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5 surprises from the book of disability-free life

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Public and private organizations seem to conduct an endless series of health surveys, surveys of older Americans, and surveys focusing on the health of older Americans.

But the data users have complained about lack of coordination, and gaps in the data. One source of irritation has been a lack of information about how long older U.S. residents can expect to live free from any major disabling conditions.

The U.S. Centers for Disease Control and Prevention (CDC) has published some data suggesting that U.S. residents’ healthy lifespan has been increasing along with their overall lifespan.

See also: CDC Charts Progress at Increasing Years of Healthy Life

But researchers elsewhere have found evidence that U.S. residents might be living longer while dealing with more disabling conditions. Those researchers’ work implied that sellers of private long-term care insurance (LTCI), for example, might find that a higher percentage of their insureds were living with severe disabilities longer.

See also: MetLife: High-income Americans look sicker

But Michael Chernew, a Harvard University economist, and three other researchers have published an interesting study, on the National Bureau of Economic Research website, on years of disability-free life expectancy in the U.S. elderly population.

They defined “disability” to refer to anyone unable to to handle any activity of daily living (ADL), such as getting from a bed to a wheelchair, or any instrumental activity of daily living (IADL), such as going shopping. The researchers used data from the period for 1992 through 2009 to estimate how many years an individual turning 65 in various years could expect to live with or without a disability.

The researchers found that overall life expectancy at age 65 increased 1.3 years, to 18.8 years, from 17.5 years.

The number of expected disabled life years fell to 8 years toward the end of the period, from 8.5 years at the beginning.

The number of disability-free years increased to 10.8 years, from 9 years. 

Of course, the category that includes “all Americans,” “all older Americans,” or even “all older Americans who have private LTCI” is much different from the category of people who have gone to the trouble to apply for, and pay for, private LTCI. Insuers are just starting to pore through a big batch of LTCI experience data.

See also: Actuaries post LTCI terminations study

Even if the Americans born around 1920 ended up with more years of disability-free life than those born around 1905, that does not necessarily mean that improvement in disability-free life expectancy will continue to improve for the generations brought up with television sets in the playroom and fast food for breakfast, lunch and dinner.

But the Chernew team has found some evidence for optimism about the well-being of older Americans.

For some of the details from their research, read on.

Calendar

1. The last three years of life look a lot better than the last year of life.

About 80 percent of Medicare enrollees who were in their last 12 months of life had problems with at least one ADL or one IADL in 2009, and that percentage did not change much from the early 1990s through 2009.

The disability rate for Medicare enrollees who are more than 36 months away from death fell to less than 40 percent, from about 50 percent, and the disability rate for enrollees who had 24 to 36 months to live fell to about 70 percent, from 75 percent.

“The vast bulk of the reduction in disability is among people a few years away from death,” the researchers write. “The reduction in disability farther away from death implies that there is a compression of morbidity into the period just before death.”

See also: Experts: Insurers should post death-care quality stats

Brain scan

2. In the disability-free life tables, Alzheimer’s disease and Parkinson’s disease are surprisingly minor factors.

The researchers came up with a model for estimating which conditions caused people to have more or fewer disabled years between the beginning of the study period and the end of the study period.

Alzheimer’s and Parkinson’s might be especially likely to lead use of long-term care (LTC) services, but they accounted for only about 7.4 percent of disability from 2006 through 2009, and, even though prevalence increased, the increased prevalence added only 0.5 percentage points to older Americans’ disability rate.

Sixty-five-year-old U.S. residents saw their disabled life expectancy associated with central nervous disorders fall 0.1 years, and their years of disability-free life expectancy associated with those disorders fell 0.13 years.

Central nervous disorders as a whole accounted for much less of a change in disability-free life expectancy than conditions such as ischemic heart disease, diabetes and diseases of the eye.

See also: 5 things to know about a scary neurological death study

Arthritic hands

3. Arthritis is a player.

Improvements in arthritis care cut the disability rate by 0.5 percentage points over the study period.

That reduction helped increase a 65-year-old American’s expected years of disabled life by 0.1 years and increased that America’s expected years of disability-free life by 0.1 years.

See also: LTC medicine chest: Top 10 supplements

Image: Effects of rheumatoid arthritis on the human hand. (NIH Photo)

Clogged blood vessel

4. Pharmaceutical companies may drive health insurers up a tree with high prices for brand-name drugs, but they help keep many older Americans functional.

Ischemic heart disease and stroke accounted for about 44 percent of disability in the elderly toward the end of the study period, and improvements in care for those conditions cut the disability rate by 2.5 percentage points.

The researchers estimate that 12 percent of the improvement in mortality during the study period was the result of doctors using statins and warfarin to prevent new heart attacks.

Improvements in heart disease and stroke care increased older Americans’ disabled life expectancy by 0.33 years but also increased their disability-free life expectancy by 0.85 years.

See also: Researchers quantify effects of stroke treatment delay

Eyes

5. In the disability-free life game, eye doctors are bruisers.

Improvements in cataract surgery helped cut older Americans’ disabled life expectancy by 0.27 years and increase their years of disability-free life expectancy by 0.28 years.

To some extent, the apparent increase may be the result of healthier older people being more likely to get cataract surgery, but it may also indicate real and large benefits of the diffusion of cataract surgery, the researchers say.

See also: U.S. Health Care is Expensive – but There are Some Bargains…

 

 

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