U.S. Department of Health and Human Services

International Evidence on Disability Trends among the Elderly

Executive Summary

Timothy A. Waidmann
The Urban Institute

Kenneth G. Manton
Duke University

June 18, 1998

This report was prepared under contract #HHS-100-97-0010 between the U.S. Department of Health and Human Services (HHS), Office of Disability, Aging and Long-Term Care Policy (DALTCP) and the Urban Institute. For additional information about this subject, you can visit the DALTCP home page at http://aspe.hhs.gov/_/office_specific/daltcp.cfm or contact the office at HHS/ASPE/DALTCP, Room 424E, H.H. Humphrey Building, 200 Independence Avenue, S.W., Washington, D.C. 20201. The e-mail address is: webmaster.DALTCP@hhs.gov. The Project Officer was Robert Clark.

The opinions and views expressed in this report are those of the authors. They do not necessarily reflect the views of the Department of Health and Human Services, the contractor or any other funding organization.

The nonpartisan Urban Institute publishes studies, reports and books on timely topics worthy of public consideration. The views expressed are those of the authors and should not be attributed to the Urban Institute, its trustees, or its funders. The authors would like to thank Vicki Freedman and Korbin Liu for helpful comments. Felicity Skidmore provided excellent editorial assistance. Gregory Capaldini provided able assistance in preparing the document. Any remaining errors are our own.

Life expectancy continues to increase in the United States and much of the industrialized world as death rates at older ages decline. But are today's elderly healthier than previous generations or does increased longevity come with increased risk of disability and reduced quality of life? This question is not only of personal and intellectual interest. It is of crucial policy importance, because it affects the public costs of the income, health, and long-term care needs of the elderly population. In aging societies like those of the United States and much of the industrialized world, these costs could have critical implications for the future financial stability of national budgets. Unfortunately for the public debate, it is a complex question to answer and has stimulated substantial controversy among the analytic community--with some evidence pointing to increasing disability rates as mortality rates fall and other evidence pointing in the opposite direction.

In the ongoing search for a definitive answer, this report provides a comprehensive review of the evidence, both for the United States and internationally. The most defensible conclusion is that disability rates are falling in most industrialized countries.

In the United States, where several surveys have been used to estimate disability trends, a growing body of evidence points toward declines in disability rates among the elderly. Some studies show smaller declines than others, but in a variety of disability research employing different surveys and analytic methods, no sustained increase in disability rates has been observed. To the contrary, several sources of survey data, which in earlier years appeared to show either increasing disability or no pattern over time, now show statistically significant declines in elderly disability rates.

Similarly, in much of the industrialized world outside of the United States, available survey data point to an increase in the amount of time the elderly can expect to live without disability. The countries where disability among the elderly appears to be declining include France, Belgium, Taiwan, Italy, Netherlands and Switzerland. In countries where no substantial decline is apparent there is no consistent evidence that disability rates are rising. These include Australia, Canada, and Britain.

How fast disability rates are falling is still unclear, however, because wide disparities in the disability measures, field procedures, and sample designs prevent comparability across data sources. After reviewing and assessing the quality of the evidence, the paper ends with recommendations for future data collection and analysis to increase comparability and narrow the range of the estimates. Such measures are recommended to improve national estimates of disability trends and enhance the opportunities for international comparisons.