Vicki L. Lamb

Change in chronic disability from 1982 to 2004/2005 as measured by long-term changes in function and health in the U.S. elderly population

Changes in the health and functioning of the Medicare-enrolled population aged 65+ are tracked by using the 1982–2004/2005 National Long-Term Care Surveys. We found a significant rate of decline in the prevalence of chronic disability that accelerated from 1982 to 2004. These declines are significant for both persons with less severe chronic disability, which might be compensated by modifying the built environment and providing assistive devices, and for persons with more serious disability, which may be affected by reductions in the incidence and severity of disease through biomedical interventions. Declines in chronic disability continued over the 22-year period at a rate fast enough (i.e., 1.52% per annum) to contribute significantly to the long-term fiscal stability of the Medicare (and Medicaid) programs. Changes in the rate and substance of disability declines seem consistent with the intentions of policy interventions in Medicare and Medicaid.

Child and Youth Well-Being in the United States, 1975–1998: Some Findings from a New Index

This paper addresses the following questions: Overall, on average, how did child and youthwell-being in the United States of Americachange in the last quarter of the 20thcentury? Did it improve or deteriorate? Byhow much? In which domains or areas of sociallife? For specific age groups? For particularrace/ethnic groups? And did race/ethnic groupsdisparities increase or decrease? To addressthese questions, some 28 national-level timeseries of social indicators in sevenquality-of-life domains – material well-being,social relationships (with family and peers),health, safety/behavioral concerns, productiveactivity (educational attainments), place incommunity (participation in schooling or workinstitutions), and emotional/spiritualwell-being – are reviewed. Twenty-five ofthese time series date back to 1975 or earlier,while three are based on indicators thatcommenced in the 1980s. The 25 time seriesthat date back to 1975 are indexed bypercentage change from the base year 1975 –that is, subsequent annual observations arecomputed as percentages of the base yearvalues. Similarly, all 28 time series that areavailable by 1985 also are indexed separatelywith 1985 as the base year. This is followedby the construction of seven domain-specificsummary well-being indices in which each of thecomponent time series in each of sevenwell-being domains are equally weighted. Theseven component indices then are combined intotwo equally-weighted summary indices of childand youth well-being – the first of which isbased on the 25 social indicator time seriesthat date back to 1975 and the second of whichis based on the 28 time series that date backto 1985. We also examine the impact ofaveraging the well-being indicators across theindividual time series rather than across theseven quality of life domains. For this, wecalculate corresponding base year 1975 and 1985summary well-being indices that average equallyacross the individual component series. Basicfindings about trends in child and youthwell-being in the United States in the lastquarter of the 20th century are shown todepend on both the base year and the formula bywhich the summary indices are calculated. Findings about child and youth well-being alsoare dependent upon the specific indicators anddomains used in the composition of the summaryindices.Using our general indices as metrics by whichto measure change, we reach severalconclusions. First, using 1975 as a base year – overall conditions of life for children andyouths in the United States deteriorated fairlysteadily for a number of years in the 1980s andreached low points in the early-1990s. From1993, they then began an upturn that continuedthrough 1998 towards, but still slightly below,1975 levels. In other words, while somedomains and conditions of life forchildren/youths improved by 1998 as compared to1975, others deteriorated. Averaging acrossall of the domains of life and conditionsincluded in our summary indices, the basicfinding is that the overall quality of life ofchildren/youths in the United States was notbetter in 1998 than in 1975. Using 1985 as abase year, the trend in overall well-being forchildren/youths shows a similar pattern ofdecline through the early-1990s followed by animprovement through 1998 to levels slightlyabove those of the 1985 base year. In otherwords, compared to 1985 base levels, averageconditions of well-being for children/youths inthe United States had slightly improved by thelate-1990s. Additional findings are discussedpertaining to trends over time in each of theseven domains of well-being, trends withininfancy, childhood, and adolescence/teenage agegroupings, and trends inrace/ethnic-group-specific comparisons anddisparities.

Medicare Cost Effects of Recent U.S. Disability Trends in the Elderly Future Implications

Objective: The authors examine how trends in disability prevalence and in inflation-adjusted per capita, per annum Medicare costs, 1982 to 1999 and 1989 to 1999, affected total Medicare costs projected to 2004 and 2009. Method: To describe disability trends, the authors applied grade of membership analyses to 27 measures of disability from the 1982 to 1999 National Long Term Care Surveys (NLTCS). This identified seven disability profiles for which individual scores were calculated. These were used to calculate sample weighted Medicare costs and cost trends. Results: Significant declines (up to 19%) in Medicare costs were found in 2004 and 2009 assuming continuation of the 1982 to 1999 disability declines and Medicare cost trends. In addition to declines in disability prevalence, inflation-adjusted per capita, per annum Medicare costs declined for nondisabled persons aged 65 to 84. Discussion: Preserving health in the growing nondisabled population did not require increased health care expenditures.

A comparative study of successful aging in three Asian countries

The purpose of this research is to examine successful aging in three Asian countries, Indonesia, Sri Lanka and Thailand, using data from the WHO regional studies of Health and Social Aspects of Aging. Successful aging is defined as having no ADL difficulties, and at most, one Nagi difficulty. For the most part, the results are similar to those using more developed populations in that gender, age, no morbid conditions, positive attitude toward ones own aging and the ability to manage money are all correlated with successful aging. An interesting finding is that for the least developed country, Indonesia, being an unskilled worker is significantly associated with increased odds for successful aging. The final section of the paper discusses the theoretical implications regarding a disability transition for elderly populations as countries develop. We also focus on the current political and economic situations in the countries under study, and consider the possible impacts on elderly health.

Dementia and Medicare at Life's End

OBJECTIVE To determine the effect of a diagnosis of Alzheimers disease or related dementias (ADRD), and the timing of first ADRD diagnosis, on Medicare expenditures at end of life. DATA SOURCES Monthly Medicare payment data for the 5 years before death linked to the National Long-Term Care Survey (NLTCS) for decedents between 1996 and 2000 (N=4,899). DATA EXTRACTION METHODS Medicare payment data for the 5 years before death were used to compare 5-year and 6-month intervals of expenditures (total and six subcategories of services) for persons with and without a diagnosis of ADRD during the last 5 years of life, controlling for age, gender, race, education, comorbidities, and nursing home status. Covariate matching was used. PRINCIPAL FINDINGS On average, ADRD diagnosis was not significantly associated with excess Medicare payments over the last 5 years of life. Regarding the timing of ADRD diagnosis, there were no significant 5-year total expenditure differences for persons diagnosed with dementia more than 1 year before death. Payment differences by 6-month intervals were highly sensitive to timing of ADRD diagnosis, with the highest differences occurring around the time of diagnosis. There were reduced, non-significant, or negative total payment differences after the initial diagnosis for those diagnosed at least 1 year before death. Only those diagnosed with ADRD in the last year of life had significantly higher Medicare payments during the last 12 months of life, primarily for acute care services. CONCLUSIONS ADRD has a smaller impact on total Medicare expenditures than previously reported in controlled studies. The significant differences occur primarily around the time of diagnosis. Although rates of dementia are increasing per se, our results suggest that long-term (1+ year) ADRD diagnoses do not contribute to greater total Medicare costs at the end of life.

The CWI and Its Components: Empirical Studies and Findings

Chapter 2 described the conceptual and methodological foundations of the Child and Youth Well-Being Index (CWI). The question now becomes: What can the CWI and its component time series tell us about the well-being of America’s children and its changes (improvements and deteriorations) over time? Related to this are questions, such as what are the properties of the CWI?, how robust is it?, how does it relate to data on the subjective well-being of children and youth? and how can the CWI be used to study and anticipate changes in well-being? This chapter addresses these questions.

Scalability of the CWI: State-Level Indicators and Composite Indices

This chapter addresses the question of scalability of the child and youth well-being concepts, indicators, and composite indices. Prior chapters have exposited the conceptual basis of the CWI. But the empirical analyses presented, for example, in Chaps. 3 and 4 all were developed with national-level sample survey, census, and vital statistics data. The question remains as to whether similar well-being concepts, indicators, domains of well-being, and composite indices can be constructed and interpreted at subnational levels such as individual states within the USA. This chapter reports on studies of these and related questions for the 50 US states.

Conceptual and Methodological Foundations of the Child and Youth Well-Being Index

The general question addressed in this volume is: Are the circumstances of life for children and youth in the United States bad and worsening, or good and improving? In terms of the concepts articulated in Chap. 1, the question becomes: Has the well-being of America’s children improved or deteriorated?

Child Well-Being and Child Suffering

“How are the kids?” is a well-being question. Reversing the spectrum of this question, it becomes “Are the kids suffering?” Adults might be able to answer these questions for their own children or those in their immediate surroundings, and many children could provide information about their own well-being and suffering (or those of other children). However, applied to large populations of children at the national and cross-national levels, well-being and suffering questions are more challenging. This conundrum has stimulated the rapid development of child well-being indicators. This chapter reviews the objective and subjective approaches to measuring well-being, describing the United Nations Convention on the Rights of the Child and how it has been used in cross-national studies of child well-being. We then report some descriptive international comparisons of country-specific indicators of child suffering in relation to corresponding values of the Human Development Index and what these tell us against one another. We conclude with future directions for necessary developments to advance the global monitoring of child suffering.

Demography of Aging

Demography of aging is a subfield of demography that focuses on the older members of a population as well as the processes and consequences of population aging. Research in the demography of aging examines a number of topics, including the state and status of the older population, changes in the numbers, proportionate size, and composition of the older population, demographic forces of fertility, mortality, and migration that bring about these changes, and the effects of these changes on the social, economic, health, and personal well-being of the elderly. Major factors associated with population aging are reviewed.