Disability and Care Needs Among Older Americans
Context: The cost of late-life dependency is projected to grow rapidly as the number of older adults in the United States increases in the coming decades. To provide a context for framing relevant policy discussions, we investigated activity limitations and assistance, care resources, and unmet need...
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| Published in | The Milbank quarterly Vol. 92; no. 3; pp. 509 - 541 |
|---|---|
| Main Authors | , |
| Format | Journal Article |
| Language | English |
| Published |
United States
Blackwell Publishing Ltd
01.09.2014
THE MILBANK MEMORIAL FUND |
| Subjects | |
| Online Access | Get full text |
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| Abstract | Context: The cost of late-life dependency is projected to grow rapidly as the number of older adults in the United States increases in the coming decades. To provide a context for framing relevant policy discussions, we investigated activity limitations and assistance, care resources, and unmet need for a national sample of older adults. Methods: We analyzed the 2011 National Health and Aging Trends Study, a new national panel study of more than 8,000 Medicare enrollees. Findings: Nearly one-half of older adults, or 18 million people, had difficulty or received help in the last month with daily activities. Altogether, 1 in 4 older adults receiving help lived in either a supportive care (15%) or a nursing home (10%) setting. Nearly 3 million received assistance with 3 or more self-care or mobility activities in settings other than nursing homes, and a disproportionate share of persons at this level had low incomes. Nearly all older adults in settings other than nursing homes had at least 1 potential informal care network member (family or household member or close friend), and the average number of network members was 4. Levels of informal assistance, primarily from family caregivers, were substantial for older adults receiving help in the community (164 hours/month) and living in supportive care settings (50 hours/month). Nearly all of those getting help received informal care, and about 3 in 10 received paid care. Of those who had difficulty or received help in settings other than nursing homes, 32% had an adverse consequence in the last month related to an unmet need; for community residents with a paid caregiver, the figure was nearly 60%. Conclusions: The older population—especially those with few economic resources—has substantial late-life care needs. Policies to improve long-term services and supports and reduce unmet need could benefit both older adults and those who care for them. |
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| AbstractList | CONTEXTThe cost of late-life dependency is projected to grow rapidly as the number of older adults in the United States increases in the coming decades. To provide a context for framing relevant policy discussions, we investigated activity limitations and assistance, care resources, and unmet need for a national sample of older adults.METHODSWe analyzed the 2011 National Health and Aging Trends Study, a new national panel study of more than 8,000 Medicare enrollees.FINDINGSNearly one-half of older adults, or 18 million people, had difficulty or received help in the last month with daily activities. Altogether, 1 in 4 older adults receiving help lived in either a supportive care (15%) or a nursing home (10%) setting. Nearly 3 million received assistance with 3 or more self-care or mobility activities in settings other than nursing homes, and a disproportionate share of persons at this level had low incomes. Nearly all older adults in settings other than nursing homes had at least 1 potential informal care network member (family or household member or close friend), and the average number of network members was 4. Levels of informal assistance, primarily from family caregivers, were substantial for older adults receiving help in the community (164 hours/month) and living in supportive care settings (50 hours/month). Nearly all of those getting help received informal care, and about 3 in 10 received paid care. Of those who had difficulty or received help in settings other than nursing homes, 32% had an adverse consequence in the last month related to an unmet need; for community residents with a paid caregiver, the figure was nearly 60%.CONCLUSIONSThe older population-especially those with few economic resources-has substantial late-life care needs. Policies to improve long-term services and supports and reduce unmet need could benefit both older adults and those who care for them. Policy Points: Nearly half of elderly Medicare beneficiaries have difficulty performing daily activities without assistance or receive help with such activities. This help is most often from informal caregivers. Substantial numbers of older adults living at home or in supportive settings other than nursing homes experience adverse consequences related to unmet need. With continuing care shifts away from nursing homes, strategies are needed to improve community‐based long‐term care services and supports to aid both older adults and the informal caregivers who provide most care. Context The cost of late‐life dependency is projected to grow rapidly as the number of older adults in the United States increases in the coming decades. To provide a context for framing relevant policy discussions, we investigated activity limitations and assistance, care resources, and unmet need for a national sample of older adults. Methods We analyzed the 2011 National Health and Aging Trends Study, a new national panel study of more than 8,000 Medicare enrollees. Findings Nearly one‐half of older adults, or 18 million people, had difficulty or received help in the last month with daily activities. Altogether, 1 in 4 older adults receiving help lived in either a supportive care (15%) or a nursing home (10%) setting. Nearly 3 million received assistance with 3 or more self‐care or mobility activities in settings other than nursing homes, and a disproportionate share of persons at this level had low incomes. Nearly all older adults in settings other than nursing homes had at least 1 potential informal care network member (family or household member or close friend), and the average number of network members was 4. Levels of informal assistance, primarily from family caregivers, were substantial for older adults receiving help in the community (164 hours/month) and living in supportive care settings (50 hours/month). Nearly all of those getting help received informal care, and about 3 in 10 received paid care. Of those who had difficulty or received help in settings other than nursing homes, 32% had an adverse consequence in the last month related to an unmet need; for community residents with a paid caregiver, the figure was nearly 60%. Conclusions The older population—especially those with few economic resources—has substantial late‐life care needs. Policies to improve long‐term services and supports and reduce unmet need could benefit both older adults and those who care for them. Context The cost of late-life dependency is projected to grow rapidly as the number of older adults in the United States increases in the coming decades. To provide a context for framing relevant policy discussions, we investigated activity limitations and assistance, care resources, and unmet need for a national sample of older adults. Methods We analyzed the 2011 National Health and Aging Trends Study, a new national panel study of more than 8,000 Medicare enrollees. Findings Nearly one-half of older adults, or 18 million people, had difficulty or received help in the last month with daily activities. Altogether, 1 in 4 older adults receiving help lived in either a supportive care (15%) or a nursing home (10%) setting. Nearly 3 million received assistance with 3 or more self-care or mobility activities in settings other than nursing homes, and a disproportionate share of persons at this level had low incomes. Nearly all older adults in settings other than nursing homes had at least 1 potential informal care network member (family or household member or close friend), and the average number of network members was 4. Levels of informal assistance, primarily from family caregivers, were substantial for older adults receiving help in the community (164 hours/month) and living in supportive care settings (50 hours/month). Nearly all of those getting help received informal care, and about 3 in 10 received paid care. Of those who had difficulty or received help in settings other than nursing homes, 32% had an adverse consequence in the last month related to an unmet need; for community residents with a paid caregiver, the figure was nearly 60%. Conclusions The older population-especially those with few economic resources-has substantial late-life care needs. Policies to improve long-term services and supports and reduce unmet need could benefit both older adults and those who care for them. Adapted from the source document. Context: The cost of late-life dependency is projected to grow rapidly as the number of older adults in the United States increases in the coming decades. To provide a context for framing relevant policy discussions, we investigated activity limitations and assistance, care resources, and unmet need for a national sample of older adults. Methods: We analyzed the 2011 National Health and Aging Trends Study, a new national panel study of more than 8,000 Medicare enrollees. Findings: Nearly one-half of older adults, or 18 million people, had difficulty or received help in the last month with daily activities. Altogether, 1 in 4 older adults receiving help lived in either a supportive care (15%) or a nursing home (10%) setting. Nearly 3 million received assistance with 3 or more self-care or mobility activities in settings other than nursing homes, and a disproportionate share of persons at this level had low incomes. Nearly all older adults in settings other than nursing homes had at least 1 potential informal care network member (family or household member or close friend), and the average number of network members was 4. Levels of informal assistance, primarily from family caregivers, were substantial for older adults receiving help in the community (164 hours/month) and living in supportive care settings (50 hours/month). Nearly all of those getting help received informal care, and about 3 in 10 received paid care. Of those who had difficulty or received help in settings other than nursing homes, 32% had an adverse consequence in the last month related to an unmet need; for community residents with a paid caregiver, the figure was nearly 60%. Conclusions: The older population—especially those with few economic resources—has substantial late-life care needs. Policies to improve long-term services and supports and reduce unmet need could benefit both older adults and those who care for them. Policy Points: Nearly half of elderly Medicare beneficiaries have difficulty performing daily activities without assistance or receive help with such activities. This help is most often from informal caregivers. Substantial numbers of older adults living at home or in supportive settings other than nursing homes experience adverse consequences related to unmet need. With continuing care shifts away from nursing homes, strategies are needed to improve community-based long-term care services and supports to aid both older adults and the informal caregivers who provide most care. Context The cost of late-life dependency is projected to grow rapidly as the number of older adults in the United States increases in the coming decades. To provide a context for framing relevant policy discussions, we investigated activity limitations and assistance, care resources, and unmet need for a national sample of older adults. Methods We analyzed the 2011 National Health and Aging Trends Study, a new national panel study of more than 8,000 Medicare enrollees. Findings Nearly one-half of older adults, or 18 million people, had difficulty or received help in the last month with daily activities. Altogether, 1 in 4 older adults receiving help lived in either a supportive care (15%) or a nursing home (10%) setting. Nearly 3 million received assistance with 3 or more self-care or mobility activities in settings other than nursing homes, and a disproportionate share of persons at this level had low incomes. Nearly all older adults in settings other than nursing homes had at least 1 potential informal care network member (family or household member or close friend), and the average number of network members was 4. Levels of informal assistance, primarily from family caregivers, were substantial for older adults receiving help in the community (164 hours/month) and living in supportive care settings (50 hours/month). Nearly all of those getting help received informal care, and about 3 in 10 received paid care. Of those who had difficulty or received help in settings other than nursing homes, 32% had an adverse consequence in the last month related to an unmet need; for community residents with a paid caregiver, the figure was nearly 60%. Conclusions The older population--especially those with few economic resources--has substantial late-life care needs. Policies to improve long-term services and supports and reduce unmet need could benefit both older adults and those who care for them. [PUBLICATION ABSTRACT] Policy Points:Nearly half of elderly Medicare beneficiaries have difficulty performing daily activities without assistance or receive help with such activities. This help is most often from informal caregivers.Substantial numbers of older adults living at home or in supportive settings other than nursing homes experience adverse consequences related to unmet need.With continuing care shifts away from nursing homes, strategies are needed to improve community-based long-term care services and supports to aid both older adults and the informal caregivers who provide most care. The cost of late-life dependency is projected to grow rapidly as the number of older adults in the United States increases in the coming decades. To provide a context for framing relevant policy discussions, we investigated activity limitations and assistance, care resources, and unmet need for a national sample of older adults. We analyzed the 2011 National Health and Aging Trends Study, a new national panel study of more than 8,000 Medicare enrollees. Nearly one-half of older adults, or 18 million people, had difficulty or received help in the last month with daily activities. Altogether, 1 in 4 older adults receiving help lived in either a supportive care (15%) or a nursing home (10%) setting. Nearly 3 million received assistance with 3 or more self-care or mobility activities in settings other than nursing homes, and a disproportionate share of persons at this level had low incomes. Nearly all older adults in settings other than nursing homes had at least 1 potential informal care network member (family or household member or close friend), and the average number of network members was 4. Levels of informal assistance, primarily from family caregivers, were substantial for older adults receiving help in the community (164 hours/month) and living in supportive care settings (50 hours/month). Nearly all of those getting help received informal care, and about 3 in 10 received paid care. Of those who had difficulty or received help in settings other than nursing homes, 32% had an adverse consequence in the last month related to an unmet need; for community residents with a paid caregiver, the figure was nearly 60%. The older population-especially those with few economic resources— ;has substantial late-life care needs. Policies to improve long-term services and supports and reduce unmet need could benefit both older adults and those who care for them. Reprinted by permission of Blackwell Publishers The cost of late-life dependency is projected to grow rapidly as the number of older adults in the United States increases in the coming decades. To provide a context for framing relevant policy discussions, we investigated activity limitations and assistance, care resources, and unmet need for a national sample of older adults. We analyzed the 2011 National Health and Aging Trends Study, a new national panel study of more than 8,000 Medicare enrollees. Nearly one-half of older adults, or 18 million people, had difficulty or received help in the last month with daily activities. Altogether, 1 in 4 older adults receiving help lived in either a supportive care (15%) or a nursing home (10%) setting. Nearly 3 million received assistance with 3 or more self-care or mobility activities in settings other than nursing homes, and a disproportionate share of persons at this level had low incomes. Nearly all older adults in settings other than nursing homes had at least 1 potential informal care network member (family or household member or close friend), and the average number of network members was 4. Levels of informal assistance, primarily from family caregivers, were substantial for older adults receiving help in the community (164 hours/month) and living in supportive care settings (50 hours/month). Nearly all of those getting help received informal care, and about 3 in 10 received paid care. Of those who had difficulty or received help in settings other than nursing homes, 32% had an adverse consequence in the last month related to an unmet need; for community residents with a paid caregiver, the figure was nearly 60%. The older population-especially those with few economic resources-has substantial late-life care needs. Policies to improve long-term services and supports and reduce unmet need could benefit both older adults and those who care for them. |
| Author | FREEDMAN, VICKI A. SPILLMAN, BRENDA C. |
| Author_xml | – sequence: 1 givenname: VICKI A. surname: FREEDMAN fullname: FREEDMAN, VICKI A. email: vfreedma@umich.edu organization: Institute for Social Research, University of Michigan – sequence: 2 givenname: BRENDA C. surname: SPILLMAN fullname: SPILLMAN, BRENDA C. organization: Urban Institute |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/25199898$$D View this record in MEDLINE/PubMed |
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| ContentType | Journal Article |
| Copyright | 2014 Milbank Memorial Fund 2014 Milbank Memorial Fund. 2014 Milbank Memorial Fund 2014 |
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| DOI | 10.1111/1468-0009.12076 |
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| References_xml | – year: 2011 – volume: 51 start-page: M123 issue: 3 year: 1996 end-page: M130 article-title: Progressive versus catastrophic disability: a longitudinal view of the disablement process publication-title: J Gerontol Ser A: Biol Sci Med Sci – year: 2005 – volume: 29 start-page: 22 year: 2010 end-page: 28 article-title: Medicare and Medicaid in long‐term care publication-title: Health Aff – volume: 84 start-page: 493 issue: 3 year: 2006 end-page: 520 article-title: Promoting declines in the prevalence of late‐life disability: comparisons of three potentially high‐impact interventions publication-title: Milbank Q – volume: 41 start-page: 82 year: 2001 end-page: 88 article-title: Unmet need for personal assistance with activities of daily living among older adults publication-title: Gerontologist – volume: 21 start-page: 222 year: 2002 end-page: 231 article-title: Challenged to care: informal caregivers in a changing health system publication-title: Health Aff – volume: 60 start-page: S272 issue: 5 year: 2005 end-page: S280 article-title: Reconsidering substitution in long term care: when does assistive technology take the place of personal care publication-title: J Gerontol Ser B: Psychol Sci Soc Sci – volume: 66 start-page: 1013 year: 2011 end-page: 1021 article-title: Validation of new measures of disability and functioning in the National Health and Aging Trends Study publication-title: J Gerontol Ser A: Biol Sci Med Sci – volume: 36 start-page: 461 issue: 4 year: 1999 end-page: 473 article-title: The role of education in explaining and forecasting trends in functional limitations among older Americans publication-title: Demogr – volume: 42 start-page: 171 issue: 2 year: 2005 end-page: 182 article-title: Unmet long‐term care needs: an analysis of Medicare‐Medicaid dual eligibles publication-title: Inquiry – volume: 69 start-page: 287 issue: 2 year: 2014 end-page: 302 article-title: Psychosocial influences in onset and progression of late life disability publication-title: J Gerontol Ser B: Psychol Sci Soc Sci – year: 2014 – volume: 82 start-page: 157 issue: 1 year: 2004 end-page: 194 article-title: Changes in elderly disability rates and the implications for health care utilization and cost publication-title: Milbank Q – volume: 33 start-page: 207 issue: 2 year: 2014 end-page: 226 article-title: Everyone's talking about it, but does it work? 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| Snippet | Context: The cost of late-life dependency is projected to grow rapidly as the number of older adults in the United States increases in the coming decades. To... Policy Points: Nearly half of elderly Medicare beneficiaries have difficulty performing daily activities without assistance or receive help with such... The cost of late-life dependency is projected to grow rapidly as the number of older adults in the United States increases in the coming decades. To provide a... Policy Points: Nearly half of elderly Medicare beneficiaries have difficulty performing daily activities without assistance or receive help with such... CONTEXTThe cost of late-life dependency is projected to grow rapidly as the number of older adults in the United States increases in the coming decades. To... Policy Points:Nearly half of elderly Medicare beneficiaries have difficulty performing daily activities without assistance or receive help with such... Context The cost of late-life dependency is projected to grow rapidly as the number of older adults in the United States increases in the coming decades. To... |
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| SubjectTerms | Activities of Daily Living Adults Age Age Factors Aged Aged, 80 and over Aging Benefits Care of the aged Caregivers Caregivers - supply & distribution Community power Community structure Cost Disabilities Disability Disabled Disabled Persons - statistics & numerical data Elderly Family Friendship Health services Health Services Needs and Demand - statistics & numerical data Home Nursing - statistics & numerical data Households Humans Income Inpatient treatment Kinship Networks Long term health care long-term care Low income Low Income Groups Medicare Medicare - statistics & numerical data Nursing Homes Nursing Homes - statistics & numerical data Old age Older adults Older people Original Investigation Panel surveys Residents Retirement communities U.S.A United States United States - epidemiology |
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| Title | Disability and Care Needs Among Older Americans |
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