of the survey and (b) a checklist of cognitive, affective, and substance abuse conditions.

For table 12, based on the DRQ, discharged

residents with specific cognitive disabilities were

identified by responses to a question on primary

and secondary diagnoses at the time of discharge. The checklist in the CRQ was not included in the DRQ. Hence, data on discharges

from table 12 maybe an underestimate in comparison to data on current residents, particularly

for affective and substance abuse conditions.

Table B presents the specific International

Classification of Diseases, Ninth Revision codes

and the checklist categories used to define specific

cognitive disabilities. Data presented in this section may differ from other estimates of cognitive

disabilities from the 1985 NNHS (7,9,10) because of differences in the definitions and methodologies.

Findings

Prevalence by demographic charactenktics –

Cognitive disabilities are a significant health

problem in nursing homes. In 1985, nursing

home residents of all ages were more likely to

have one or more cognitive disabilities than not.

This analysis includes residents of all ages beTable B. Codes for items in the current resident questionnaire of the 1985 National Nursing Home

Survey used to identify cognitive disability

Checklist code

Cognitive disabilities ICD-9-CM1 code (question 14) (question 15)

Organic brain syndromes . . . . . . . . . . . . . . . . . . . . . . . . . . . . 290,310,797 or 04

Alzheimer’s disease and other degeneration of the brain. . . 331.0–331.9

Schizophrenia and other psychoses , ., . . . . . . . . . . . . . . . . 293–299 or 06,07

Depressive disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 311,300.4 or 05

Anxiety disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 300.7,300.9,

300.00,300.10,

300.11,300.20,

300.81 or 08

Alcohol and drug abuse, , . . . . . . . . . . . . . . . . . . . . . . . . . . . 291–292 or 02

303–305 or 03

Mental retardation, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 317-319 or 01

‘International Classification of Diseases, Ninth Revision, Clinical Modification.

145
Table C. Rate of cognitive disabilities per 1,000

nursing home residents: United States, 1985

Cognitive disabilities Rate

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

One or more . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Organic brain syndromes . . . . . . . . . . . . . . . . . . .

Alzheimer’s disease and other degeneration of

the brain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Schizophrenia and other psychoses . . . . . . . . . .

Depressive disorders . . . . . . . . . . . . . . . . . . . . . .

Anxiety disorders. . . . . . . . . . . . . . . . . . . . . . . . . .

Alcohol and drug abuse . . . . . . . . . . . . . . . . . . . .

Mental retardation . . . . . . . . . . . . . . . . . . . . . . . . .

326

674

461

53

130

144

144

39

56

cause most were either elderly (88 percent) or

pre-elderly(6 percent were age 55–64) and because cognitive disabilities areprevalentfor both

the pre-elderly and the elderly groups. For every

1,000 residents, 674 had at least one cognitive

disability (table C,calculated fromtable 1). The

prevalence of multiple disabilities was high. When

only the 1.0 million residents of all ages with

cognitive disabilities were considered, an averageofl.5 disabilities was reported per resident.

Nursing homes provide the bulk ofinpatient

care to the elderly (65 years and over) population with cognitive disabilities. In 1985, there

were 868,000 elderly with cognitive disabilities

who were current residents in nursing homes.

This is in contrast to the 17,909 elderly under

care in inpatient psychiatric facilities as of April

1, 1986 (14), One possible reason for this 98-2

percent split between nursing home residence

versus psychiatric facility residence is that those

in nursing homes have serious physical infirmities as well. The upcoming discussion of physical

health status (see table 2) addresses this issue in

detail for the nursing home population,

The most prevalent cognitive disability in

nursing homes was organic brain syndromes,

with a rate of 461 per 1,000 residents, Schizophrenia and other psychoses (hereafter labeled

“schizophrenia”), depressive disorders, and anxiety disorders were less common, with rates of

about 140 per 1,000. Least common were Alzheimer’s disease and other degeneration of the

brain (hereafter labeled “Alzheimer’s disease”),

mental retardation, and alcohol and drug abuse,

with rates of around 50 per 1,000 residents.

For most of the cognitive disabilities, prevalence decreased with age (table D, calculated

from table 1). When only the elderly are considered, rates were highest for the young-old (aged

65-74) and lowest for the oldest-old (age 85 and

over). There were two exceptions to this inverse

relationship. For Alzheimer’s disease, the rates

by age did not differ. For organic brain syndromes, the rates rose significantly from 385 to

551 per 1,000.

There were no significant differences in the

rates for white compared with black residents

for any of the specific cognitive disabilities

(table E, calculated from table 1).

Table D. Rate of cognitive disabilities per 1,000 nursing home residents by age: United States, 1985

Under 65 65–74 75–84 85 years

Cognitive disabilities years years years and over

None . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207 294 346 351

One or more . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 793 706 654 649

Organic brain syndromes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186 385 477 551

Alzheimer’s disease and other degeneration of the brain, ., , *3 I 82 66 40

Schizophrenia and other psychoses . . . . . . . . . . . . . . . . . . . . 316 212 103 74

Depressive disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178 186 159 108

Anxiety disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195 165 152 116

Alcohol and drug abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101 81 33 13

Mental retardation, ,,, .,, . . . . . . . . . . . . . . . . . . . . . . . . . . . . 263 98 27 *1

146
Table E. Rate of cognitive disabilities per 1,000

nursing home residents by race: United States,

1985

Cognitive disabilities White Black

None . . . . . . . . . . . . . . . . . . . . . . . . . . . 324 343

One or more . . . . . . . . . . . . . . . . . . . . . 676 657

Organic brain syndromes. . . . . . . . . . . 460 479

Alzheimer’s disease and other

degeneration of the brain . . . . . . . . . . 55 *34

Schizophrenia and other psychoses . . 128 153

Depressive disorders . . . . . . . . . . . . . . 147 101

Anxiety disorders . . . . . . . . . . . . . . . . . . 145 135

Alcohol and drug abuse. . . . . . . . . . . . 38 60

Mental retardation . . . . . . . . . . . . . . . . . 56 *45

When rates for male residents were compared with those for female residents, there

were no significant differences in the prevalence

of cognitive disabilities. For both sexes, the rate

for having one or more cognitive disabilities was

about 675 per 1,000 (table F, calculated from

table 1), There were differences, however, for

specific cognitive disabilities. Female residents

had higher rates of organic brain syndromes

(4S6 versus 397 per 1,000). Male residents had

rates four times higher for alcohol and drug

abuse @9

higher for

1,000).

Health,

versus 20 per 1,000) and two times

mental retardation (89 versus 42 per

behavioq and memory –Does the physical health of residents with cognitive disabilities

differ from that of residents without such disabilities’? Staff of the nursing homes were asked to

Table F. Rate of cognitive disabilities per 1,000

nursing home residents by sex: United States,

1985

Cognitive disabilities Male Female

None . . . . . . . . . . . . . . . . . . . . . . . . . . . 324 326

Oneormore . . ..o . . . . . .. o...... . . 676 674

Organic brain syndromes . . . . . . . . . . . 397 486

Alzheimer’s disease and other

degeneration of the brain. . . . . . . . . . 55 52

Schizophrenia and other psychoses . . 152 122

Depressive disorders . . . . . . . . . . . . . . 129 150

Anxiety disorders . . . . . . . . . . . . . . . . . . 137 147

Alcohol and drug abuse . . . . . . . . . . . . 89 20

Mental retardation . . . . . . . . . . . . . . . . . 89 42

rate the sampled residents’ physical health using

four categories from excellent to poor (table 2).

In comparison to residents with no cognitive

disabilities, the proportion of all residents judged

to be in fair or poor physical health was greater

for those with organic brain syndromes, Alzheimer’s disease, and depressive and anxiety disorders. This physical-mental comorbidity may be

one reason that more cognitively disabled elderly are in nursing homes than in mental hospitals. Nursing homes may be the locus of care

because they can address the resident’s heavy

needs for physical care.

The notable exception to the association between poor physical and cognitive health was for

residents with mental retardation, who had a

smaller percentage in fair or poor physical health.

This group may be physically healthier because

it is somewhat younger; the prevalence of mental

retardation is highest for those under age 65

(see table D). For certain cognitive disabilities,

the percentage of residents in fair or poor health

increased with age. Table G presents data to

compare the percentage in fair or poor health of

the young-old with that of the oldest-old for

selected cognitive disabilities. For organic brain

syndromes and schizophrenia, the percentage in

fair or poor health increased with age. For

Alzheimer’s disease and for depressive disorders,

observable differences were not statistically

significant.

Serious disruptive behavior, along with the

need for ADL assistance, can be a precipitating

factor in a family’s decision to admit an elderly

family member to a nursing home (15), In particular, families find it difficult to cope with

abusive behavior or with wandering, especially if

wandering occurs in the middle of the night. A

study of disruptive behavior of residents in skilled

nursing facilities found that more than 11 percent were physically resistant to care in that they

exhibited such behaviors as spitting out medicine

and refusing to eat (16). Table 3 presents data

147
Table G. Percent of young-old and oldest-old nursing home residents in fair or poor physical health

by selected cognitive disabilities: United States, 1985

Percentin fairorpoor health

Cognitive disabilities Young-old 1 Oldest-old 2

Organic brain syndromes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62.4 72.8

Alzheimer’s disease and other degeneration ofthe brain.... ,. 56.8 75,9

Schizophrenia and other psychoses . . . . . . . . . . . . . . . . . . . . . . 47.2 64.0

Depressive disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66.5 79.4

1Aged65–74years.

2Aged 85 years and over.

on whether the resident displayed any of six

disruptive behaviors, including disrobing or exposing oneself, screaming, being physically abusive, stealing, getting lost or wandering, and

being unable to avoid simple dangers. Wandering has been associated with increased use of

restraints during the first month of a nursing

home stay (17). Compared with residents without cognitive disabilities, a greater percentage of

those with each of the cognitive disabilities under analysis here exhibited one or more disruptive behaviors. More than one-half of residents

with Alzheimer’s disease, anxiety disorders, organic brain syndromes, or schizophrenia displayed such behavior.

Table 4 presents the percentage of residents

with memory impairment, that is, the inability to

remember dates or time, familiar locations or

people, or recent events, or to make straightforward judgments to such an extent that performance of ADL’s, instrumental ADL’s, and

mobility is impaired nearly every day. Not surprisingly, memory impairment was a major problem for the cognitively disabled in nursing homes.

A greater percentage of those with the specific

cognitive disabilities studied here had such memory impairment than did those without such

disability. For each cognitive disability except

alcohol and drug abuse, the percentage of those

with memory impairment was twice as high.

There were no differences, however, in the

percentage of women versus men with impaired

memory.

Severe depression and anxiety– The nursing

staff were asked if the sampled residents displayed depression or anxiety to such a degree

that functioning was restricted nearly every day

(table 5). This question was independent of questions on diagnoses and conditions used here to

classify residents with specific cognitive disabilities (see table B). Data on degree of restriction

is a measure of the functional impact of depressive and anxiety disorders. Some possible reasons that residents with these disorders did not

display an impact on functioning were that the

impact was less severe (i.e., did not meet the

“nearly every day” criterion) or was mitigated by

medication, Symptoms of depression have been

associated with increased use of physical restraints during the first year after admission

(17). Depression has also been associated with

mortality in nursing homes. When significant

predictors of mortality were examined for new

admissions, those with major depressive disorders were 59 percent more likely to die during

the first year of stay than those without such

disorders (18).

In comparison to those with no cognitive

disabilities, those with each cognitive disability

studied here had a significantly higher percentage with anxiety that restricted functioning, The

percentage with such anxiety was at least three

148
times higher for those with cognitive disabilities.

For all of the cognitive disabilities except mental

retardation, the percentage with depression was

twice as high as the percentage for those without

cognitive disabilities. For each cognitive disability, there were no differences in the percentage

with anxiety or depression between males and

females. The one exception was for schizophrenia, for which a greater percentage of females

than males had anxiety that restricted functioning (41 versus 29 percent, as calculated from

tables 1 and 5).

Activities of daily living and continence –ADL

disabilities have been found to be significant

predictors of mortality in general and admission

to a nursing home (19), as well as of mortality

during the first year of a nursing home stay (18).

The nursing staff reported on whether help of

another person was required for each of seven

ADL’s listed in table 6. Compared with residents without cognitive disabilities, those with

Alzheimer’s disease, organic brain syndromes,

and anxiety and depressive disorders had significantly higher proportions who required help

with five to seven ADL’s. Given the relationship

between ADL disabilities and mortality in nursing homes, this subgroup of residents had a

higher risk of mortality during the first year of

their stays. Residents with schizophrenia and

alcohol and drug abuse, in contrast, had significantly lower proportions who required help with

five to seven ADL’s and a lower risk of mortality.

The percentage of residents requiring help

for specific ADL’s differed by type of cognitive

disability and by type of ADL. Residents with

organic brain syndromes and Alzheimer’s disease had a significantly greater percentage who

required help in transferring (getting in or out of

a bed or chair), About 70 percent of these

persons required personal help, The inability to

transfer from bed or chair has been found to be

a significant predictor for use of physical restraints in the first month after admission and

during the first year of a stay (17). Given this

finding, cognitively disabled people who required help to transfer were likely to be at

increased risk of being physically restrained. In

contrast, residents with schizophrenia, alcohol

and drug abuse, and mental retardation had

significantly lower percentages (33–41 percent)

of persons who required help in transferring.

When the need for help with walking was examined, the situation was quite different. There was

no significant increase in the percentage of residents with specific cognitive disabilities studied

here who required help with walking when compared with those with no cognitive disabilities.

The only notable difference was in the smaller

percentage requiring help for those with schizophrenia, alcohol and drug abuse, and mental

retardation. As discussed earlier, this lower level

of ADL disability may be because residents with

these cognitive disabilities were younger and had

fewer physical infirmities. Residents with Alzheimer’s disease, organic brain syndromes, and

depressive and anxiety disorders were 1.5–2 times

more likely to require personal help with eating

than those with no cognitive disabilities. In conclusion, ADL disability, both in aggregate and

for specific activities, is significantly greater for

residents with cognitive disabilities studied here.

Because personal help is required, the extent of

ADL disability of this special subpopulation

places important demands on the staff directly

providing care.

Instrumental activities of daily living (IADL’s)

are activities more complex than ADL’s that are

essential for living independently in the community (20). The questions on IADL’s in the 1985

NNHS covered the receipt of personal help or

supervision for four IADL’s: care of personal

possessions, handling money, securing personal

items (such as newspapers, toilet articles, snack

food), and using the telephone for dialing or

receiving calls. When compared with residents

without cognitive disabilities, a greater percent149
age of those with disabilities (except alcohol and

drug abuse) received personal help for three to

four IADL’s (table 7). The situation was the

same when specific IADL’s were analyzed. A

significantly higher percentage of residents with

cognitive disabilities (except for alcohol and drug

abuse) received help for each of the four specific

IADL’s. Assuming that help was provided because it was needed (rather than as a blanket

policy of the facility or because of a dependencyinduced phenomenon), it is likely that residents

with cognitive disabilities would have extreme

difficulty living independently in the community.

Table 8 presents continence status, that is,

whether the resident currently had difficulty in

controlling bladder, bowels, or both. A smaller

percentage of residents with Alzheimer’s disease, organic brain syndromes, anxiety and depressive disorders, and mental retardation were

continent (30-60 percent), in comparison to those

with no cognitive disabilities (nearly 75 percent). About 12 percent of residents with no

cognitive disabilities had severe incontinence,

that is, difficulty in controlling both bladder and

bowels. For these same cognitive disabilities listed

above, the percentage with severe incontinence

was 1.5–3.5 times greater. Those with Alzheimer’s disease (45 percent) and organic brain

syndromes (40 percent) had the highest levels of

severe incontinence.

Receipt of therapy – Do the cognitively disabled receive mental health therapy or other

therapy services at a greater rate than residents

without such disabilities? Table 9 presents data

on mental, social, and other types of therapy

received in the past month. Therapy provided by

a licensed, registered, or professionally trained

therapist was counted, whether it was received

inside or outside the facility. A significantly

greater percentage of residents with schizophrenia, depressive and anxiety disorders, alcohol

and drug abuse, and mental retardation received

mental health evaluation or treatment in the

past month. This included mental health evaluation or treatment by a psychiatrist, psychologist,

psychiatric or clinical social worker, psychiatric

nurse, or physician other than a psychiatrist,

Although the percentages receiving mental therapy were significantly higher than the 3 percent

of nondisabled persons receiving such therapy,

the percentages were not large. Only 10-20

percent of these five subgroups of cognitively

disabled residents received mental health therapy. The 3 percent of cognitively nondisabled

persons who fell into this category likely received a mental health evaluation rather than a

treatment. Some view restrictions on public reimbursements for psychiatric services (18) as a

probable factor in the limited receipt of mental

health therapy. For example, States differ as to

whether services beyond those federally required are allowable costs. A national survey in

1988 (21) on Medicaid payment policies found

major differences among the States. Only residents with mental retardation and depressive

disorders had greater receipt of social services

from a social worker than did those without

cognitive disabilities. Receipt of social services

by the mentally retarded was twice as high as for

those not cognitively disabled (20 versus 10 percent). Other therapy services cover physical,

occupational, recreational, and speech-hearing

therapies. These were combined into one category because the estimates for each specific

therapy did not meet established levels of precision. The notable difference was that the percentage of persons using other therapy services

was significantly lower for those with organic

brain syndromes and alcohol and drug abuse

than for those with no cognitive disabilities. The

percentage receiving other therapy was similar

for all other types of cognitive disability under

study here compared with those without such

disability. Although receipt of the various therapy

services was less than 30 percent, it is possible

that special services were provided through special

150
units or programs for meeting the needs of the

cognitively disabled. A 1987 national survey (22)

found that 8 percent of all nursing homes had

such specialty units and that they accounted for

54,000 beds (3.3 percent), The 1985 NNHS did

not collect information on whether patients with

cognitive disabilities were in specialty care units.

Primary source of payment – The most prevalent primary source of payment (PSP) for last

month’s care for residents without cognitive disabilities was own income or family support

(48 percent) (table 10). It was followed closely

by Medicaid (44 percent). Medicare, in contrast, was the PSP for less than 3 percent. The

PSP profile for those with Alzheimer’s disease

was similar. Own income was the PSP for 52 percent, Medicaid for 44 percent, and Medicare for

less than 1 percent of those with Alzheimer’s

disease. For persons with the remaining cognitive disabilities (except alcohol and drug abuse),

the PSP profile was quite different, Medicaid

was the most prevalent PSP and own income or

family support played a lesser role. The percentage whose PSP was Medicaid was significantly

higher (52–65 percent) than for those with no

cognitive disabilities (44 percent). As noted previously, there are major differences among States

in the amount of Medicaid payments and in the

services that are covered (21). These differences

make it difficult to determine what special services are available to the cognitively disabled

who are Medicaid residents. The percentage of

the mentally retarded who used other sources as

their PSP (i.e., government assistance other than

Medicaid and Medicare, religious or volunteer

groups, and life care) was four times larger than

for those with no cognitive disabilities.

Living amangementspriorto admission– Living

arrangements prior to admission can provide

information about the informal support system

for those residents admitted from a private

residence and about shifts in the locus of care

for those admitted from other health facilities.

The percentage of residents with organic brain

syndromes and Alzheimer’s disease that were

admitted directly from home (i.e., a private or

semiprivate residence) was the same as for those

with no cognitive deficits (table 11). The major

difference was that a smaller percentage of those

with organic brain syndromes and Alzheimer’s

disease lived alone at home prior to admission.

This is consistent with other findings about the

importance of the informal support system to

elderly with dementia. Families try to maintain

their elderly members at home for as long as

possible (13). The weakening or breakdown of

the informal support system precipitates the

admission to a nursing home (15). The small

percentage living alone also relates to the previous finding that cognitively disabled residents

are unable to live independently in the community as indicated by the large percentage who

needed personal help with three to four IADL’s

(see table 7).

The profile of living arrangements prior to

admission was different for residents with schizophrenia, depression, anxiety, alcohol and drug

abuse, and mental retardation. A greater percentage of persons with these disabilities was

admitted from another health facility and a

smaller percentage from home. At least 60 percent of these residents were admitted from another health facility, usually from a short-stay

hospital (9). There were few admissions from

another nursing home (about 5 percent), regardless of the type of cognitive disability. Nearly

25 percent of residents with mental retardation

or with schizophrenia were admitted from a

mental hospital or mental center. This was three

times more than for residents with any cognitive

disabilities. The shift in locus of care for elderly

schizophrenics from mental hospital to nursing

home can be viewed as a consequence of the

deinstitutionalization of the mentally ill. Because

community-based residential programs for the

mentally ill have not been developed to meet the

151
needs of deinstitutionalized persons, nursing

homes have provided an unintended source of

community placement for the mentally ill who

are elderly or near-elderly (9). Another possible

factor in this shift could be the need for a care

setting to address the increasing physical infirmities of the elderly with schizophrenia. The positive relationship between age and fair or poor

health for schizophrenic residents is illustrated

in table G.

Discharges –In addition to collecting data

about residents who were currently living in the

nursing home, the 1985 NNHS also collected

data about discharges. The sample included persons discharged 12 months prior to the survey.

Because of the dates of the data collection for

the NNHS, data on discharges cover the period

August 1984–January 1986. Data about discharges over a 12-month period highlight persons with relatively short stays and underestimate

those with relatively long stays. Data about current residents, however, have the opposite characteristics; they highlight persons with relatively

long stays and underestimate those with relatively short stays. Because persons with relatively

longer stays are more likely to be in a nursing

home on any given day, they are more likely to

be eligible for the current resident sample. It is

often useful to examine both discharge and resident data to gain a greater understanding of

nursing home utilization. A detailed description

of the conceptual differences between discharge

and current resident data in the 1985 NNHS has

been published (23).

Table H presents the rate of cognitive disabilities per 1,000 nursing home discharges. For

every 1,000 discharges, 273 had at least one

cognitive disability. The rate of cognitive disabilities per 1,000 discharges was significantly lower

for current residents (273 versus 674, from tables

H and C, respectively). The same was true when

rates for the individual cognitive disabilities were

compared. This difference is an indication that

Table H. Rate of cognitive disabilities per 1,000

nursing home discharges: United States,

1984-85

Cognitive disabilities Rate

None, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 727

One or more . . . . . . . . . . . . . . . . . . . . . . . . . . . 273

Organic brain syndromes . . . . . . . . . . . . . . . . . 141

Alzheimer’s disease and other degeneration

of the brain . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

Schizophrenia and other psychoses . . . . . . . . 62

Depressive disorders . . . . . . . . . . . . . . . . . . . . 24

Anxiety disorders . . . . . . . . . . . . . . . . . . . . . . . . 11

Alcohol and drug abuse . . . . . . . . . . . . . . . . . . 22

Mental retardation . . . . . . . . . . . . . . . . . ., ..., 10

?

the cognitively disabled tend to have relatively

longer lengths of stay. This is because discharge

data, in highlighting shorter stays, focus on those

without cognitive disability, while currentresident data, in highlighting longer stays, focus

on those with cognitive disability.

One strength of data on nursing home discharges is that it characterizes a completed episode of care and sheds light on outcomes of

care. In comparison to discharges without cognitive disabilities, a greater percentage of discharges with organic brain syndromes,

Alzheimer’s disease, schizophrenia, and mental

retardation had long stays of 1 year or more

(table 12). For the mentally retarded, the percentage with long stays was twice as high. About

70 percent of those without cognitive disability

were discharged alive. About 70 percent of those

discharged with organic brain syndromes and

Alzheimer’s disease also had a live outcome.

The percentage discharged alive was higher for

the other cognitive disabilities: schizophrenia,

depressive and anxiety disorders, alcohol and

drug abuse, and mental retardation. Except for

those with schizophrenia, more than 90 percent

of those discharged with these cognitive disabilities were discharged alive. The large percentage

of those discharged alive with depressive disorders

is not consistent with findings from a 1-year

longitudinal study of new admissions with major

depressive disorders (18). However, the longitu152
dinal nature of the study, its focus on new

admissions, and its use of research psychiatrists

to identify depressive disorders differ so greatly

from the methodology of the 1985 NNHS that

comparisons are not appropriate.

Summary

In summary, cognitive disabilities are a significant health problem in nursing homes. For

every 1,000 residents, 674 had one or more

cognitive disabilities. Residents with cognitive

disabilities are not a homogeneous group. Rather,

different profiles exist depending on the type of

cognitive disability.

The profile for residents with organic brain

syndromes and with Alzheimer’s disease identifies certain common characteristics. When compared with residents with no cognitive disabilities,

they had:

. a greater percentage in fair or poor physical

health

. a greater percentage who required help with

five to seven ADL’s

● a greater percentage with disruptive behavior

● a greater percentage with severe incontinence

. a smaller percentage who lived alone at home

prior to admission

Residents with organic brain syndromes had

a distinctive profile in the’ ‘following respects:

Rates were higher for females than males and

increased with age. The percentage in fair or

poor physical health also increased with age.

The percentage receiving other therapy last

month (that is, physical, occupational, recreational, or speech-hearing therapy) was significantly lower when compared with those without

cognitive disability,

Although the cognitive disabilities of schizophrenia and mental retardation differ substantially, profiles of residents with these disabilities

had some similarities. The prevalence of these

disabilities decreased with age. When compared

with residents with no cognitive disabilities, those

with schizophrenia and with mental retardation

had:

● a greater percentage who received a mental

health evaluation or treatment in the past

month

● a greater percentage admitted from another

health facility, usually a mental hospital

● a greater percentage discharged alive

● a smaller percentage who needed help transferring and walking

Note that this profile differs substantially

from the profile for residents with organic brain

syndromes and with Alzheimer’s disease.

Residents with mental retardation had a distinctive profile in the following respects: Rates

were twice as high for males as for females. In

comparison to those with no cognitive disabilities, those with mental retardation had a smaller

percentage in fair or poor physical health, a

smaller percentage with severe depression, and a

larger percentage receiving social services. Residents with mental retardation also had a greater

percentage who used government sources other

than Medicaid or Medicare, religious sources, or

life care as a primary source of payment.

Residents with schizophrenia also had a distinctive profile. They had a large percentage

admitted from a mental hospital, a large percentage with disruptive behavior, and a smaller percentage needing help with five to seven ADL’s.

Use of informal and formal care by

elderly in the communitp

Background

Long-term care (LTC) refers to care delivered to individuals who are dependent on others

for assistance with the basic tasks necessary for

bbYB~il~Miller,ph.D.,andSylviaE. Furrier,Ph.D.,UniVerS@

ofIllinoisat Chicago

153
physical, mental, and social functioning over

sustained periods. The goal of such care is to

enable the recipients to function at the highest

level of autonomy possible (l). Approximately

80-90 percent of community-based LTC comes

from informal networks of family or friends (24).

Although most family care is provided by a

primary caregiver, recent studies suggest that

60–70 percent of frail older persons have two or

more helpers (25,26). Formal sources of help

include medical and community services provided by profit, nonprofit, and governmental

agencies. Distribution of and access to these

services varies by community.

This section presents data on the use of

health and social services in 1984 and change in

the number of informal helpers between 1982

and 1984 for a national sample of frail elders. In

the context of this section, frail elders are defined as persons who are eligible for Medicare,

living in the community, and needing assistance

with at least one ADL. The number of helpers

used may be interpreted in two different ways. It

may reflect family composition and the range of

social networks of the dependent elder. Secondary caregivers are most likely to occur when the

primary caregiver is offspring, another relative,

or friends of the older person (26,27). Alternatively, use of more than one helper may reflect

increased need for help by those older persons

with higher levels of dependency. Each interpretation suggests ways that the number of helpers

may be associated with mortality and nursing

home placement. If having more helpers reflects

family composition and social network availability, little association between number of helpers

and mortality and nursing home use rates would

be expected. If having more helpers reflects

greater ADL dependency, however, it is expected that the number of helpers will be positively associated with mortality and nursing home

use rates.

The hypotheses examined in this section focus

on variations by age, sex, race, and level of ADL

154

disability in use of formal services, the number

of helpers in 1982, and the amount of change in

the number of helpers over a 2-year period, It is

hypothesized that: (a) males and white persons

will be more likely to use formal services than

females and persons of all other races as a result

of having greater socioeconomic resources, and

older elderly persons and those with higher

levels of ADL dependency will be more likely to

use formal services than younger elderly and

those with less ADL dependency because of a

greater need for services; (b) for similar reasons,

males, white people, older elderly persons, and

those with higher levels of ADL dependency will

be more likely to have more than one helper in

1982 than females, persons of all other races,

younger elderly, and those with less ADL dependency; and (c) patterns of stability and change in

the number of informal and formal helpers over

the 2 years will not differ by age, sex, race, or

ADL status.

Sources of data

The sources of data for this section are the

1982 and 1984 National Long-Term Care Surveys, which investigated the demographic characteristics, health and functioning, and patterns

of assistance of a national sample of noninstitutionalized persons 65 years of age or over (see

tables 13–15). A similar questionnaire for

community-dwelling residents was used in both

surveys. The 1982 survey was funded by the

Department of Health and Human Services,

Office of the Assistant Secretary for Planning

and Evaluation (ASPE), and the Health Care

Financing Administration (HCFA). The 1984

survey was funded by HCFA and the National

Institute on Aging (NIA). Recently, the data

from the 1989 survey, funded by NIA and ASPE,

were released but could not be included in these

analyses because of time constraints,

In 1982, a random sample of approximately

36,000 persons drawn from the Master Medicare

Beneficiary Files was screened to identifj per-
sons with functional limitations, defined as the

inability to perform at least one activity of personal care or management of daily affairs for 3

months or more. More than 6,400 persons were

identtied and 96 percent were interviewed. These

interviews and completed followup interviews of

those remaining in the community in 1984 are

the sources of data for the longitudinal analyses

in tables 14 and 15 (28).

The source of the cross-sectional data in

table 13 is the 1984 survey, along with two

additional sampling design elements. First, persons identified as chronically disabled in 1982

and still living in the community were reinterviewed (n = 4,530). Second, more than 12,000

persons identified as nondisabled in 1982 were

rescreened, and those identified as disabled in

19S4 were interviewed (n = 1,170). Table 13

presents estimates based on the complete responses from this set of interviews,

Findings

Use of selected community health and social

services —The percentages of frail persons aged

65 and over utilizing selected community health

and social services are presented in table 13.

Examination of utilization rates by type of service suggests variation. Physician office care and

hospitalization were frequently used health care

services, at 39 and 34 percent, respectively. Auxiliary health care services, such as care by dentists and optometrists, were used by 18 percent

of older frail persons. Four percent used the

services of rehabilitation therapists, and less

than 1 percent used mental health services. Approximately 7 percent used the services of senior centers.

Relatively few differences in the use of community health and social services by sociodemographic factors were evident. As expected, white

persons were more likely to be hospitalized in

the previous year and to use auxiliary health

care services than persons of all other races, but,

contrary to expectation, did not differ in their

utilization patterns for the other health and

social services. Women (20 percent) were more

likely to receive care from auxiliary health services than men (15 percent), but no other utilization differences by sex were evident. There

were few differences by age group in the use of

these services, except that, contrary to expectation, a smaller proportion of those 85 years of

age and over used physician office care and

hospitalization than those 65–74 years of age.

Use of health care services was, to some

extent, dependent on the need for service. As

expected, those receiving help with three to five

ADL’s were more likely to be hospitalized in the

previous year (55 percent) than those receiving

no help (29 percent). Surprisingly, however, those

who received help with three to five ADL’s were

less likely to use auxiliary health services (13 percent) than those who received no help

(19 percent).

In 1982, as expected, persons of all other

races, persons aged 85 years and over, and

persons receiving help with three to five ADL’s

were significantly more likely to have more than

one helper than were white people, elderly people in the younger age groups, and elderly people with less ADL dependency (table J). Contrary

to what was hypothesized, females were more

likely to have more than one helper than males.

Marital patterns may account for some of this

difference. A person is more likely to have

multiple helpers when the primary caregiver is

not a spouse (26). Because older men are more

likely to be married than older women, female

spouses are more available to care for dependent men. Dependent women are more likely to

be widowed, divorced, or never married, and

cared for by adult children (24).

Changes in use of informal helpers between

1982 and 1984 – Table 14 presents the number

of informal helpers used in 1982 and the change

in number of informal helpers between 1982 and

155
Table J. Percent of frail persons 65 years of age and over using only informal helpers in 1982 by

the number ofinformai helpers in1982, according to race, sex, age, and help with activitiesof daily

living: United States

Number ofinformal helpersin 1982

Race, sex, age, and help with ADL’s 1 2 3 or more

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

Race

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

Another. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sex

Male, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Female. , . .,, , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Age

65–74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

75–84 years, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65 years And over. . . . . . . . . . . . . . . . . . . . . . . . . . . .

75 years And over . . . . . . . . . . . . . . . . . . . . . . . . . . . .

85 years and over, . . . . . . . . . . . . . . . . . . . . . . . . . . .

HelpwithADL’s

No help received.....,.......,.. . . . . . . . . . . . . .

Help with l................,,,., . . . . . . . . . . . .

Help with 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Help with 3-5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

53.1

54.5

45.3

65.0

45,0

61.7

49.7

53.1

46.4

39.3

56.9

47.5

52.7

39.5

26.8

26.2

30.4

21.7

30,4

21,8

28.9

26.8

30.9

35,2

25.7

29,1

24.6

31.7

20.0

19,3

24,3

13.3

24,6

16.5

21.5

20,0

22,8

25,5

17,4

23.4

22.7

28,8

NOTE: ADL is activity of daily living.

1984. For purposes of this analysis, all of the

frail elders had at least one informal helper in

1982. The number of informal helpers a frail

elder had was associated with subsequent mortality; those with three ormore informal helpers

in 1982 were more likely to die by 1984(25 percent deceased) than those with one informal

helper (18 percent deceased), Furtherinvestigation of the association between the number of

informal helpers and mortality revealed a trend

ofincreasingmortality rates with increasing number of informal helpers for males only. For

females, there was a higher mortality rate for

those who had three or more helpers in 1982

(20 percent), compared with those who had one

helper (15 percent); however, therewasno trend

of increasing mortality rates with increasing

156

numbers of informal helpers. The association

between mortality and number of informal helperswas evident inwhite people :thosewith three

ormore informal helpers were more likely to die

(25 percent) than those with one helper (18 percent), but this was not true for persons of all

other races, Among the age groups, theassociation between number of informal helpers and

mortalitywas only evident in the 65–74-year age

group and the 85-and-over age group. Those

withthree ormore helpers in the65–74-year age

group were more likely to die (21 percent) than

those with one helper in the same age group

(13 percent) .Thesame relationship wasevident

forthe85-and-over group. Contra~to expectation, there was no association between mortality

and number of informal helpers within levels of
ADL dependency. Although it appeared that,

among those who received help with three to five

ADL’s, those with three or more helpers were

more likely to die than those with fewer helpers,

the difference was not statistically significant.

With respect to institutionalization, i.e., nursing home residence, those who had two helpers

in 19S2 were more likely to be institutionalized

in 19S4 than those with one helper. In contrast

to the association seen with mortality, there was

no trend of increasing institutionalization rates

with increasing numbers cif informal helpers.

This was true for all sex, race, age, and ADL

dependency groups.

Stability and change in the number of informal helpers over the 2-year period can be observed in table 14 by comparing the number of

helpers in 1982 with the number of helpers in

1984, Overall, 45 percent of the sample who had

one helper in 1982 had one helper in 1984.

Twenty-nine percent of those with two helpers

in 19S2 had the same number of helpers in 1984.

Similarly, 29 percent of those with three or

more helpers in 1982 had the same number of

helpers in 1984. Of note is a change to no

helpers in 1984. A larger percentage of those

with one helper in 1982 did not have any helpers

in 1984 (8 percent), compared with those with

two (4 percent) or three or more helpers (3 percent) in 1982,

There is an association between change in

use of informal helpers and race, White persons

with one helper in 1982 were more likely to show

stability in the number of helpers (46 percent)

than were persons of all other races (35 percent). People of all other races with one helper

were more likely than white people to show an

increase to two informal helpers (20 percent

compared with 14 percent). Men showed more

stability in having one helper than women, but

there was no difference in stability of helper

networks for men and women with two or three

or more helpers. There was no difference by sex

in the shift to no helpers; however, women were

more likely to shift from one informal helper to

two (17 percent) than were men (12 percent).

Comparison of the stability of having one

helper by age group revealed a decreasing trend

with increasing age. Fifty-one percent of those

65-74 years of age with one helper in 1982 had

one helper in 1984, in comparison to 42 percent

and 33 percent for those 75–84 and 85 and over.

No association was evident between the stability

in the number of helpers and the level of ADL

disability.

Changes in the use of both formal and infornzal

he@ers between 1982 and 1984 – Change in the

use of only formal helpers cannot be estimated

because of the overall low use and the subsequent large variance in these estimates. Table 15 presents the use of both formal and

informal helpers in 1984 by such use in 1982. For

purposes of this analysis, all older persons in the

1982 sample had at least one informal helper.

Thus, if both informal and formal helpers were

used, the minimum size of the helper network

was two. Examination of mortality rates by number of formal and informal helpers across race,

sex, age, and ADL groupings revealed only one

significant difference. For persons of all races

other than white, those with three or more

helpers were more likely to die within 2 years

(38 percent) than those with two helpers (20 percent). More than 45 percent of males with three

or more helpers and persons receiving help with

three to five ADL’s died during the 2-year interval; this suggests that these are the groups at

highest risk of death. No consistent pattern

between institutionalization rates and use of

formal and informal helpers was evident.

For the total sample, those persons with

three or more formal and informal helpers in

1982 showed greater stability (36 percent) in

network size than those with two-helper networks (18 percent). This stability was evident

157
among females and white persons but not among

males and persons of all other races.

Summary

In summary, this section suggests that hospital care and physician office care are frequently

used community health care services. There were

relatively few differences by sex, age, or race in

patterns of community health service use. There

were differences by sex, age, race, and level of

ADL disability in the number of informal helpers a frail elder used. Marital patterns appear to

be an important underlying influence on the

number of informal helpers. When a spouse is

present, he or she becomes the primary and only

helper in many instances. The number of informal helpers that a frail elder had was associated

with an increased risk of mortality and institutionalization, Overall, there is somewhat more

stability than change in the number of informal

helpers over the 2-year period. This section,

however, could not identify if the composition of

the informal helper network remained the same

over time.

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Rovner BW, German PS, Brant LJ, et al. Depression and mortality in nursing homes. JAMA

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Wiener JM, Hanley RJ, Clark R, Van Nostrand

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Buchanan R, Madel P, Persons D. Medicare

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Leon J, Potter D, Cunningham P. Current and

projected availability of special nursing home

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Medicare Expenditure Survey Data Summary 1.

1990.

Sekscenski ES. Discharges from nursing homes:

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159
G Table 1. Number and percent of nursing home residents, by presence of selected cognitive disabilities, sex, age, and race:

0 United States, 1985

[Data are based on personal interviews of the nursing home staff most knowledgeable about the residents sampled]

No Organic Schizophrenia Alcohol

cognitive Cognitive brain Alzheimer’s and other Depressive Anxiety

Sex, age, and race

and drug Mental

Total disabilities disabi/itiesl syndromes disease psychoses disorders disorders abuse retardation

All residents. . . . . . . . . . . . 1,489,500

Sex

Male . . . . . . . . . . . . . . . . . . 422,600

Female . . . . . . . . . . . . . . . . 1,066,900

Age

Under 65 years . . . . . . . . . 166,500

65–74 years . . . . . . . . . . . . 209,100

75–84 years . . . . . . . . . . . . 501,800

65 years and over. . . . . . . 1,314,700

75 years and over. ., . . . . 1,105,700

85 years and over. . . . . . . 603,900

Racez

White . . . . . . . . . . . . . . . . . 1,373,100

Black . . . . . . . . . . . . . . . . . 104,000

All residents . . . . . . . . . . . .

Sex

Male . . . . . . . . . . . . . . . . . .

Female . . . . . . . . . . . . . . . .

Age

Under 65 years . . . . . . . . .

65–74 years . . . . . . . . . . . .

75–84 years . . . . . . . . . . . .

65 years and over. . . . . . .

75 years and over. . . . . . .

85 years and over. . . . . . .

Racez

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

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

100.0

28.4

71.6

11.2

14.0

33.7

88.3

74.2

40.5

92.2

7.0

485,100

137,100

348,000

34,400

61,400

173,500

446,800

385,500

212,000

445,100

35,700

100.0

28.3

71.7

7.1

12.7

35.8

92.1

79.5

43.7

91.8

7.4

1,004,400

285,500

718,900

132,100

147,700

328,300

867,900

720,200

391,900

928,000

68,300

100.0

28.4

71.6

13.2

14.7

32.7

86.4

71.7

39.0

92.4

6.8

686,000

167,700

518,300

31,000

80,400

239,300

652,300

571,900

332,600

631,900

49,800

100.0

24,4

75.6

4.5

11.7

34.9

95.1

83.4

48.5

92.1

7.3

Number

79,200 194,200

23,300 64,300

55,900 129,900

*5,1OO 52,600

17,100 44,300

32,900 51,700

74,000 140,400

57,000 96,100

24,000 44,400

75,300 176,400

*3,500 15,900

Percent

100.0 100.0

29.4 33.1

70.6 66.9

*6.4 27.1

21.6 22.8

41.5 26.6

93.4 72.3

72.0 49.5

30.3 22.9

95.1 90.8

*4.4 8.2

214,800

54,700

160,200

29,700

38,900

79,700

183,800

144,900

65,200

201,600

10,500

100.0

25.5

74.6

13.8

18.1

37.1

85.6

67.5

30.4

93.9

4.9

215,000

57,800

157,200

32,400

34,500

76,500

180,900

146,400

69,900

198,500

14,000

100.0

26.9

73.1

15.1

16.0

35.6

84.1

68.1

32.5

92.3

6.5

58,700

37,700

21,000

16,800

16,900

16,600

41,300

24,400

7,800

51,800

6,200

100.0

64.2

35.8

28.6

28.8

28.3

70.4

41.6

13.3

88.2

10.6

82,800

37,700

45,200

43,800

20,400

13,400

38,300

17,900

‘4,500

76,700

*4,700

100.0

45.5

54.6

52.9

24.6

16.2

46.3

21.6

*5.4

92.6

*5.7

'includes residents with all&pes ofcognitive disabilities Residents with multiple disabilities arecounted only once in teetotal.

2Excludes races other than white and black.

NOTE: Column percents may not add to 100 because of rounding.

SOURCE: National Center for Health Statistics: Data from the National Nursing Home Survey.
Table 2. Percent of nursing home residents, by presence of selected cognitive disabilities, sex, age, race, and staff-assessed

physical health status: United States, 1985

[Data are based on personal interviews of the nursing home staff most knowledgeable about the residents sampled]

Sex, age, race, and No Organic Schizophrenia Alcohol

staff-assessed cognitive Cognitive brain Alzheimer’s and other Depressive Anxiety and drug Mental

health status Total disabilities disabilities syndromes disease psychoses disorders disorders abuse retardation

All residents. . . . . . . . . . . 1,452,300

Al[ statuses . . . . . . . . . . . .

Excellent to good . . . . . . .

Fair and poor . . . . . . . . . .

Sex

Male:

Al[ statuses . . . . . . . . . .

Excellent to good . . . . .

Fair and poor . . . . . . . . .

Female:

AH statuses . . . . . . . . . .

Excellent to good . . . . .

Fair and poor . . . . . . . . .

Age

Under 65 years:

Al[ statuses . . . . . . . . . .

Excellent to good . . . . .

Fair and poor . . . . . . . . .

65-74 years:

All statuses . . . . . . . . . .

Excellent to good . . . . .

Fair and poor . . . . . . . . .

75-84 years:

Ali statuses . . . . . . . . . .

Excellent to good . . . . .

Fair and poor . . . . . . . . .

65 years and over:

All statuses . . . . . . . . . .

Excellent to good . . . . .

Fair and poor . . . . . . . . .

75 years and over:

All statuses . . . . . . . . . .

Excellent to good . . . . .

Fair and poor . . . . . . . . .

0)

100.0

39.3

60.7

28.4

11.6

16.8

71.6

27.7

43.9

11.0

6.4

4,6

14.0

5.8

8.2

33.8

13.0

20.8

88.5

32.8

55.7

74.5

27.0

47.5

472,000

100.0

44.7

55.3

28.3

11.7

16.6

71.6

32.9

38.6

7.0

3.0

4.0

12.5

5.4

7.0

35.7

16.0

19.8

92.3

41.6

50.7

79.7

36.1

43.7

980,300

100.0

36.7

63.3

28.4

11.5

16.9

71.6

25.2

46.4

12.9

8.0

5.0

14.8

6.0

8.8

32.8

11.6

21.2

86.6

28.6

58.1

71.9

22.6

49.3

669,500

100.0

31.5

68.5

24.6

7.5

17.1

75.4

24.0

51.4

4.4

2.1

2.3

11.7

4.3

7.3

34.9

11.7

23.2

95.2

29.3

65.9

83.5

24.9

58.6

Number

77,000 189,000

Percent

100.0

36.3

65.3

29.4

9.8

20.0

71.6

26.2

44.7

*6. O

*2.9

*3.2

22.2

9.6

12.6

42.1

16.0

26.6

95.2

33.4

62.0

73.0

23.4

49.2

100.0

49.3

50.4

32.5

16.8

15.8

67.2

32.4

34.8

26.6

17.0

9.6

23.1

12.1

10.9

26.5

11.2

15.3

72.8

31.8

41.1

49.3

19.5

29.9

212,000

100.0

30.7

69.0

25.5

8.0

17.4

74.6

22.8

51.7

13.6

6.8

6.9

18.2

6.1

12.1

37.2

11.3

25.9

85.5

23.8

61.8

67.3

17.6

49.7

212,000

100.0

34.7

65.3

26.6

10.0

16.7

73.6

24.7

48.7

15.0

8.8

6.3

16.0

5.0

11.0

35.6

10.6

25.0

84.2

25.6

58.7

68.3

20.5

47.8

56,600

100.0

49.4

51.4

64.0

34.1

30.2

36.7

15.6

21.4

27.7

19.1

*8.7

28.8

12.9

15.8

29.4

11.0

18.1

72.6

29.4

42.8

43.9

16.6

26.8

81,300

100.0

60.3

40.1

45.6

28.7

17.1

53.7

31.2

22.7

52.3

37.7

14.5

25.0

12.5

12.5

16.3

*7.2

8.9

47.4

22.3

24.9

21.3

9.6

11.9
~ Table 2. Percent of nursing home residents, by presence of selected cognitive disabilities, sex, age, race, and staff-assessed

physical health status: United States, 1985 – Con.

[Data are based on personal interviews of the nursing home staff most knowledgeable about the residents sampled]

Sex, age, race, and No Organic Schizophrenia Alcohol

staff-assessed cognitive Cognitive brain Alzheimer’s and other Depressive

hea/th status Total

Anxiety

disabilities disabilities

and drug Mental

syndromes disease psychoses disorders disorders abuse retardation

85 years and over Percent

All statuses . . . . . . . . . . 40.7 43.9 39.1 48.6 29.9 22.8 30.1 32.6

Excellent to good. . . . 14.0 20.1 11.0

13.6 *5.8

13.2 *7.7 8.4 6.3 9.9

Fair and poor . . . . . . . 26.7 23.8

*5.7

28.1 35.4 22.7

*2.2

14.6 23.9 22.7 *8.2 *3.3

Race3

White:

All statuses . . . . . . . . . . 92.3 91.7 92.6 92.3 95.8 91.6 93.5 92.3

Excellent to good . . . . . 36.4 42.3 33.5 28.6

89.9 92.3

33.6 44.5 29.2 31.1

Fair and poor . . . . . . . . . 55.9 49.5 59.0 63.5

43.8

62.2

54.6

Black:

46.9 64.3 61.3 45.9 37.9

All statuses . . . . . . . . . . 6.9 7.4 6.7 7.2 *4.6 7.6 4.9 6.4

Excellent to good . . . . . 2.6 2.1 2.8

10.6 *5.8

2.8 *2.3 3.8

Fair and poor . . . . . . . . . 4.4

*1.2

5.3

*2.8 *5.7

3.9 4.4 *2.2

*3.7

3.8 3.7 3.7 *4.8 *2.1

‘Includes residents with all types of cognitive disabilities. Residents with multiple disabilities are counted only once in the total.

2Excludes those for whom health status was missing.

3Excludes races other than white and black.

NOTE: Column percents may not add to 100 because of rounding.

SOURCE: National Center for Health Statistics: Data from the National Nursing Home Survey.
Table 3. Percent of nursing home residents, by presence of selected cognitive disabilities, sex, age, race, and number of

disruptive behaviors: United States, 1985

[Data are based on personal interviews of the nursing home staff most knowledgeable about the residents sampled]

Sex, age, race, and No Organic Schizophrenia Alcohol

number of disruptive cognitive Cognitive brain Alzheimer’s and other Depressive Anxiety and drug Mental

behaviors Total disabilities disabilities syndromes disease psychoses disorders disorders abuse retardation

All residents. . . . . . . . . . . . 1,489,500

Al[ statuses . . . . . . . . . . . .

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

I or more . . . . . . . . . . . .

3 or more . . . . . . . . . . . .

Sex

Male:

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

I or more . . . . . . . . . . . .

3 or more . . . . . . . . . . . .

Female:

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

I or more . . . . . . . . . . . .

3 or more . . . . . . . . . . . .

Age

Under 65 years:

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

I or more . . . . . . . . . . . .

3 or more . . . . . . . . . . . .

65–74 years:

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

I or more . . . . . . . . . . . .

3 or more . . . . . . . . . . . .

75–84 years:

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

I or more . . . . . . . . . . . .

3 or more . . . . . . . . . . . .

65 years and over:

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

I or more . . . . . . . . . . . .

3 or more . . . . . . . . . . . .

75 years and over:

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

I or more . . . . . . . . . . . .

m

3 or more . . . . . . . . . . . .

Ccl

100.0

61.6

38.4

7.6

17.4

10.9

2.5

44.2

27.4

5.1

6.8

4.4

0.8

8.9

5.1

1.1

20.5

13.2

2.7

54.4

33.9

6.8

45.5

28.7

5.6

485,400

100.0

84.9

15.1

*1 .0

24.2

4.1

*0.6

60.8

10.9

*0.5

6.1

*1 .0

*0. I

11.1

1.6

*0. I

31.1

4.6

*0.1

78.2

13.9

*1 .0

67.1

12.4

*0.8

1,004,100

100.0

50.4

49.6

10.7

14.2

14.3

3.4

36.2

35.4

7.3

7.2

6.0

1.1

7.8

6.9

1.6

15.3

17.4

3.9

42.9

43.5

9.5

35.1

36.6

8.0

686,400

100.0

44.1

55.9

12.7

9.8

14.6

3.9

34.3

41.2

8.9

2.0

2.5

‘0.3

5.1

6.7

1.9

14.0

20.8

4.9

41.9

53.1

12.4

36.9

46.4

10.5

Number

79,600 194,100

Percent

100.0

40.4

59.6

17.8

8.5

20.7

5.7

31.5

39.0

12.2

*3.2

*3.3

—

8.5

12.9

*4.9

16.1

25.2

8.4

36.7

56.4

17.8

28.1

43.5

12.9

100.0

47.3

52.7

13.7

17.1

16.0

4.3

30.2

36.6

9.5

14.9

12.2

*2.4

12.9

10.0

*2.8

10.5

16.1

4.4

32.2

40.0

11.4

19.2

30.2

8.5

214,400

100.0

57.4

42.6

9.9

13.4

12.1

2.9

43.9

30.7

6.9

7.7

6.2

*0.3

9.9

8.2

*1 .8

20.9

16.3

4.6

49.5

36.4

9.5

39.5

28.1

7.7

214,800

100.0

43.6

56.4

13.7

10.8

16.1

4.1

33.1

40.1

9.6

5.9

9.1

*1 .5

7.5

8.6

*1 .7

15.5

20.2

6.2

37.4

46.7

12.1

30.0

38.0

10.4

58,700

100.0

61.0

39.0

*9.8

37.2

27.0

*6.3

24.7

11.1

*3.5

17.1

11.5

*2.7

20.1

*8.5

*1 .4

14.5

14.1

*3.6

42.8

26.6

*7.O

23.1

18.2

*5.6

82,700

100.0

48.9

51.1

12.1

25.7

19.7

*4.6

23.1

31.1

7.5

27.5

25.4

*5.7

11.8

12.8

*1 .8

7.4

9.0

*3.O

20.6

25.0

*6.2

9.0

12.4

*4.5
~ Table 3. Percent of nursing home residents, by presence of selected cognitive disabilities, sex, age, race, and number of

disruptive behaviors: United States, 1985

[Data are based on personal interviews of the nursing home staff most knowledgeable about the residents sampled]

Sex, age, race, and No Organic Schizophrenia Alcohol

number of disruptive cognitive Cognitive brain Alzheimer’s

behaviorsl

and other Depressive

Total

Anxiety

disabilities disabi/itie&’

and drug Mental

syndromes disease psychoses disorders disorders abuse retardation

85 years and over: Percent

None . . . . . . . . . . . . . . . 25.1 35.9 19.8 22.9 12.2 8.8 18.6 14,6

I or more . . . . . . . . . . . . 15.5 7.7 192 25.6 18.0

*8.9

14.0

*2.3

11.8 17.9

3 or more . . . . . . . . . . . . 3.0 *0.7

*4.3

4.1

*3.3

5.6 *4.6 4.1 3.1 4.2 *2.O *1 .3

Race3

White:

None . . . . . . . . . . . . . . . 57.0 78.2 46.7 40.6 38.4 42.8 53.8 41.5

I or more . . . . . . . . . . . . 35.2 13.5 45.7 51.5

56.4

56.7

46.2

48.1 40.1 51.0

3 or more . . . . . . . . . . . . 7.0 *1 .1 9.9 11.9

32.2

16.9

46.9

Black:

12.6 9.5 12.5 *7.3 11.4

None . . . . . . . . . . . . . . . 4.1 6.0 3.1 3.2 *1 .2 3.9 *2.7 *1.9

I or more . . . . . . . . . . . . 2.9 1.3 3.7

*4.O *2.6

4.1 *3.3 4.3 *2.2 4.6

3 or more . . . . . . . . . . . . 0.5 0.8 *0.8

*6.5 *3.O

— *1 .0 *1 .1 *0.2 *1 .3 *2.4 *0.6

‘ Includes six behaviors: Disrobing or exposing oneself, screaming, being physically abusive, stealing, getting lost or wandering, and being unable to avoid simple

dangers.

2 Includes residents with all types of cognitive disabilities. Residents with multiple disabilities are counted only once in the total.

3 Excludes races other than white and black.

NOTE: Column percents may not add to 100 because of rounding.

SOURCE: National Center for Health Statistics: Data from the National Nursing Home Survey.
Table 4. Percent of nursing home residents, by presence of selected cognitive disabilities, sex, age, race, and whether memory

impaired: United States, 1985

[Data are based on personal interviews of the nursing home staff most knowledgeable about the residents sampled]

Sex, age, race, and No Organic Schizophrenia Alcohol

presence of memory cognitive Cognitive brain Alzheimer’s and other Depressive Anxiety and drug Mental

impairment Total disabilities disabilities svndromes disease psychoses disorders disorders abuse retardation

AIl residents . . . . . . . . . . . .

AH statuses . . . . . . . . . . . .

Not impaired . . . . . . . . .

Impaired . . . . . . . . . . . . .

Sex

Male:

Notimpaired . . . . . . . . .

Impaired . . . . . . . . . . . . .

Female:

Notimpaired . . . . . . . . .

Impaired . . . . . . . . . . . . .

Age

Under 65 years:

Notimpaired . . . . . . . . .

Impaired . . . . . . . . . . . . .

65–74 years:

Notimpaired . . . . . . . . .

Impaired . . . . . . . . . . . . .

75–84 years:

Notimpaired . . . . . . . . .

Impaired . . . . . . . . . . . . .

65 years and over:

Notimpaired . . . . . . . . .

Impaired . . . . . . . . . . . . .

75 years and over:

Notimpaired . . . . . . . . .

Impaired . . . . . . . . . . . . .

85 years and over:

Notimpaired . . . . . . . . .

Impaired . . . . . . . . . . . . .

1,471,500

100.0

37.4

62.6

11.5

16.8

25.9

45.8

4.7

6.3

6.0

8.0

13.1

20.6

32.4

56.0

26.4

48.0

13.3

27.4

478,100

100.0

67.2

32.8

19.2

9.2

48.0

23.7

4.9

2.1

9.6

3.0

24.5

11.3

61.6

30.5

52.0

27.6

27.6

16.3

993,400

100.0

23.1

76.9

7.8

20.5

15.2

56.4

4.6

8.4

4.3

10.5

7.7

25.0

18.3

68.3

14.1

57.8

6.4

32.7

678,800

100.0

13.3

86.7

3.7

20.7

9.6

65.9

1.2

3.2

1.8

9.9

4.7

30.2

12.0

83.0

10.2

73.2

5.5

43.0

Number

79,000 191,400

Percent

100.0 100.0

9.1 24.4

90.9 75.6

3.2 9.5

26.0 23.5

5.3 14.9

64.8 52.1

*1.2

*4.8

*0.9

20.7

*4.2

37.6

*7.2

85.5

*6.4

65.2

*2.5

27.5

8.1

18.7

7.0

16.1

5.9

20.6

16.2

56.4

9.1

40.2

3.3

19.8

212,700

100.0

34.2

65.8

9.4

16.1

24.7

50.0

5.2

8.2

6.2

12.0

14.0

23.2

28.7

57.3

22.5

45.1

8.4

22.2

212,000

100.0

28.3

71.7

7.8

19.1

20.6

52.7

5.0

9.8

5.2

11.1

10.5

25.2

23.4

61.0

18.3

49.9

7.7

24.9

58,800

100.0

46.8

53.2

28.6

34.9

18.1

17.2

14.1

13.9

12.3

16.1

15.1

13.4

31.6

39.2

19.1

22.8

4.0

8.9

82,300

100.0

26.1

73.9

14.3

31.3

12.0

42.6

16.0

36.9

*6.7

18.1

*3.5

12.5

10.4

36.1

3.3

18.0

0.0

5.4
Table 4. Percent of nursing home residents, by presence of selected cognitive disabilities, sex, age, race, and whether memory

impaired: United States, 1985 – Con.

[Data are based on personal interviews of the nursing home staff most knowledgeable about the residents sampled]

Sex, age, race, and No Organic Schizophrenia Alcohol

presence of memory cognitive Cognitive brain Alzheimer’s and other Depressive Anxiety

impairment Total disabilities disabilities

and drug Mental

syndromes disease psychoses disorders disorders abuse retardation

Race2 Percent

White:

Not impaired . . . . . . . . 34.7 62.2 21.5 12.3 8.4 22.2 32.7 26.8

Impaired . . . . . . . . . . . . . 57.5 29.5 70.9

40.8

79.8

24.2

Black:

86.7 69.4 61.3 65.8 46.0 67.9

Not impaired . . . . . . . . . 2.3 4.4 1.3 *0.8 *0.4 *1 .9 *1.1 1.5

Impaired . . . . . . . . . . . . . 4.6 3.0 5.4

4.3 1.3

6.4 *4.1 5.8 3.8 5.1 6.3 4.4

‘Includes residents with all types of cognitive disabilities. Residents with multiple disabilities are counted only once in the totaL

2Excludes races other than white and black.

NOTE: Memory impairment is inability to remember dates or time, familiar location or people, or recent events or to make straightforward judgments to such an extent

that performance of activities of daily living, instrumental activities of daily living, and mobility is impaired.

NOTE: Column percents may not add to 100 because of rounding.

SOURCE: National Center for Health Statistics: Data from the National Nursing Home Survey.
Table 5. Percent of nursing home residents, by presence of selected cognitive disabilities, sex, age, race, and presence of

depression or anxiety: United States, 1985

[Data are based on Personal intewiews of the nursing home staff most knowledgeable about the residents sampledl

Sex, age, race, and No Organic Schizophrenia Alcohol

presence of depression cognitive Cognitive brain Alzheimer’s and other Depressive Anxiety and drug Mental

or anxiety Total disabilities disabilities’ syndromes disease psychoses disorders disorders abuse retardation

All residents. . . . . . . . . . . . 1,489,500

All statuses . . . . . . . . . . . .

Depression. . . . . . . . . . .

Anxiety . . . . . . . . . . . . . .

Neither . . . . . . . . . . . . . .

Sex

Male:

Depression. . . . . . . . . . .

Anxiety . . . . . . . . . . . . . .

Neither . . . . . . . . . . . . . .

Female:

Depression. . . . . . . . . . .

Anxiety . . . . . . . . . . . . . .

Neither . . . . . . . . . . . . . .

Age

Under 65 years:

Depression, , . . . . . . . . .

Anxiety . . . . . . . . . . . . . .

Neither . . . . . . . . . . . . . .

65–74 years:

Depression.. . . . . . . . . .

Anxiety . . . . . . . . . . . . . .

Neither . . . . . . . . . . . . . .

75-84 years:

Depression.. . . . . . . . . .

Anxiety . . . . . . . . . . . . . .

Neither . . . . . . . . . . . . . .

65 years and over:

Depression.. . . . . . . . . .

Anxiety . . . . . . . . . . . . . .

Neither . . . . . . . . . . . . . .

75 years and ovec

Depression.. . . . . . . . . .

Anxiety . . . . . . . . . . . . . .

Neither . . . . . . . . . . . . . .

In-J

100.0

23.6

25,4

57.1

6.3

6.5

17.4

17.3

18.9

39.7

3.1

2.9

6.4

4.1

4.1

7.3

8.4

8.4

19.6

20.4

22.5

50.3

16,3

18.4

43.0

485,100

100.0

12.3

10.4

74.4

3.2

2.6

22.2

9.0

7.9

52.0

1.3

*0.7

5.0

2.4

1.5

8.9

4.6

3.7

27.3

11.0

9.7

68.6

8.6

8.2

59.7

1,004,400

100.0

29.1

32.7

48.8

7.7

8.4

15.1

21.3

24.3

33.7

3.9

3.9

7.1

5.0

5.3

6.6

10.2

10.7

16.0

25.0

28.7

41.5

20.0

23.3

35.0

686,000

100.0

25.3

31.0

50.7

6.2

7.4

13.0

19.0

23.6

37.7

1.5

1.6

2.2

3.9

4.0

5.1

9.1

10.3

18.3

23.6

29.2

48.4

19.7

25.1

43.2

Number

79,200 194,200

Percent

100.0

24.9

31.6

50.5

7.7

10.0

14.4

16.9

21.7

35.8

*1 .4

*2.3

*3.3

*5.8

*7. 1

9.4

11.0

12.8

22.9

23.4

29.2

47.3

17.8

22.2

38.0

00.0

34.9

37.3

44.2

11.1

9.6

15.6

23.8

27.6

28.6

11.1

10.2

10.4

8.2

8.3

10.4

8.7

9.9

12.2

23.5

26.7

33.6

15.1

18.5

23.1

214,800

100.0

71.4

49.1

20.2

17.8

11.6

6.2

53.6

37.4

14.0

10.6

7.4

2.9

12.4

9.3

4.1

26.5

18.3

7.8

60.4

41.5

17.1

47.9

32.2

13.1

215,000

100.0

50.9

71.7

18.6

13.3

18.8

5.6

37.6

52.9

12.9

8.0

8.6

4.4

9.2

12.4

*2.1

19.3

26.7

5.9

42.6

62.8

13.6

33.3

50.4

11.6

58,700

100.0

28.8

34.9

50.7

17.2

19.8

34.5

11.4

14.9

16.1

*8.3

*8.5

15.5

*6.3

*1 0.6

16.3

*8.3

10.5

13.5

19.7

26.3

34.5

13.2

15.9

18.6

82,800

100.0

14.9

28.4

63.7

6.4

13.4

28.2

8.4

15.0

35.7

*5.3

9.8

38.8

*3.9

9.5

12.4

*3.9

*5.6

9.5

9.6

18.6

24.4

*5.6

8.9

11.6
~ Table 5. Percent of nursing home residents, by presence of selected cognitive disabilities, sex, age, race, and presence of

depression or anxiety: United States, 1985–Con.

[Data are based on personal interviews of the nursing home staff most knowledgeable about the residents sampled]

Sex, age, race, and No Organic Schizophrenia Alcohol

presence of depression cognitive Cognitive brain Alzheimer’s, and other Depressive Anxiety

or anxiety Total disabilities disabilities

and drug Mental

syndromes disease psychoses disorders disorders abuse retardation

Percent

85 years and over:

Depression.. . . . . . . . . . 7.9 3.9 9.9 10.6 *6.7 6.5 21.5 14.0 *5.O

Anxiety . . . . . . . . . . . . . . 10.0 4.6

*1.7

12.6 14,9 9.4 8.6 13.8 23.8 *5.3

Neither . . . . . . . . . . . . . . 23.4 32.4

*3.4

19.0 25.0 14.9 10.9 5.3 5.7 *5.3 *2.1

Race2

White:

Depression. . . . . . . . . . . 21.9 11.6 26.9 23.3 22.7 33.1 66.2 47.2 27.2

Anxiety . . . . . . . . . . . . . . 24.0 10.1 30.7

13.0

29.0 29.3 34.9 46.0 66.4 31.0

Neither . . . . . . . . . . . . . . 52.3 67.8 44.9

26.3

46.5 48.2

Black:

38.9 19.6 17.0 43.8 59.3

Depression. . . . . . . . . . . 1.5 *0.6 1.9 1.7 *2.O *1.7 4.0 3.4 *1.5 *1 .3

Anxiety . . . . . . . . . . . . . . 1.3 *0.2 1.8 1.8 *2.2 *2.2 *2.4 4.7 *3.6 *1.6

Neither . . . . . . . . . . . . . . 4.3 5.8 3.5 4.0 *1.4 4.6 *0.8 *1.1 *6.O *3.5

‘includes residents with all types of cognitive disabilities. Residents with multiple disabilities are counted only once in the total.

2Excludes races other than white and black.

NOTE: Presence of depression or anxiety means that depression or anxiety is displayed to such a degree that functioning is restricted. Column percents may exceed

100 because a resident may have had both depression and anxiety.

SOURCE: National Center for Health Statistics: Data from the National Nursing Home Survey.
Table 6. Percent of nursing home residents, by presence of selected cognitive disabilities, age, and number and type of activities

of daily living for which help of another person is required: United States, 1985

[Data are based on personal interviews of the nursing home staff most knowledgeable about the residents sampled]

Age and ADL’s for which No Organic Schizophrenia Alcohol

help of another person cognitive Cognitive brain Alzheimer’s and other Depressive Anxiety and drug Mental

is required Total disabilities disabi/itiesl syndromes disease psychoses disorders disorders abuse retardation

Alleges . . . . . . . . . . . . . . . 1,489,500

Number:

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

1–2 . . . . . . . . . . . . . . . . .

3-4 . . . . . . . . . . . . . . . . .

5-7 . . . . . . . . . . . . . . . . .

Type:

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

Toileting . . . . . . . . . . . . .

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

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

Transferring2 . . . . . . . . .

Walking . . . . . . . . . . . . .

Getting outside . . . . . . .

65 years and over

Number:

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

1–2 . . . . . . . . . . . . . . . . .

3–4 . . . . . . . . . . . . . . . . .

5–7 . . . . . . . . . . . . . . . . .

Type:

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

Toileting . . . . . . . . . . . . .

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

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

Transferringz . . . . . . . . .

Walking . . . . . . . . . . . . .

Getting outside . . . . . . .

75 years andover

Number:

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

1–2 . . . . . . . . . . . . . . . . .

3–4 . . . . . . . . . . . . . . . . .

5–7 . . . . . . . . . . . . . . . . .

8.2

20.1

27.9

43.8

37.0

48.2

73.7

88.0

59.2

34.1

36.7

5.5

17.3

25.0

40.5

33.7

44.7

67.2

79.9

54.7

31.9

31.9

3.8

14.1

21.4

34.9

484,600

10.5

24.1

26.5

38.9

25.6

42.2

65.7

84.6

55.7

33.8

40.7

9.2

22.8

24.9

35.2

22.5

38.4

60.6

78.6

50.6

31.6

37.3

7.6

19.8

22.2

29.9

1,004,900

7.1

18.2

28.5

46.2

42.5

51.0

77.6

89.6

60.9

34.3

34.8

3.7

14.6

25.1

43.0

39.1

47.8

70.5

80.5

56.7

32.0

29.2

2.0

11.3

21.0

37.3

685,500

2.8

14.5

30.1

52.6

51.0

58.1

85.7

95.4

69.1

37.4

31.7

1.9

13.4

28.8

51.1

49.3

56.6

82.7

91.6

67.1

36.2

29.9

1.2

11.3

25.0

45.8

Number

78,800 194,300

Percent

*2.6

8.7

33.2

55.5

60.1

65.5

87.8

96.4

69.4

38.7

36.1

*2.4

7.8

30.3

52.8

57.3

62.5

82.6

90.5

65.1

36.7

32.5

*2.O

*7.2

22.7

40.2

17.2

28.4

25.2

29.2

27.0

33.6

59.9

77.6

37.2

25.4

36.0

6.8

19.1

19.0

27.3

24.0

31.2

50.5

63.1

34.0

22.7

26.6

*2.4

11,1

14.6

21.4

214,700

10.2

18.4

25.5

45.9

37.0

49.5

73.7

87.3

60.0

36.4

36.9

5.3

15.2

22.9

42.1

33.7

45.9

66.7

78.1

55.1

33.9

31.8

2.9

11.7

18.0

34.9

215,200

8.2

20.6

24.5

46.7

39.2

48.0

74.5

87.7

58.2

37.3

36.8

4.3

15.9

20.8

42.9

35.2

44.3

66.1

77.4

53.4

35.5

31.1

*2.3

12.4

16.9

36.5

58,800

21.9

32.1

20.5

25.5

18.8

29.3

50.5

73.6

33.0

24.2

35.3

*9.7

22.8

15.9

21.6

15.4

26.1

40.9

58.7

27.7

19.4

25.8

*2.4

14.6

*9.8

15.0

83,200

8.4

25.6

29.9

36.1

33.8

39.7

70.0

83.5

41.4

23.8

47.3

*0.7

12.4

13.0

20.3

15.7

24.0

36.1

42.9

22.5

16.6

18.8

*0.8

*5.3

*6.5

9.4
Table 6. Percent of nursing home residents, by presence of selected cognitive disabilities, age, and number and type of activities

of daily living for which help of another person is required: United States, 1985–Con.

[Data are based on personal interviews of the nursing home staff most knowledgeable about the residents sampled]

Age and ADL’s for which No Organic Schizophrenia Alcohol

help of another person cognitive Cognitive brain Alzheimer’s and other Depressive Anxiety and drug Mental

is required Total disabilities disabilities~ .swndromes disease psychoses disorders disorders abuse retardation

75 years and over– Con.

Type:

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

Toileting . . . . . . . . . . . . .

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

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

Transferringz

Walking

Getting outside

85 years and over

Number:

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

1-2 . . . . . . . . . . . . . . . . .

3-4 . . . . . . . . . . . . . . . . .

5-7 . . . . . . . . . . . . . . . . .

Type:

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

Toileting . . . . . . . . . . . . .

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

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

Transferring2 . . . . . . . . .

Walking . . . . . . . . . . . . .

Getting outside . . . . . . .

Percent

29.2

38.3

57.5

68.1

47.4

27.7

26.9

19.3

32.8

52.0

68.2

43.5

27.8

32.6

44.2 18.8

46.3 24.1

63.1 38.8

69.4 45.4

48.3 27.2

27.3 18.5

23.9 18.3

34.0

40.9

60.2

68.0

49.2

27.7

24.1

44.1

50.1

73.3

80.8

60.0

32.4

26.2

28.2

37.7

53.9

62.8

45.7

27.7

26.5

30.5

37.6

55.0

64.1

45.2

29.4

25.7

11.1

16.5

27.7

38.0

18.0

13.4

18.4

7.3

11.0

17.5

19.5

11.9

8.9

*6.7

1.5

6.7

12.0

20.3

3.5

11.1

12.4

16.6

*0.6

4.6

11.8

22.0

*0.9

*1.8

9.1

18.8

*0.4

5.2

14.6

28.3

*0.6

3.9

7.1

11.4

*0.6

4.8

8.1

19.1

—

4.3

8.8

16.7

*3.9

*2.4

*6.7

*0.6

*2.1

*2.9

16.8

22.5

32.7

37.8

27.6

15.9

14.3

10.2

18.9

29.0

37.8

23.7

15.6

18.2

20.0

24.3

34.4

37.8

29.5

16.0

12.5

26.8

31.1

43.7

47.4

37.5

19.5

14.6

20.3

20.0

27.8

29.3

24.0

12.0

9.2

10.7

13.5

19.5

21.8

15.0

9.3

7.5

13.1

18.1

25.9

29.1

22.4

14.0

11.5

15.9

19.5

28.1

31.2

23.7

15.1

11.3

*5.9

*6.3

11.6

13.4

*8.4

*4.4

*6.2

*2.1

*4.O

*4.7

*5.4

*4.5

*2.3

*1 .3

‘Includes residents with all types of cognitive disabilities. Residents with multiple disabilities are counted only once in the total.

~ransferring means getting in and out of a bed or chair.

NOTE: Column percents may not add to 100 because of rounding. ADL is activity of daily living.

SOURCE: National Center for Health Statistics: Data from the National Nursina Home Survev.

u–––- .
Table 7. Percent of nursing home residents, by presence of selected cognitive disabilities, age, and number and type of

instrumental activities of daily living for which help of another person is required: United States, 1985

[Data are based on personal interviews of the nursing home staff most knowledgeable about the residents sampled]

Age and IADL’s for which No Organic Schizophrenia Afcohol

help of another person is cognitive Cognitive brain Alzheimer’s and other Depressive Anxiety and drug Mental

required Total disabilities disabilities syndromes disease psychoses disorders disorders abuse retardation

Number

All ages . . . . . . . . . . . . . . . 1,489,600 485,300 1,004,300 685,400 78,700 194,300 214,600 214,700 58,900 82,700

Percent

Number:

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

1–2 . . . . . . . . . . . . . . . . .

3–4 . . . . . . . . . . . . . . . . .

Type:

Care of personal

possessions. . . . . . . . .

Handling money . . . . . .

Securing personal

items . . . . . . . . . . . . . .

Using the telephone . . .

65 years and over

15.3

14.9

69.9

25.7 10.2 5.5 *3.2 18.6 13.3 12.5 25.8 8.0

19.9 12.5 9.3 *5.6 13.9 15.4 15.3 22.9 19.0

54.5 77.3 85.2 91.2 67.5 71.3 72.2 51.2 73.0

73.4

75.3

59.3 80.3 87.8 93.1 68.7 74.9 76.4 55.7 79.4

61.3 82.1 87.7 94.0 75.6 76.3 77.9 62.8 86.8

76.2

62.7

63.9 82.2 89.0 93.7 71.9 77.2 78.3 61.7 78.3

49.6 69.0 77.1 84.2 58.2 65.3 65.7 44.4 59.9

Number:

None . . . . . . . . .

1–2 . . . . . . . . . . .

3–4 . . . . . . . . . . .

Type:

Care of personal

possessions. . .

Handling money

12.3

12.6

63.4

23.0

18.7

50.4

7.1

9.7

69.6

4.6

8.5

82.1

*3.O

*5.5

85.1

9.4

8.1

54.9

8.7

12.5

64.7

8.6

10.8

65.1

13.9

17.6

38.4

*2.9

8.6

35.4

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

66.4

67.6

54.6

57.1

72.1

72.7

84.3

84.1

86.7

88.3

55.5

58.1

67.3

68.5

67.7

68.0

43.7

46.2

38.3

39.0

S;~wJg personal

. . . . . . . . . . . . . .

Using the telephone . . .

75 years and over

Number:

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

1–2 . . . . . . . . . . . . . . . . .

3-4 . . . . . . . . . . . . . . . . .

Type:

Care of personal

possessions. . . . . . . . .

Handling money . . . . . .

Sww$g personal

. . . . . . . . . . . . . .

Using the telephone . . .

-J

69.0

57.1

59.5

45.8

73.6

62.6

85.4

74.1

87.4

78.9

57.6

48.6

68.9

59.1

69.4

58.6

48.8

36.1

37.3

27.8

9.7

10.4

54.1

19.4

16.2

43.8

5.0

7.6

59.0

3.7

7.4

72.4

*2.2

*3.7

66.5

4.0

5.1

40.2

6.3

9.8

51.4

6.5

8.5

53.3

*5.7

11.6

24.6

*1 .2

*3.9

16.6

56.5

57.6

47.7

49.8

60.7

61.3

74.2

74.1

67.3

67.5

40.3

42.4

53.7

54.8

55.7

55.5

27.1

30.6

18.3

17.6

58.8

48.8

51.6

39.7

62.3

53.2

75.5

65.0

69.0

60.0

41.9

36.3

54.3

47.7

56.3

48.4

28.2

23.4

18.0

13.2
~ Table 7. Percent of nursing home residents, by presence of selected cognitive disabilities, age, and number and type of

instrumental activities of daily living for which help of another person is required: United States, 1985 – Con.

[Data are based on personal interviews of the nursing home staff most knowledgeable about the residents sampled]

Age and IADL’s for which No Organic Schizophrenia Alcohol

help of another person is cognitive Cognitive brain Alzheimer’s and other Depressive Anxiety and drug Mental

required Total disabilities disabilities syndromes disease psychoses disorders disorders abuse retardation

85 years and over Percent

Number:

None . . . . . . . . . . . . . . . 4.4 9.4 2.0 1.6 *1.4 *1.2 *2.3 *2.O *0.7

1-2. . . . . . . . . . . . . . . . . 5.5

—

9:4 3.5 3.7 *0.7 *2.O 3.8 4.0 *3.7 *1 .0

3-4, . . . . . . . . . . . . . . . . 30.7 24.8 33.5 43.2 28.4 19.8 24.3 26.6 *8.5 *4.4

Type:

Care of personal

possessions. . . . . . . . . 31.7 27.2 33.9 43.6 27.6 19.7 24.7 27.7 *9.6 *5.7

Handling money . . . . . . 32.4 28.3 34.4 43.9 28.2 20.4 25.9 28.4 11.5 *4.7

Securing personal ●

items2 . . . . . . . . . . . . . . 33.3 29.5 35.2 44.9 29.0 20.7 25.4 27.5 *1O.I *4.8

Using the telephone 27.4 22.5 29.7 38.3 25.4 . 17.4 21.7 23.6 *9.O *3.9

‘Includes residents with all types of cognitive disabilities. Residents with multiple disabilities are counted only once in the total.

2Securing personal items means shopping for items such as newspapers, toilet articles, and snack foods.

NOTE: Column percents may not add to 100 because of rounding. IADL is instrumental activity of daily living.

SOURCE: National Center for Health Statistics: Data from the National Nursing Home Survey.
Table 8. Percent of nursing home residents, by presence of selected cognitive disabilities, age, and continence status: United

States, 1985

[Data are based on personal interviews of the nursing home staff most knowledgeable about the residents sampled]

No Organic Schizophrenia Alcohol

Age and cognitive Cognitive brain Alzheimer’s and other Depressive Anxie~ and drug Mental

continence status Total disabilities disabi/itiesl syndromes disease psychoses disorders disorders abuse retardation

Number

All ages . . . . . . . . . . . . . . . 1,310,000 70,900 173,000

100.0

57.6

13.1

4.5

24.9

48.1

12.4

3.9

23.4

38.7

11.2

3.4

20.2

20.3

6.5

1.8

11.4

432,500 877,500 592,000 188,300 188,400

100.0

58.0

13.4

4.6

23.9

44.8

12.5

3.6

23.2

33.3

11.5

*2.9

20.1

14.3

6.1

*1 .4

9.8

52,500 70,900

Percent

100.0 100.0

31.9 68.0

All statuses . . . . . . . . . . . .

Continent . . . . . . . . . . . . . .

Incontinent:

Bladder only . . . . . . . . .

Bowel only . . . . . . . . . . .

Both . . . . . . . . . . . . . . . .

100.0

73.9

100.0

49.5

100.0

38.0

100.0

59.3

100.0

76.1

100.0

62.7

9.3

4.3

12.4

14.9

4.5

31.1

17.3

5.1

39.6

17.9 12.0

*5.6 *2.7

44.6 17.3

15.9

4.0

20.8

*8.2

*0.8

14.9

8.9

*2.6

25.8

65 years and over

Continent . . . . . . . . . . . . . .

Incontinent:

Bladder only . . . . . . . . .

Bowel only . . . . . . . . . . .

Both . . . . . . . . . . . . . . . .

67.9 38.4 34.9 29.3 40.1 46.9 48.0 22.2

8.6

3.8

11.3

14.2

4.0

29.3

16.8

4.8

38.7

17.4 11.1

*4.9 *2.4

41.0 16.6

14.8

3.5

19.8

*7.1

*0.8

12.8

*5.9

*1 .5

14.7

75 years and over

Continent . . . . . . . . . . . . . .

Incontinent

Bladder only . . . . . . . . .

Bowel only . . . . . . . . . . .

Both . . . . . . . . . . . . . . . .

58.1 29.1 29.1 22.1 23.4 34.2 25.1 8.6

8.0

3.3

9.7

12.7

3.4

25.3

15.4

4.2

34.3

14.6 8.5

*3.4 *1 .7

30.9 13.3

13.1

*2.6

16.4

*6.1

*9.6

*4.3

*1.1

*6.O

85 years and over

Continent . . . . . . . . . . . . . .

Incontinent

Bladder only . . . . . . . . .

Bowel only . . . . . . . . . . .

Both . . . . . . . . . . . . . . . .

32.2 14.5 16.0 9.0 9.9 15.0 *7.6 *1.1

4.6

1.6

4.8

7.4

1.8

14.6

9.6

2.4

20.2

*7.5 *2.8

*1.1 *1.2

13.8 7.3

5.5

*1.O

8.1

*1.3

*3.1

*1 .7

*0.4

*1 .3

‘Includes residents with all types of cognitive disabilities. Residents with multiple disabilities are counted only once in the total,

NOTE: Column percents may not add to 100 because of rounding.

SOURCE: National Center for Health Statistics: Data from the National Nursing Home Survey.

-J

w
~ Table 9. Percent of nursing home residents, by presence of selected cognitive disabilities, age, and type of therapy received in

past month: United States, 1985

[Data are based on personal interviews of the nursing home staff most knowledgeable about the residents sampled]

No Organic Schizophrenia Alcohol

Age and therapy received cognitive Cognitive brain A/zheimer’s and other Depressive Anxiety and drug Mental

in past monthi Total disabilities disabilities? syndromes disease psychoses disorders disorders abuse retardation

Number

77,500 189,100

Percent

100.0 100.0

72.0 64.5

Total. . . . . . . . . . . . . . . . . 1,464,500

100.0

70.0

6.2

11.3

23.4

63.2

4.2

9.6

19.9

53.6

3.1

8.0

16.4

29.7

1.5

4.6

8.6

476,500 988,000 677,800 213,100 212,000

100.0

65.5

9.8

12.6

24.6

58.0

6.2

9.4

19.9

48.0

3.8

7.3

15.9

22.3

*1.5

4.6

8.5

58,200 81,400

All ages

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

Notherapy . . . . . . . . . . . . .

Mental health evaluation

or treatment . . . . . . . . . . .

Social services by social

worker . . . . . . . . . . . . . . .

Othef l . . . . . . . . . . . . . . .

100.0

70.7

100.0

69.8

100.0

72.7

100.0

63.6

100.0

47.3

100.0

63.1

3.2 7.6 4,7 *5.2 18.5 11.6 9.5 12.4

9.9

26.1

11.9

22.1

11,2

20,9

10.7 11.6

22.6 21.2

14.7

26.3

8.8

16.2

19.7

28.5

65 years and over

Notherapy . . . . . . . . . . . . .

Mental health evaluation

ortreatment . . . . . . . . . . .

Social services by social

worker . . . . . . . . . . . . . . .

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

65.7 62.1 69.9 68.0 49.7 55.5 49.3 29.9

2.6 4.9 4.1 *5.2 9.0 8.5 *7.4 *4.2

9.0

22.8

9.9

18.6

10.5

19.6

10.3 8.1

21.2 15.3

12.9

22.6

*6.4

16.0

8.0

11.6

75 years and over

Notherapy . . . . . . . . . . . . .

Mental health evaluation

ortreatment . . . . . . . . . . .

Social services by social

worker . . . . . . . . . . . . . . .

Othefi . . . . . . . . . . . . . . . .

57.1 52.0 61.3 52.3 34.8 44.1 31.4 14.5

2.2 3.5 3.3 *4.1 4.7 5.4 *2.1 *2.7

8.1

19.2

8.1

15.0

9.2

17.0

8.0 5.1

14.8 10.0

9.2

17.6

*2.4

*9.1

*3.9

*4.1

85 years and over

Notherapy . . . . . . . . . . . . .

Mental health evaluation

ortreatment . . . . . . . . . . .

Social services by social

worker . . . . . . . . . . . . . . .

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

31.6 28.8 35.8 19.5 16.2 21.1 10.8 *4.9

1.3 1.7 1.9 *2.3 *2.2 *2.4 *0.4

5.2

10.2

4.3

7.9

5.3

9.7

*6.2 *2.8

8.4 5.2

3.7

7.8

*0.5

*1.7

*0.2

*0.6

‘Therapy received either inside oroutside the nursing home.

‘Includes residents with alltypes ofcognitive disabilities. Residents with multiple disabilities arecounted only once inthetotaI.

3Residents with more than onetype of therapy are counted only once.

41ncludes physical, occupational, recreational, and speech or hearing therapy.

NOTE: Column percents may add to more than 100 because a person may have received several types of therapy.

SOURCE: National Center for Health Statistics: Data from the National Nursing Home Survey.
Table 10. Percent of nursing home residents, by presence of selected cognitive disabilities, age, and primary source of payment:

United States, 1985

[Data are based on personal interviews of the nursing home staff most knowledgeable about the residents sampled]

No Organic Schizophrenia Alcohol

Age and primary source cognitive Cognitive brain Alzheimer’s and other Depressive Anxiety and drug Mental

of payment in last month Total disabilities disabilities syndromes disease psychoses disorders disorders abuse

.,

retardation

All sources. . . . . . . . . . . . .

All ages

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

Own income or family

support . . . . . . . . . . . . . .

Medicare . . . . . . . . . . . . . .

Medicaid:

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

Skilled care . . . . . . . . . .

Intermediate care. . . . . .

Veteran’s Administration

contract . . . . . . . . . . . . . .

Al[ other* . . . . . . . . . . . . . .

65 years and over

All sources . . . . . . . . . . . . .

Own income or family

support . . . . . . . . . . . . . .

Medicare . . . . . . . . . . . . . .

Medicaid:

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

Skilled care . . . . . . . . . .

Intermediate care. . . . . .

Veteran’s Administration

contract . . . . . . . . . . . . . .

Allother2 . . . . . . . . . . . . . .

75 years and over

All sources . . . . . . . . . . . . .

Own income or family

support . . . . . . . . . . . . . .

Medicare . . . . . . . . . . . . . .

Medicaid:

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

Willedc are. . . . . . . . . .

Intermediate care. . . . . .

Veteran’s Administration

contract . . . . . . . . . . . . . .

4 Allother2 . . . . . . . . . . . . . .

(n

1,470,100

100.0

42.2

1.4

51.0

17.8

33.2

1.1

4.2

88.4

39.0

1.4

44.3

15.2

29.1

0.7

3.1

74.5

34.1

1.0

36.9

13.1

23.9

*0.4

2.1

476,300

100.0

48.2

2.5

44.3

14.8

29.4

*1.O

4.0

92.0

45.8

2.4

39.7

12.8

27.0

*0.7

3.5

79.8

40.2

1.6

35.0

11.4

23.6

*0.4

2.8

993,800

100.0

39.4

0.9

54.3

19.2

35.0

1.2

4.3

86.7

35.7

0.9

46.6

16.3

30.2

0.7

2.9

72.0

31.3

0.8

37.9

13.8

24.0

*0.3

1.7

682,100

100.0

41.2

1.1

54.4

20.0

34.4

1.0

2.1

94.9

39.7

1.1

51.5

18.7

32.7

*0.7

1.9

83.2

35.5

1.0

44.9

16.8

28.0

*0.4

1.5

79,400

100.0

52.4

*0.4

43.5

16.8

26.4

*1.9

*1.6

93.4

51.2

*0.4

39.4

15.5

24.3

*1.6

*0.7

71.7

42.4

*0.4

28.7

13.3

15.0

*0.3

*0.5

Number

191,100

Percent

100.0

32.8

*1.1

56.1

17.1

39.3

*2.5

7.2

72.8

24.3

*1.1

42.3

11.7

30.7

*1 .2

4.0

50.4

19.2

*0.7

27.8

8.9

18.9

*0.3

*2.3

211,700

100.0

41.3

*0.7

52.8

16.9

35.8

*1 .4

4.1

86.6

36.8

*0.7

45.9

14.1

31.8

*0.2

*2.7

68.3

29.9

*0.6

35.6

11.2

24.5

*0.2

*1.7

213,200

100.0

40.5

*1 .0

52.1

20.3

31.8

*1 .0

5.4

84.2

36.0

*1.0

42.8

16.4

26.3

*0.5

3.9

67.8

29.9

*0.8

34.6

13.6

21.1

*2.5

57,300

100.0

32.5

*1.1

51.0

20.5

30.7

*6.1

*8.2

72.6

26.0

*0.7

37.5

12.1

25.4

*3.5

*4.7

42.0

14.9

*0.5

24.6

*7.7

16.5

*1 .7

*1.1

82,300

100.0

18.1

*0.5

64.7

16.9

48.6

*0.4

16.3

45.8

8.4

*0.5

30.1

7.6

22.4

—

7.4

21.3

*4.3

*0.5

14.5

*3.7

10.7

*2.6
~ Table 10. Percent of nursing home residents, by presence of selected cognitive disabilities, age, and primary source of payment:

United States, 1985 – Con.

[Data are based on personal interviews of the nursing home staff most knowledgeable about the residents sampled]

No Organic Schizophrenia Alcohol

Age and primary source cognitive Cognitive brain Alzheimer’s and other Depressive Anxiety and drug Mental

of payment in last month Total disabilities disabi/itiesl syndromes disease psychoses disorders disorders abuse retardation

85 years and over Percent

All sources . . . . . . . . . . . . . 40.6 43.7 39.1 48.4 30.1 23.1 30.4 32.5 13.5 *5.8

Own income or family

support . . . . . . . . . . . . . . 18.5 22.0 16.9 20.2 15.1 9.3 13.0 13.9 *6.6 *1 .0

Medicare . . . . . . . . . . . . . . *0.4 ‘0.7 *0.2 *0.3 — *0.3 *0.2 ‘0.3 *0.5

Medicaid:

—

Total . . . . . . . . . . . . . . . . 20.6 19.1 21.3 26.9 14.9 13.0 16.3 17.2 *6.9 *3.7

Skilled care . . . . . . . . . . 7.5 6.0 8.2 10.3 *6.7 5.0 6.0 7.2 *1 .7 *2.O

Intermediate care. . . . . . 13.1 13.1 13.1 16.6 8.2 7.9 10.3 10.0 *5.O *1.6

Veteran’s Administration

contract . . . . . . . . . . . . . . *0.1 *0.2 *0. I *0.2 *0.1

Allother2 . . . . . . . . . . . . . .

— — —

1,0 1.7 0.7 *0.9 *0.3 *0.6 *1 .1 *1 .2 — *0.1

1Includes residents with all types of cognitive disabilities. Residents with multiple disabilities are counted only once in the total.

21ncludes other Government assistance or welfare, religious or volunteer agencies, life care, and other sources.

NOTE: Column percents may not add to 100 because of rounding.

SOURCE: National Center for Health Statistics: Data from the National Nursing Home Survey.
Table 11. Percent of nursing home residents, by presence of selected cognitive disabilities, age, and living arrangement prior to

admission: United States, 1985

[Data are based on personal interviews of the nursing home staff most knowledgeable about the residents sampled]

Age and living No Organic Schizophrenia Alcohol

arrangement prior to cognitive Cognitive brain Alzheimer’s and other Depressive Anxiety and drug Mental

admission Total disabilities disabilities syndromes disease psychoses disorders disorders abuse retardation

Number

470,300 971,300 664,600 78,253 185,500 206,600 209,900 55,800 79,600

Percent

Alleges . . . . . . . . . . . . . . . 1,441,600

100.0

39.3

13.9

22.4

60.7

5.3

5.1

36.3

13.4

20.2

52.2

4.8

2.7

32.1

12.2

17.5

42.3

4.0

1.6

All arrangements. . . . . . . . 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

Private or semiprivate

residence . . . . . . . . . . . .

Alone . . . . . . . . . . . . . . .

With others . . . . . . . . . .

Another health facilityz . . .

Nursing home . . . . . . . .

Mental hospital, unit, or

center . . . . . . . . . . . . . .

65 years and over

Private or semiprivate

residence . . . . . . . . . . . .

Alone . . . . . . . . . . . . . . .

With others . . . . . . . . . .

Another health facilityz . . .

Nursing home . . . . . . . .

Mental hospital, unit, or

center . . . . . . . . . . . . . .

75 years and over

Private or semiprivate

residence . . . . . . . . . . . .

Alone . . . . . . . . . . . . . . .

With others . . . . . . . . . .

Another health facilityz . . .

Nursing home . . . . . . . .

Mental hospital, unit, or

center . . . . . . . . . . . . . .

42.8

18.1

21.1

57.2

5.4

37.5

11.9

23.0

62.5

5.3

40.5

12.5

25.0

59.5

5.4

46.3

10.0

34.2

53.7

*4.9

26.8

9.9

14.8

73.2

4.2

36.4

13.5

20.8

63.6

5.8

35.3

13.0

20.0

64.7

5.9

29.4

12.2

15.6

70.6

*7.5

28.5

*4.O

22.7

71.5

*4.4

*0.2 7.4 3.5 *2.7 22.5 6.7 7.3 *6.4 25.4

40.6

18.0

19.3

51.8

4.8

34.2

11.2

20.7

52.4

4.8

39.5

12.2

24.4

55.7

5.2

44.8

9.9

33.9

48.1

*4.9

22,3

8.3

12.1

50.7

3.6

32.7

12.4

18.5

52.8

5.3

31.2

11.6

17.5

53.4

5.5

23.4

*1 0.4

11.5

47.2

*6.6

12.5

*2.7

9.2

35.0

*2.8

*0.2 3.9 2.6 *2.3 11,4 3.9 3.2 *2.9 9.4

30.4

10.3

18.0

41.5

4.0

36.0 36.7

11.5 9.2

21.8 26.7

47.4 35.1

4.6

17.5

7.1

9.1

32.9

*2.8

28.9 27.6 16.6 *5.2

11.5 10.1 *8.2 *1.1

15.7 15.6 *7.7 *4.1

38.6 41.0 25.1 16.9

4.4 4.5 *4.1 *0.7

35.7

16.1

16.5

43.9

4.0

*0.1 2.3 2.0 *1.8 5.3 *1 .3 *I .3 *1 ,1 *5.5
~ Table 11. Percent of nursing home residents, by presence of selected cognitive disabilities, age, and living arrangement prior to

admission: United States, 1985 —Con.

[Data are based on personal interviews of the nursing home staff most knowledgeable about the residents sampled]

Age and living No Organic Schizophrenia Alcohol

arrangement prior to cognitive Cognitive brain Alzheimer’s and other Depressive Anxiety and drug Mental

admission Total disabilities disabilities syndromes disease psychoses disorders disorders abuse retardation

85 years and over Percent

Private or semiprivate

residence . . . . . . . . . . . . 18.1 20.4 17.0 20.8 16.0 9.7 13.5 13.9 *7.5 *1.O

Alone . . . . . . . . . . . . . . . 7.2 9.2 6.3 7.3 *4.9 3.8 6.3 4.6 *4. 1

With others . . . . . . . . . . 9.4

—

9.2 9.5 11.7 10.9 4.7 6.2 7.6 *3.1 *0.8

Another health facility2 . . . 22.5 23.1 22.2 27.8 14.5 13.8 16.9 18.7 *5.8 *4.5

Nursing home . . . . . . . . 1.8 1.9 1.8 2.3 *0.6 *1 .0 *1.6 *1 .9 *0.4

Mental hospital, unit, or

—

center . . . . . . . . . . . . . . 0.5 *0. I 0.7 *0.8 *1.O *1 .7 *0.4 *0.2 *0.7 *0.4

‘Includes residents with all types of cognitive disabilities. Residents with multiple disabilities are counted only once in the total.

2Does not add to total shown because of missing information and other categories.

NOTE: Column percents may not add to 100 because of rounding.

SOURCE: National Center for Health Statistics: Data from the National Nursing Home Survey.
Table 12. Percent of nursing home discharges, by presence of selected cognitive disabilities, age, duration of stay, and discharge

status: United States, 1984-85

[Data are based on personal interviews of the nursing home staff most knowledgeable about the discharges sampled]

No Organic Schizophrenia Alcohol

Age, duration of stay, and cognitive Cognitive brain Alzheimer’s and other

discharge status

Depressive

Total

Anxiety

disabilities disabilities

and drug Mental

syndromes disease psychoses disorders disorders abuse retardation

Number

All ages . . . . . . . . . . . . . . .

All ages

Duration of stay:

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

Less than 6 months. ., .

6 months to less than

I year . . . . . . . . . . . . . .

1 year to less than

3 years . . . . . . . . . . . . .

3 years or more . . . . . . .

Discharge status:

Alive . . . . . . . . . . . . . . . .

Dead . . . . . . . . . . . . . . .

65 years and over

Duration of stay:

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

Less than 6 months. . . .

6 months to less than

I year . . . . . . . . . . . . . .

1 year to less than

3 years . . . . . . . . . . . . .

3years or more. ,. ..,.

Discharge status:

Alive . . . . . . . . . . . . . . . .

Dead . . . . . . . . . . . . . . .

75 years and over

Duration of stay:

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

Less than 6 months. . . .

6 months to less than

I year . . . . . . . . . . . . . .

1 year to less than

3 years . . . . . . . . . . . . .

3years or more . . . . . . .

2

1,221,300

100.0

56.3

17.7

15.1

10.9

71.7

28.1

88.3

49.3

15.5

13.5

10.0

61.5

26.7

74.3

40.2

13.3

11.5

9.2

887,900

100.0

59.3

17.5

13.4

9.8

69,8

29.9

89.9

53.1

15.5

12.0

9.2

61.5

28.3

76.1

43.4

13.5

10.5

8.7

333,400

100.0

48.3

18.2

19.7

13.7

76.7

23.3

84.1

39.0

15.5

17.3

12.2

61.5

22.4

69.4

31.8

12.6

14.3

10.6

172,200

100.0

43.5

19.1

21.0

16.7

70.7

29.7

96.5

41.6

18.3

20.0

16.4

67.2

28.9

86.4

36.8

16.3

17.7

15.6

47,600

100.0

46.2

18.6

28.3

*6. 1

66.2

33.1

92.9

43.0

18.3

25.9

*5.1

61.5

30.8

74.3

37.1

14.7

19.2

*3.8

75,700

Percent

100.0

48.1

18.8

20.3

12.5

82.1

17.7

72.7

33.4

14.0

14.8

10.2

54.6

17.2

53.9

25.3

9.4

12.1

7.3

29,300

100.0

58.6

16.2

17.0

*7.7

89.6

*9.4

84.6

49.3

*1 2.9

*14.6

*7.9

76.9

*8.9

68.1

41.9

*9.4

*1O.1

*6.5

13,400

100.0

61.4

*12.9

*11.O

*16.8

91.3

*10.2

80.3

44.8

*9.9

*7.4

*14.6

67.1

*9.7

40.2

*4.8

*6.3

*10.9

26,900

100.0

66.5

18.5

*6.2

*6.9

94.5

*3.8

48.2

29.1

*8.5

*5.5

*2.7

42.0

*3.6

20.3

*1 2.8

*2.4

*4.2

*1 .7

12,200

100.0

45.0

*14.1

*1 9.7

*27.2

86.6

*1 3.4

44.2

*1 4.8

*3.1

*9.4

*1 6.0

36.9

*1 0.7

*22.3

*4.O

—

*4.6

*1 2.0
~ Table 12. Percent of nursing home discharges, by presence of selected cognitive disabilities, age, duration of stay, and discharge

status: United Statesj 1984-85 – Con.

[Data are based on personal interviews of the nursing home staff most knowledgeable about the discharges sampled]

No Organic Schizophrenia Alcohol

Age, duration of stay, and cognitive Cognitive brain A/zheimer’s and other Depressive Anxiety

discharge status Total disabilities

and drug Mental

disabilities syndromes disease psychoses disorders disorders abuse retardation

75 years and over–Con. Percent

Discharge status:

Alive . . . . . . . . . . . . . . . . 50.5 50.9 49.6 59.1 47.9 40.7 61.1 50.5 18.4 *10. I

Dead . . . . . . . . . . . . . . . 23.6 25.1 19.7 27.2 26.7 13.0 *6.9 *I 0.7 *1 .1 *7.1

85 years and over

Duration of stay:

Total . . . . . . . . . . . . . . . . 38.1 38.7 36.6 51.4 25.4 19.7 23.8 38.1 *5.2

Less than 6 months. . . . 18.0

*7.6

19.1 15.2 20.2 *9.3 7.3 *1 5.0 *29.5 *2.5

6 months to less than

I year . . . . . . . . . . . . . . 6.6 6.9 6.0 8.6 *3.9 *3.7 *1.1 *0.6 *1.2

1 year to less than

3 years . . . . . . . . . . . . . 6.8 6.3 8.1 10.4 10.5 6,3 *5.1 *1 .2 *1.9 *1.4

3years or more . . . . . . . 6.6 6.4 7.4 12.1 *1 .5 *2.7 *3.3 *7.3 *0.6 *6.O

Discharge status:

Alive . . . . . . . . . . . . . . . . 23.5 23.4 23.8 32.4 12.1 13.3 22.6 34.2 *6.4

Dead . . . . . . . . . . . . . . . 14.5

*4.7

15.2 12.8 19.0 13.8 6.6 *1.8 *6.6 *2.9

‘Includes residents with all types of cognitive disabilities. Residents with multiple disabilities are counted only once in the total.

NOTE: Column percents may not add to 100 because of rounding.

SOURCE: National Center for Health Statistics: Data from the National Nursing Home Survey.
Table 13. Percent of frail persons 65 years of age and over using selected community health and

social services, by race, sex, age, and help with activities of daily living: United States, 1984

[Data are based on personal interviews of the functionally impaired Medicare eligibles living in the community]

Health and social services

Number of Hospital- Auxiliary Mental RehabilRace, sex, age, and persons in ization Physician health health itation Senior

help with ADL’s thousands last year office care servicesl services therapie$ centers

Race

White, ,,, , . . . . . . . . . . . . . . . 4,872

Another,. , . . . . . . . . . . . . . . . 782

34.7

27.4

38.8

41.7

19.1

12,9

0.9

*0.8

3.5

3.2

6.5

6.5

Sex

Male. ,,, . . . . . . . . . . . . . . . . . 1,951

Female, . . . . . . . . . . . . . . . . . . 3,703

35.9

32.5

37.7

40.0

15.0

19.9

0.9

0.9

3.3

3.5

5.0

7.3

5.9

7.7

6.5

6.9

5.1

Age

65-74 years,,,..,.,....,., 2,083

75–84 years.....,,,,...,.. 2,459

34.6

34.8

33.7

33.2

29.7

41.5

39.5

39.2

37.9

34.3

19.0

18,2

18.2

17.7

16.8

1.8

*0.5

0.9

*0.4

*0. O

4.3

3.3

3.5

3.0

2.2

65 years And over. . . . . . . . . . 5,654

75 years and over. .,....... 3,571

85 years And over. . . . . . . . . . 1,133

Help with ADLs3

No help received. ., . . . . . . . . 4,023

Help with l.........,,.,.. 765

Help with 2 . . . . . . . . . . . . . . . 318

Helpwith 3-5, ,,, ,. ..,,.., 548

29.3

38.4

41.8

55.1

38.8

42.0

44.7

35.4

19.0

17.9

17,9

12,6

0.8

*1.3

*1.3

*1.6

2.3

3.7

4,4

11.1

7.8

4.3

3.5

*1.8

‘Includes dentists, podiatrists, optometrists, and chiropractors,

21ncludes physical therapists, occupational therapists, speech therapists, and hearing therapists.

3Receives help of another person with the following activities of daily living (ADL’s): bathing, dressing, transferring, toileting,

eating,

SOURCE: National Long Term Care Survey, 1984.

181
Table 14. Percent of frail persons 65 years of age and over using only informal helpers in 1982 by

use in 1984, according to race, sex, age, and help with activities of daily living: United States

[Data are based on personal interviews of the functionally impaired Medicare eligibles living in the community]

Number of informal helpers or status in 1984

Race, sex, age, help received with Number of

ADL’s, and number of informal persons in /nstituhelpers in 1982 thousands o 1 2 3 tionalized Deceased

Total:

I helper . . . . . . . . . . . . . . . . . . . .

2 helpers, . . . . . . . . . . . . . . . . . .

3or more helpers . . . . . . . . . . . .

Race

White:

I helper . . . . . . . . . . . . . . . . . . . .

2heIpers . . . . . . . . . . . . . . . . . . .

3or more helpers . . . . . . . . . . . .

All othec

I helper . . . . . . . . . . . . . . . . . . . .

2 helpers . . . . . . . . . . . . . . . . . . .

3ormore helpers.....,,..,..

Sex

Male:

I helper . . . . . . . . . . . . . . . . . . . .

2 helpers . . . . . . . . . . . . . . . . . . .

3or more helpers . . . . . . . . . . . .

Female:

I helper . . . . . . . . . . . . . . . . . . . .

2 helpers . . . . . . . . . . . . . . . . . . .

3or more helpers . . . . . . . . . . . .

Age

65–74 years:

I helper..,,....,,,.,,.,,,,.

2 helpers . . . . . . . . . . . . . . . . . . .

3or more helpers . . . . . . . . . . . .

75–84 years:

I helper . . . . . . . . . . . . . . . . . . . .

2 helpers . . . . . . . . . . . . . . . . . . .

3or more helpers . . . . . . . . . . . .

65 years and over:

I helper, . . . . . . . . . . . . . . . . . . .

2 helpers . . . . . . . . . . . . . . . . . . .

3or more helpers . . . . . . . . . . . .

75 years and over:

I helper ., . . . . . . . . . . . . . . . . . .

2 helpers . . . . . . . . . . . . . . . . . . .

3ormore helpers . . . . . . . . . . . .

85 years and over:

I helper . . . . . . . . . . . . . . . . . . . .

2 helpers . . . . . . . . . . . . . . . . . . .

3or more helpers . . . . . . . . . . . .

1,717

867

646

1,508

727

534

208

140

112

853

286

174

863

582

472

880

310

236

615

357

266

1,717

867

646

837

557

410

222

200

145

8.2

3.9

3.3

7.6

3.8

3.6

12.7

*4.6

*2. 1

7.6

*2,2

*1 .9

8.9

4.8

3.8

11.4

4,5

5.3

6.0

4.5

*2.5

8.2

3.9

3.3

4.9

3.6

2.2

*1 .9

*2,0

*1 .5

45.0

18.5

15.2

46.4

18.8

14.8

34.5

17.5

17.4

48.8

17.0

17.8

41.2

19.3

14.3

50.5

23.9

20!2

41.5

16.9

16.1

45.0

18.5

15.2

39.1

15.6

12.3

32.6

13.2

5.4

Percent

14.4

29.1

19.5

13.6

29.9

18.8

20.4

25.2

22.8

11,7

26.7

11.6

17.1

30.3

22.4

13.6

29.0

19.8

15.4

29.1

19.6

14.4

29.1

19.5

15.2

29.2

19.3

14.9

29.4

18.7

8.6

17.0

28.9

8.2

16,3

28.9

11.5

20.7

29.1

7.1

14,8

23.9

10.0

18.1

30,8

8.1

20.2

28.6

8.4

13.3

31.6

8.6

17.0

28.9

9.1

15.2

29.1

11.0

18.6

24.5

5.8

9.0

7,9

6.2

9.9

8,7

*3.2

*4.2

*4,3

3,9

8.2

*4.5

7.6

9.4

9.2

3,3

5,6

5,6

7.3

10.7

7.6

5.8

9.0

7,9

8.5

10,9

9.3

11.7

11.2

12.4

18.1

22.4

25.1

18,1

21.4

25,3

17,7

27.9

24,4

20,9

31.2

40.2

15.2

18.1

19.5

13.2

16,9

20,5

21.4

25.5

22.5

18,1

22.4

25.1

23.2

25,5

27.8

28.0

25,6

37.5

182
Table 14. Percent of frail persons 65 years of age and over using only informal helpers in 1982 by

use in 1984, according to race, sex, age, and help with activities of daily living: United States – Con.

[Data are based on personaI interviews of the functionally impaired Medicare eligibles living in the community]

Number of informal helpers or status in 1984

Race, sex, age, help received with Number of

ADL’s, and number of informal persons in lrrstituhelpers in 1982 thousands o 1 2 3 tionalized Deceased

Help with ADL’s1

No help received:

I helper . . . . . . . . . . . . . . . . . . . .

2 helpers . . . . . . . . . . . . . . . . . . .

3or more helpers . . . . . . . . . . . .

Help with 1:

I helper, , . ., .,, , ., .,,....,.

2 helpers .,, , . . . . . . . . . . . . . . .

3or more helpers,........,,,

Help with 2:

I helper..,.,............,,,

2 helpers . . . . . . . . . . . . . . . . . . .

3ormore helpers, . . . . . . . . . . .

Help with 3-5:

I helper . . . . . . . . . . . . . . . . . . . .

2 helpers,..,,,...,,.....,,.

3or more helpers . . . . . . . . . . . .

Percent

1,211

547

370

10.3

5.1

4.2

47.0

20.1

17.7

15.4

31.6

22.6

7.9

17.6

29.9

5.2

7.7

5.7

14.3

17.9

19.8

245

150

121

4.9

*1.7

*3.2

45.0

14.9

11.5

12,4

28,4

18.7

9.2

17.9

34.1

7.3

12.5

*8.O

21.3

24.7

24.6

119

55

51

*1 .6

*6.5

—

36.0

18.3

*14,3

13.6

17.2

15,4

8.0

13,7

26.9

*8.5

*11.8

*15.3

32.3

32.5

28.2

142

114

104

*2.3

—

*1.7

34.8

16.0

11.2

10.3

23.9

11.4

13.7

14.5

20.4

*6.3

9.2

12.2

32.5

36.4

43.1

‘Receives help of another person with the following activities of daily living (ADL’s): bathing, dressing, transferring, toileting,

eating.

SOURCE: National Long Term Care Survey, 1984.

183
Table 15. Percent of frail persons 65 years of age and over using both formal and informal

in 1982 by use in 1984, according to race, sex, age, and help with activities of daily living:

United States

helpers

[Data are based on personal interviews of the functionally impaired Medicare eligibles living in the community]

Number of formal and informal helpers or status in 1984

Race, sex, age, help with ADL’s, and Number of lnstitnumber of formal and informal persons in utionhelpers in 1982 thousands o 1 2 3 alized Deceased

Total:

2 helpers, . . . . . . . . . . . . . . . . . . . .

3or more helpers . . . . . . . . . . . . . .

Race

White:

2 helpers . . . . . . . . . . . . . . . . . . . . .

3or more helpers . . . . . . . . . . . . . .

All other:

2 helpers . . . . . . . . . . . . . . . . . . . . .

3or more helpers . . . . . . . . . . . . . .

Sex

Male:

2 helpers . . . . . . . . . . . . . . . . . . . . .

3or more helpers . . . . . . . . . . . . . .

Female:

2 helpers . . . . . . . . . . . . . . . . . . . . .

3or more helpers . . . . . . . . . . . . . .

Age

65–74 years:

2heIpers . . . . . . . . . . . . . . . . . . . . .

3or more helpers . . . . . . . . . . . . . .

75–84 years:

2 helpers, . . . . . . . . . . . . . . . . . . . .

3ormore heipers . . . . . . . . . . . . . .

65 years and over:

2 helpers . . . . . . . . . . . . . . . . . . . . .

3ormore heIpers . . . . . . . . . . . . . .

75 years and over:

2 helpers . . . . . . . . . . . . . . . . . . . . .

3or more helpers . . . . . . . . . . . . . .

85 years and ovec

2 helpers . . . . . . . . . . . . . . . . . . . . .

3or more helpers . . . . . . . . . . . . . .

347

527

308

453

39

75

107

138

240

389

105

167

149

223

347

527

243

360

93

137

3.4

*0.9

3.7

*0.5

*1 .6

*3.3

*2.8

3.7

1.2

*5.7

*1 ,5

*3.4

*1.1

3.4

*0.9

*2.5

*0.7

*0.9

12.8

6.3

11.7

5.5

21.3

*10.6

9.9

8.3

14.0

5.5

17,7

7.1

10.1

7.7

12.8

6.3

10.6

5.9

11.4

*2.9

Percent

18.2

11.9

17.6

11.4

22.8

14.7

14.9

9.9

19.7

12.6

18.6

12.8

21.4

13.5

18.2

11.9

18.0

11.4

12,5

8,0

25.2

36.3

24.8

37.6

28,7

28.5

24.5

24.1

25.5

40.7

24.7

39.1

26.6

34.0

25.2

36.3

25.5

35.0

23.6

36.8

12,2

13.4

13.0

14.8

*5.8

*5,4

9.8

12.5

13.3

13.8

*5.1

10,4

15,6

12.8

12.2

13,4

15.3

14.8

14.8

18.2

28,2

31.2

29.3

30.2

19.9

37,6

38.2

45.3

23.8

26.2

28.3

29.2

22.8

31.0

28.2

31.2

28,2

32,2

36,7

34.1

184
Table 15. Percent of frail persons 65 years of age and over using both formal and informal

in 1982 by use in 1984, according to race, sex, age, and help with activities of daily living:

United States - Con.

helpers

[Data are based on personal interviews of the functionally impaired Medicare eligibles living in the community]

Number of formal and informal helpers or status in 1984

Race, sex, age, help with ADL’s, and Number of lnstitnumber of formal and informal persons in utionhelpers in 1982 thousands o 1 2 3 alized Deceased

Help with ADL’s1

No help received:

2 helpers, . . . . . . . . . . . . . . . . . . . .

3or more helpers . . . . . . . . . . . . . .

Help with 1:

2 helpers . . . . . . . . . . . . . . . . . . . . .

3or more helpers . . . . . . . . . . . . . .

Help with 2:

2 helpers, . . . . . . . . . . . . . . . . . . . .

3or more helpers, . . . . . . . . . . . . .

Help with 3-5:

2 helpers . .,, . . . . . . . . . . . . . . . . .

3or more helpers . . . . . . . . . . . . . .

176

209

76

129

25

49

70

140

6.4

*1.9

*0.8

*0.6

—

—

—

—

16.3

9.4

15.7

7.0

*8.5

*5.4

*2.O

*1.2

Percent

22.6 23.2 11.1

15.6 41.6 11.1

13.4 25.5 16.2

12.0 34.8 16.0

*17.8 33.2 *11.8

*I 0.0 34.6 *10.0

12.5 27.2 *1 0.8

6.7 30.6 15.8

20.4

20.4

28.4

29.5

28.6

40.1

47.6

45.8

1Receives help of another person with the following activities of daily living (ADL’s): bathing, dressing, transferring, toileting,

eating,

SOURCE: National Long Term Care Survey, 1984.

185
Chapter 7

Patterns of drug prescribing

by Todd P. Semla, Pharm.D., and Arthur

Schwartz, Ph.D., University of Illinois at

Chicago; Hugo Koch, M.H.A., and Cheryl

Nelson, M.S,P.H., National Center for Health

Statistics

Introduction

The elderly utilize a disproportionate share

of health care in general, and drugs in particular. Recent statistics on drug utilization by the

elderly indicate that although this group accounts for 12 percent of the population, they

purchase 31 percent of aII prescription drugs

sold in the United States each year (1), There is

good reason for the increased use of drugs by

the elderly – the incidence and prevalence of

chronic illnesses increase with age. Medications

are the most frequently utilized and perhaps the

most important therapeutic intervention that

health care has to offer this age group. However,

the inappropriate prescribing of medications or

their misuse can increase the risk of iatrogenic

illness and toxicity. These problems are of special concern when dealing with the elderly because of their increased drug use as well as the

physiologic consequences of aging and disease

on the distribution, metabolism, and elimination

of drugs from the body or altered sensitivity to

the effects of drugs. As such, drug usage in the

elderly is an area of particular interest for practitioners and policymakers. The vast majority of

the elderly are noninstitutionalized and for the

most part are self-sufficient in the management

of their drug therapy. A description of drug

prescribing patterns in the population aged 55

and over, based on data from the 1985 National

Ambulatory Medical Care Survey (NAMCS), is

presented, This survey was chosen because of its

recent completion and focus on the ambulatory

population.

When the estimated sample size permitted,

the effects of age, race, and sex on specific drugs,

therapeutic categories, number of drugs prescribed for a principal diagnosis, number of

office visits, and physician specialty were tested

for statistical significance. All statistical tests

were based upon tables of the estimated relative

standard errors provided by the National Center

for Health Statistics for the 1985 NAMCS; specific estimates greater than or equal to 30 percent relative standard error were considered

unreliable, and statistical testing was not done.

All hypothesis testing was subjected to twotailed testing.

Sources of data

Data presented for tables 1–6 are from the

NAMCS conducted from March 1985 through

Februa~ 1986. The survey has as its sampling

unit the physician-patient encounter for officebased, patient care physicians in the conterminous United States. Physician selection was

accomplished through lists obtained from the

American Medical Association and the American Osteopathic Association. Physicians specializing in radiology, anesthesiology, and pathology

were excluded from the sample as were encounters such as telephone contacts, The survey utilizes a multistage probability design weighted to

allow for estimates of the U.S. population. A

complete description of the 1985 NAMCS and

its methodology is available from the National

Center for Health Statistics (2).

187
The 1985 NAMCS

tients, their physicians,

collected data on

their office visits,

paand

treatment characteristics. Tables 1–6 are based

on selected data from the records of office visits

by those patients aged 55 and over at the time of

the survey. Patients are divided into the following age cohorts: 55–64, 65–74, and greater than

or equal to 55, 65, or 75 years of age. There were

an estimated 205 million office visits and 297

million drug mentions for the noninstitutionalized population aged 55 and over based on the

1985 NAMCS (table 1).

Data presented for tables 7 and 8 are from

the 1986 National Health Interview Survey Supplement on Vitamins and Minerals. This supplement, conducted in collaboration with the U.S.

Food and Drug Administration, collected information to produce measures of supplement use

and the composition and quantities of specific

vitamins and minerals consumed.

Results and comments

It must be remembered that the data on

drugs refer to drugs that were either started or

to be continued as a part of patient therapy as a

result of a recorded office visit, and do not imply

actual use by the patient. Of the estimated 205

million office visits by the 55-and-over population in the 1985 NAMCS, the most common

treatment modality was drug therapy alone, accounting for 50 percent of all treatments. Only

22 percent of office visits were associated with

no form of treatment. The remaining office visits

were divided between nondrug-only treatment

and a combination of drug and nondrug treatment, representing 11 and 17 percent of all

treatment modalities, respectively (table A).

Of particular interest are those office visits in

which the treatment included drug therapy (alone

or in combination with nondrug therapy). The

breakdown of office visits and drug mentions by

select patient characteristic are shown in table 1. For persons 55 years of age and over, at

188

Table A. Distribution of therapies for persons

55 years of age and over

Therapy Percent

Drug only,....,....,,......,.,,.. ., 49.6

Neither. . . . . . . . . . . . . . . . . . . . . . . . . . . . 21,8

Nondrug only . . . . . . . . . . . . . . . . . . . . ,. 11,2

Both drug and nondrug .,, . . . . . . . . . . . 17.4

least 65 percent of all

ated with at least one

centage of office visits

office visits were associdrug mention. The perwith one or more drug

mentions did not increase with age. Among

those office visits with two or more drug mentions, there was a significant increase from

35 percent for the group aged 55-64 to 43 percent for the 75 years and over age group. For

both males and females, approximately twothirds of all office visits were associated with one

or more drug mentions. An age effect was not

found within or between the sexes with respect

to office visits involving one or more drug mentions. For women, the percentage of office visits

with two or more drug mentions increased from

36 percent for the group aged 55–64 to 44 percent for the 75-and-over age group; no age effect

was found for men. Sixty-six percent of all office

visits by white people were associated with one

or more drug mentions; the corresponding percent was 76 for black people, Seventy-two percent of all office visits by Hispanic people were

associated with one or more drug meptions,

compared with 67 percent for those who were

not Hispanic. These differences by racial and

ethnic groups were not statistically significant.

Selected characteristics of the drugs recorded in the three age cohorts are shown in

table 2. The percentage reported as new medications tended to decrease with age; however,

only the difference between the 55-64 and 75-

and-over age groups was significant. For all age

cohorts, 67–75 percent of all medications reported were a continuation of existing therapy.

This finding is in concordance with the prevalence of chronic illnesses such as hypertension,
heart disease, and diabetes mellitus, rather than

acute conditions, requiring a new prescription

for each occurrence (3). Nearly 70 percent of all

medications reported were for the patient’s principal diagnosis. The percentage of medications

mentioned for the principal diagnosis would

appear to decrease with age, however, a significant difference was not found between any of

the age groups. Approximately 85 percent of all

drugs reported were prescription drugs, and they

were most often recorded by the physician by

their trade or proprietary name. This may be a

result of the design of the survey, focusing on

physician office visits and the accompanying complaint, concentrating on prescription drugs, and

truncating the number of drugs recorded at five.

Therefore, those drugs perceived to be more

important or potent may have been selected

first. In addition, many older patients do not

always inform their physicians of all the medications they are taking, particularly nonprescription drugs, nor do they always seek the advice of

their physicians or pharmacists when selfmedicating (4). Most drug products reported

contained only a single active ingredient as opposed to combination products that contained

two or more active ingredients. Less than 10 percent of all drug products reported contained a

controlled substance. Examples included opiates, barbiturates, and other potentially addictive compounds.

The top 50 drugs for each age cohort, by

generic ingredient, are shown in table 3. The

total of 297 million drug mentions resulted in

371 million drug ingredients (because a drug

mention may contain multiple generic ingredients). Hydrochlorothiazide, alone or in combination with other drugs, was the most frequently

reported generic ingredient for patients 55-64

and 65-74 years old. Digoxin replaced hydrochlorothiazide in the 75-and-overcohort, with hydrochlorothiazide ranking second. Digoxin was the

only drug in the top 10 to show a consistent

statistically significant increase in frequency of

mention with age. The number of mentions of

furosemide, a diuretic, was significantly greater

in the group aged 75 years and over, compared

with the two younger age cohorts. Potassium

supplement mentions appeared to increase with

age. However, this increase was only statistically

significant between the groups aged 55–64 years

old and 75 and over.

The cardiac glycosides, specifically digoxin,

are one of the most commonly used drug categories by the elderly. Cardiac glycosides received

6.6 million mentions associated with a primary

diagnosis for all persons 55 years of age and over

(table B). Overall, nearly 80 percent of cardiac

glycosides were for diseases of the circulatory

system (table B). Specific diagnostic categories

most commonly associated with the cardiac glycosides were congestive heart failure, cardiac

dysrhythmias, and ischemic heart disease.

The finding that digoxin and hydrochlorothiazide were the two most frequently reported

drugs is consistent with population studies (3,5).

The number of mentions for furosemide, a more

potent diuretic than hydrochlorothiazide, increased in rank from sixth in the youngest age

group to third in the oldest. The increase in

mentions for these drugs is most likely a result of

the increased prevalence of congestive heart

failure (CHF) in the elderly. Because a common

side effect of diuretic therapy is potassium loss,

the triad of hydrochlorothiazide, digoxin, and

furosemide is responsible for the volume of

potassium-replacement products. Furthermore,

hypokalemia in the face of digoxin therapy increases the risk for digoxin-induced arrhythmias.

As a result, potassium-replacement products are

often prescribed in conjunction with diuretic

therapy.

The mentions of the remaining top 10 drugs

did not significantly increase or decrease with

age. Only those drugs in the overall top 10 were

tested. Eight out of the top 10 and 19 of the top

189
Table B. Number and percent distribution of mentions of cardiac glycosides by selected principal

diagnoses and ICD-9-CM codes for persons 55 years of age and over, according to patient age:

United States, 1985

Age, principal diagnosis, and International Number of Percent

Classification of Diseases Codes 1 mentions 2 distribution

55 years and over

All principal diagnoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,586,855 100.0

Diseases of the circulatory system. . . . . . . . . . . ...390-459 5,207,808 79.1

Other forms of ischemic heart disease. ., , . . . . ,410–414 1,907,384 29.0

Cardiac dysrhythmias . . . . . . . . . . . . . . . , ...,,,..,.427 720,177 10.9

Heart failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...428 1,025,155 15.6

65 years and over

All principal diagnoses, ., . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,379,041 100s0

Diseases of the circulatory system. . . . . . . . . . , . ..390-459 4,191,214 77.9

Other forms of ischemic heart disease. . . . . . ...410-414 1,431,141 26.6

Cardiac dysrhythmias . . . . . . . . . . . . . . . . . . . . . . . ...427 608,491 11.3

Heart failure, .,, . ., .,,....., ., . . . . . . . . . . . . . ...428 935,283 17,4

75 years andover

All principal diagnoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,185,482 100.0

Diseases ofthe circulatory system, ,....,. . .,,..390-459 2,561,280 80.4

Other forms ofischemic heart disease. . . ... . ..410–414 814,714 25.6

Cardiac dysrhythmias . . . . . . . . . . . . . . . . . . . . . . . ...427 *372,819 *11.7

Heartfailure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...428 654,095 20.5

‘Coded according to the /nternationa/ClassificationofDiseases, Ninth Revision, Clinical Modification.

20nIymentions of drugs specifically intended forthe principal (first-listed) diagnosis are included. Mentions of drugs associated

with other-listed diagnoses or utilized for any other reason are not included,

NOTES: Cardiac glycosides include digoxin, digitoxin, and gitalin. Both mentions as the generic form of single-ingredient drugs

and mentions as an ingredient of combination drugs are included.

SOURCE: National Center for Health Statistics: Data from the National Ambulatory Medical Care Survey.

50 drugs reported are considered to be cardiovascular agents. This reflects the frequency of

cardiovascular disease in the elderly (table 4).

The two other drugs in the top 10 were aspirin

and acetaminophen, both nonprescription analgesics and antipyretics. It is conceivable that

much of their use was because of the frequency

of arthritic complaints by the elderly (table 4).

The 1985NAMCS aHowed for the drug mentioned to be linked to a principal diagnosis.

Table 4 shows the distribution of office visits by

principal diagnosis and drug mentions for the

three age cohorts. Diseases of the circulatory

system ranked as the number one principal diagnosis and accounted for approximately 30 percent of drug mentions for all age groups. During

these office visits, at least one drug was prescribed 82–85 percent of the time and two or

190

more drugs 55–64 percent of the time. Within

diseases of the circulatory system, essential hypertension was the single most frequently reported principal diagnosis, resulting in 8–9

percent of office visits and 12-14 percent of all

drug mentions; a drug was prescribed for a

circulatory system disease 86–90 percent of the

time, The only single diagnosis with a higher

number of mentions was acute upper respiratory

infections (86–94 percent).

As noted previously, the percentage of office

visits with two or more drug mentions for the

principal diagnosis rose from 35 percent for the

55-64 age group to 43 percent for persons 75

years and over. The principal diagnostic categories for which 50 percent of office visits accounted for two or more drug mentions were

consistent across the three age groups with two
exceptions. Only for individuals 75 years and

over did the percentage of office visits with two

or more drug mentions for mental disorders and

the arthropathies exceed 50 percent. And only

for patients 75 and over with two or more drug

mentions for a principal diagnosis involving musculoskeletal disorders was there a significant

difference compared with patients 55–64 years

old, This finding suggests the increased prevalence and difficulty of treating these conditions

in advanced age.

The drug mentions were further categorized

based on their respective primary therapeutic

categories using the American Hospital FormuIary Service Classification System (table 5). The

largest percentage of drug mentions, overall and

within each age cohort, was the cardiovascular

drugs, Although the percentage of all cardiovascular drug mentions appeared to increase with

age, no significant difference was found between

any of the age cohorts. The second most frequently reported therapeutic category was for

electrolyte, caloric, and water balance drugs.

This category is composed primarily of diuretics

and potassium supplements. The number of drug

mentions for this therapeutic category increased

with age, with a statistically significant difference

between the youngest and oldest age cohorts. It

is unknown whether this increase is entirely the

result of an increase in the use of furosemide

and potassium replacements or a combined contribution of other drugs in this category. Other

frequently reported therapeutic categories included analgesics and antipyretics, and hormones and synthetic substances (including all

dosage forms for glucocorticosteroids).

The relationships between physician specialty, office visits, and drug mentions are shown

in table 6. For all age groups, 56 percent or

more of office visits were to physicians with

specialties in general or family practice, internal

medicine, and ophthalmology. Ophthalmology

was the only specialty to increase across all the

three age cohorts from 8 percent in the youngest cohort to 17 percent in oldest. The percentage of office visits to psychiatrists was significantly

higher in individuals 55-64 than individuals 65-74

years of age. The percentage of drug mentions

by physician specialty for all age groups showed

that general and family practitioners ranked first

and internists second in all age cohorts, accounting for 34 percent or more and 24 percent or

more of all drug mentions, respectively. Cardiologists ranked third highest in the number of

drug mentions for the two youngest age cohorts.

Ophthalmologists ranked third in the number of

drug mentions for patients age 75 and over. The

percentage of ophthalmology office visits with

one or more drug mentions was significantly

greater in the 75-and-over group compared with

the group aged 55–64.

Table C displays the number and percent of

drug mentions of three classes of psychoactive

drugs by selected principal diagnoses. These

data are shown because the indiscriminate use

of these agents is considered to be a major

health risk for older Americans. The use of

these agents is associated with an increased risk

of falls, confusion, and other iatrogenic illness in

the elderly (6). Benzodiazepines are often prescribed as antianxiety agents, as sedatives or

hypnotics, and as skeletal muscle relaxants. For

persons 55 and over, mental disorders were the

most common principal diagnosis associated with

benzodiazepines, accounting for 37.5 percent of

mentions (table C), The second most common

principal diagnosis was diseases of the circulatory system. No benzodiazepine carries a Food

and Drug Administration indication for the treatment of hypertension, congestive heart failure,

ischemic heart disease, or any disease of the

circulatory system.

The antidepressants received 2.8 million mentions associated with a principal diagnosis for all

persons 55 years of age and over (table C).

Seventy-one percent of their mentions in patients

191
Table C. Number and percent distribution of mentions of benzodiazepines, antidepressants, and

antipsychotics by selected principal diagnoses and ICD-9-CM codes for persons 55 years of age

and over, according to patient age: United States, 1985

Age, drug class, principal diagnosis, and International Number of Percent

Classification of Diseases Codes 1 mentions 2 distribution

55 years and over

Benzodiazepines:

Ali principal diagnoses . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Mental disorders, . . . . . . . . . . . . . . . . . . . . . . ...290-319

Diseases of the circulatory system ., . . . . . ., ., .390–459

Antidepressants:

All principal diagnoses . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Mental disorders, . . . . . . . . . . . . . . . . . . . . . . . ..290–319

Antipsychotics:

All principal diagnoses . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Mental disorders . . . . . . . . . . . . . . . . . . . . . . . . ..290–319

65 years and over

Benzodiazepines:

All principal diagnoses . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Mental disorders, ,, . . . . . . . . . . . . . . . . . . . . . ..290–319

Diseases of the circulatory system . . . . . . . ., . . .390–459

Antidepressants:

All principal diagnoses . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Mental disorders . . . . . . . . . . . . . . . . . . . . . . . . ..290–319

Antipsychotics:

All principal diagnoses.......,.. . . . . . . . . . . . . . . . . . .

Mental disorders . . . . . . . . . . . . . . . . . . . . . . . ...290-319

75 years andover

Benzodiazepines:

All principal diagnoses...,,..,,. . . . . . . . . . . . . . . . . . .

Mental disorders . . . . . . . . . . . . . ... ,. ., .,. .,,290–319

Diseases ofthe circulatory system ...,..... . ..390–459

Antidepressants:

All principal diagnoses ..,.,... . . . . . . . . . . . . . . . . . . . .

Mental disorders . . . . . . . . . . . . . . . . . . . . . . . ...290-319

Antipsychotics:

All principal diagnoses . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Mental disorders . . . . . . . . . . . . . ... . . . . . . . . ..290–319

3,950,590

1,482,277

888,777

2,778,385

1,967,169

1,183,800

836,450

2,111,777

752,864

601,015

1,612,245

1,071,098

730,017

*421,470

954,575

*312,889

*396,084

713,876

*416,597

*325,066

*148,619

100.0

37.5

22.5

100.0

70.8

100,0

70.6

100.0

35.7

28.5

100.0

66.4

100,0

*57.7

100.0

*32,8

*41 ,5

100.0

*58,3

*1OO.O

*45.7

‘Coded according to the /nternationa/ Classification of Diseases, Ninth Revision, Clinical Modification.

‘Only mentions ofdrugs specifically intended for the principal (first-listed) diagnosis are included, Mentions of drugs associated

with other-listed diagnoses or used for any other reason are not included.

NOTES: Benzodimepines include butarenot limited todiazepam, lorazepam, and flurmepam. Antidepressants include tticyclic

antidepressants, monoamine oxidase inhibitors, and lithium, Antipsychotics include but are not Iimited to chlorpromazine,

thioridezine, and haloperidol. Both mentions as the generic form of single-ingredient drugs and mentions as an ingredient of

combination drugs are included.

SOURCE: National Center for Health Statistics: Data from the National Ambulatory Medical Care Survey.

55 years and over were in association with a all persons 55 years of age and over (table C).

mental disorder. This percentage fell to 66.4 per- Seventy-one percent of their mentions in patent for patients 65 years and over. The preva- tients 55 years and over were in association with

lence of depression in the elderly is reported to a mental disorder.

be similar or perhaps even greater than in younger

populations (7). Vitamins and minerals

The antipsychotics received 1.2 million men- The 1986 National Health Interview Survey

tions in association with a principal diagnosis for Supplement on Vitamins and Minerals provided

192
an estimate of self-reported prescription and

nonprescription vitamin and mineral supplement use in the 2 weeks prior to interview

among persons aged 55 and over (tables 7 and

8), A larger percentage of women than men, as

well as those with higher income compared with

those with lower income, reported the current

use of a vitamin or mineral supplement at the

time of interview. Age had no apparent influence on use, and a lower percentage of black

persons reported use of vitamin or mineral supplements compared with persons of other races

(table 7). The use of individual vitamin and

mineral supplements by age and sex are displayed in table 8, No important differences were

noted based upon these variables.

Conclusion

Drug prescribing patterns for the ambulatory

elderly has been characterized by several population studies. The unique methodology of the

NAMCS does not allow a complete comparison

to these studies, For example, the mean number

of drugs per person for those 65 and over has

been reported to be between three and four,

however, the NAMCS truncated the number of

drugs at five, thus potentially underestimating

mean number of drugs prescribed (3,5). On the

other hand, the NAMCS relates drug prescribing to principal diagnosis, and population studies either do not match diagnosis to drug or they

rely upon respondents do so, The majority of

drug mentions were regarding the continuation

of existing therapy, The distribution of the most

frequently prescribed drugs and their corresponding diagnoses are consistent with what has been

identified by studies of geographically defined

populations. Multiple drug mentions for a principal diagnosis were found to increase with age.

Physician prescribers were primarily general and

family practitioners and internists.

References

1.

2.

3.

4.

5.

6.

7.

Baum C, Kennedy DL, Forbes MB, et al. Drug

use in the United States in 1981. JAMA

241(10):1293-7. 1984.

McLemore T, DeLozier J. National Ambulatory

Medical Care Survey, 1985 summary. Advance

data from vital and health statistics; no 128.

Hyattsville, Maryland: National Center for Health

Statistics. 1987.

Helling DK, Lemke JH, Semla TP, et al. Medication use characteristics in the elderly: The

Iowa 65+ Rural Health Study. J Am Geriatr Soc

35(1):4-12, 1987.

Brody EM, Kleban MH, Moles E. What older

people do about their day-to-day mental and

physical health symptoms. J Am Geriatrics Soc

31(8):489-98. 1983.

May FE, Stewart RB, Hale WE, et al. Prescribed

and nonprescribed drug use in an ambulatory

elderly population. So Med J 75(5):522–8. 1982.

Ray WA, Griffin MR, Schaffner W, et al. Psychotropic drug use and the risk of hip fracture. New

Eng J Med 316(7):363-9. 1987.

Blazer D, Hughes DC, George LK. The epidemiology of depression in an elderly community

population. Gerontologist 27(3):281-7. 1987.

193
Table 1. Number and percent distribution of office visits and drug mentions, and percent of office

visits during which 1 drug or multiple drugs were mentioned for persons 55 years of age and over,

according to age, sex, race, and ethnicity: United States, 1985

[Data are based on reporting by a sample of office-based physicians]

Percent of visits

Office visits Drug mentions during which –

1 drug 2 drugs

Age, sex, race, Number in Percent Number in Percent or more or more

and ethnicity thousands distribution thousands distribution mentioned’ mentioned’

55–64 years

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

Sex:

Female . . . . . . . . . . . . . .

Male, , .,, , . .,..,...,

Race:

White, . . . . . . . . . . . . . .

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

Other, .,,,..,,.,,.,

Ethnicity:

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

Non-Hispanic. . . . . . . . .

65–74 years

Total, , . .,, . . . . . . . . . . . .

Sex:

Female . . . . . . . . . . . . . .

Male . . . . . . . . . . . . . . . .

Race:

White .,....,.....,..

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

Other. .,, , ...,...,,

Ethnicity:

Hispanic, . . . . . . . . . . . .

Non-Hispanic. ., , . . . . .

75 years and over

Total, ...,,...,..,.,,..

Sex:

Female . . . . . . . . . . . . . .

Male. .,, ,,, ...,,,.,,

Race:

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

Black ., . .,, ...,,....

Other, .,..,,.,..,,.

Ethnicity:

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

Non-Hispanic. , , . . . . . .

75,044

43,935

31,109

68,192

5,869

983

3,688

71,356

75,427

44,662

30,765

70,107

4,559

762

3,627

71,800

55,111

34,873

20,239

51,552

3,223

336

2,771

52,341

100.0

58.5

41.5

90.9

7.8

1,3

4.9

95.1

100.0

59.2

40.8

93.0

6.0

1.0

4.8

95.2

100.0

63.3

36,7

93.5

5.8

0.6

5.0

95,0

99,132

59,033

40,099

88,982

8,758

1,392

4,926

94,206

109,785

65,579

44,206

100,926

7,616

1,242

5,848

103,936

88,797

57,461

31,336

82,397

5,912

488

5,101

831695

100.0

59.6

40.4

89.8

8.8

1.4

5.0

95.0

100.0

59.7

40.3

91.9

6.9

1.2

5.3

94.7

100.0

64.7

35.3

92.8

6.7

0.5

5.7

94.3

64.9

66.1

63.3

64.1

75.0

62.8

68.8

64.7

67,1

67.7

66.2

66.5

75.4

71,7

71,3

66.9

69.7

70.3

68.7

69.1

79.2

67.0

77.2

69.3

34.8

35.6

33.8

34.3

39.5

41,8

35.7

34,8

38.5

39.5

37.2

38,0

44.1

56,8

45.6

38.2

42.6

43.7

40,9

42.1

52.7

34,2

49.3

42.3

‘Only mentions of drugs specifically intended for the principal (first-listed) diagnosis are included. Mentions of drugs associated

with other-listed diagnoses or utilized for any other reason are not included,

2Asian, Pacific Islander, American Indian, or Alaskan Native.

194
Table 2. Percent distribution of drug mentions by selected dimensions of drugs by persons 55

years of age and over, according to patient age: United States, 1985

[Data are based on reporting by a sample of office-based physicians]

Patient age

55–64 65–74 75 years

Drug dimensions years years and over

All mentions. .,, . .,, ,,, ,,, ,,, ,. .,. ., 99,132,000

Total, . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

New or continued status

New medication,...,,........,.. . . .

Continued medication. , , . . . . . . . . . . . . .

Unknown, ., ., .,, ., . . . . . . . . . . . . . . . .

Therapeutic target

Principal diagnosis..,.....,..,,,.. .,

Other problem(s), . . . . . . . . . . . . . . . . . . .

Unknown, . . . . . . . . . . . . . . . . . . . . . . . . .

Entry statusl

Generic name, . . . . . . . . . . . . . . . . . . . . .

Trade name. .,, . . . . . . . . . . . . . . . . . . . .

Unknown, ,,, .,.,,..,,,..,.,,.. . . . .

Prescription status

Prescription drug, ,,, , .,, ,....,, ,.,,.

Nonprescription drug, . . . . . . . . . . . .,..

Unknown . . . . . . . . . . . . . . . . . . . . . . . . . .

Composition status

E%rgle-ingredient drug . . . . . . . . . . . . . . .

Combination drug, . . . . . . . . . . . . . . . . . .

Unknown, ,,, ,,, .,, . ...,,..,. . . . . . .

Federal control status

Controlled drug . . . . . . . . . . . . . . . . . . . . .

Schedule 11drug . . . . . . . . . . . . . . . . . . .

Schedule 111drug. .,, . . . . . . . . . . . . ,,.

Schedule lVdrug, , .,...,,,,,,, . . . .

Schedule V drug.,,,,.,,...,,. . . . . .

Noncontrolled drug . . . . . . . . . . . . . . . . . .

Unknown. . . . . . . . . . . . . . . . . . . . . . . . . .

100.0

29.9

67.0

3.1

72.3

25.6

2.1

16.5

76.2

7.3

84.4

8.9

6.7

77.4

15.2

7.3

7.7

0.5

1.5

5.0

0.7

85.8

6.5

Number ofdrug mentions

109,7851000

Percent distribution

100.0

26.4

70.7

2.8

68.2

29.4

2.4

17.0

77.0

5.9

84.4

9.8

5.7

78.9

15.2

5.9

6.5

0.6

1.1

4.4

0.4

87.8

5.7

88,797,000

100.0

22.2

75,3

2.5

66.6

31.4

2.0

16.7

78.1

5.3

84.8

9.9

5.3

80.2

14.6

5.3

5.5

0.2

1.0

3.7

0.6

89.4

5.1

lNational Ambulatory Medical Care Survey respondents used the same form ofentry (generic or trade name) thatwas used on

the patient’s medical recordand/oron any prescription that the respondent wrote.

NOTE: Both mentions asthe generic form of single-ingredient drugs and mentions as an ingredientof combination drugs are

included, vitamins, minerals, and vaccines are omitted,

SOURCE: National Center for Health Statistics: Data from the National Ambulatory Medical Care Survey.

195