December 8, 2011

USA: Most Elderly 90+ Dependent on Government Programs

ROCKVILLE, Maryland / Family Practice News / December 7, 2011


By Michele G. Sullivan, Family Practice News Digital Network

The long-term effects of gender, racial, and income disparities in access to health care in the United States can be seen in full magnification within the nation’s most rapidly growing population: Those adults who live into their 90s.

Whites are by far the majority of the 90+ group. They are living longer than any other racial or ethnic group in the country, and they posses the highest level of education and the greatest financial security. Despite these differences, virtually all the oldest of the old depend on government programs, including Medicaid and Social Security, according to a new report issued by the United States Census Bureau.

Dr. Audrey Chun
The report, "90+ in the United States: 2006-2008" illustrates the disparities that inevitably affect health and longevity, according to Dr. Audrey Chun, director of the Martha Stewart Center for Living at Mount Sinai Hospital in New York. The disparities at 90 years of age, "really do reflect what’s been going on with minorities across all health care issues in all stages of life," she said in an interview.

"It’s a multifactorial and complex problem. Part may be due to ethnicity, part to economic status, education, illiteracy, and employment, which all affect the ability to save [money] over a lifetime. These effects certainly continue into a person’s 90s," said Dr. Chun who did not play a role in producing the report.

Data mined from the 2006-2008 American Community Survey (ACS) indicate that the 90+ population will continue to grow both in size and proportion of the country’s elders. In 1980, there were about 720,000 people in the country aged 90 years or older; by 2010, that figure had grown to nearly 2 million.And the total number of the over-90 population is expected to more than quadruple from 2010 to 2050, compared to a doubling of the population aged 65 to 89 years, the report said.

The numbers reflect significant gains in the life expectancy: In 1931, those who reached age 65 years could expect to live another 12 years. By 2006, that figure rose to 18 years. "Today, a person 90 years of age is expected to live on average another 4.6 years (vs. 3.2 years in 1931), and those who pass the century mark are projected to live another 2.3 years."

However, the gains vary widely by gender and ethnic/racial groups. Women made up about 75% of the 90+ citizens, with 100 women for every 35 men, the report said.

"The impact of the higher male mortality is seen in the considerable differences in marital status between men and women," the report said. "About half of the men aged 90 and over were widowers, while 43% of them were married. In stark contrast, [84%] of women aged 90 and over were widows and [only 6%]) were married.

That women are outliving men is no surprise, Dr. Chun said. "Part of it is that women live healthier lifestyles. They don’t smoke as much as men, for example. In their youth, these women also were not exposed to dangerous jobs or other risky behaviors, and those without those risks simply live longer."

Psychosocial factors also play a part, she said. "Women are more socially engaged and tend to build more networks of family and friends," which positively affect long-term survival. "For all those reasons, women tend to do better than men."

Less than a third of the men were living alone, compared with 40% of the women. Half the men lived with family members or unrelated individuals, and about 15% were in nursing homes. About 31% of women lived with family and 28% in an institutional facility. Asians and Hispanics were most likely to stay with their extended families.

Among those in their 90s, whites dominated the group, composing 88%, with blacks representing 8%, Hispanics 4%, and Asians 2%. The discrepancy in the total umber (102%) reflects the tendency of Hispanics to identify with other groups.

Whites also had the edge in education, a prime factor affecting health care and lifespan, the report said. "Education is linked to many aspects of a person’s well-being, and people with higher education tend to have lower mortality rates and better overall health than their less-educated counterparts as they are more likely to have better jobs and living conditions and more likely to have healthy behavior and utilize health care," the report noted.

Fifteen percent of whites aged 90 years and older reported have at least some college education – more than double the rates among all other racial/ethnic groups. But the educational difference between men and women was slight. Overall, 15% of men and 14% of women reported some college.

Social Security payments made up almost half of the group’s income. In 2006-2008, about 15% lived in poverty, 81% of whom were women. This translates to 16% of women and 10% of men aged 90 years and older living in poverty.

Whites were most financially secure, with the lowest poverty rate (13%). The rate was 16% for Asians, 21% for Hispanics, and 25% for blacks.

Most (85%) of the sample reported some type of disability, from sight problems (24% of noninstitutionalized elders) to difficulties with doing errands, including visiting the doctor (60% of the noninstitutionalized group). Those living in nursing homes were much more likely to have a disability than were those living independently (98% vs. 81%).

"We talk about ‘compression of morbidity,’ which means keeping healthy as long as possible until you simply drop dead on a certain day," Dr. Chun said. "We have not yet compressed morbidity to the point that we can continue to live fully until that given day. There is often a long period of multimorbidity that can occur in the 90s, and we need to invest in ways to reduce that."

The report also noted the degree to which these elders relied on government health care services. "Almost everyone (99.5%) was covered by health insurance ... 99% had Medicare coverage and 28% also received Medicaid benefits in 2008."

Government entitlement services have "a huge impact" on health care access and quality of life for the oldest old, and will continue to do so as the baby boomers age into their 90s, Dr. Chun said. "To take away or change these entitlements will [have] a big impact on health care and people’s access to health. Right now, most of our elderly are able to get good medical care in most areas of the country." Changes in the way these programs are run, however, could alter their health and maybe even life expectancy, she said.

"The policy challenge that lies ahead is how to provide cost-effective ways for our older adults to get the best care. This might mean keeping them out of the hospital by coordinating care and allowing them to stay at home, living with dignity and comfort. But this has to be thoughtfully considered. There are better ways to deal with the problem than by throwing money at it heedlessly or by taking things away without considering the long-term implications,"

Dr. Chun reported no financial conflicts of interest.

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