Estimates of the Incidence, Prevalence, Duration, Intensity, and Cost of Chronic Disability Among the U.S. Elderly

The objective of this paper is to estimate the burden of chronic disability on the U.S. elderly population, using unisex and sex-specific measures of long-term care (LTC) service use, intensity, and costs. Multistate life-table analysis was performed of adjacent rounds of the National Long-Term Care Survey (NLTCS) from 1984, 1989, and 1994, using criteria introduced in the Health Insurance Portability and Accountability Act (HIPAA) of 1996 to stratify the disabled population according to level of disability based on ADL and cognitive impairment criteria. Rates of transition to and from nondisabled to disabled states and from all states to death were computed and analyzed for differences by age and sex. Rates of service use, intensity, and costs were computed conditional on age and sex. It was found that approximately 20% of the residual life expectancy at age 65 for males and 30% for females were spent in a state of chronic disability. For both sexes, the years of chronic disability above age 65 were split evenly between mild/moderate and severe disability. The expected costs of purchased LTC services were $59,000 (includes home/community care and institutional care, in constant 2000 dollars), with substantial sex differences: $29,000 for males versus $82,000 for females. For both sexes, the overwhelming majority (92%) of the LTC costs were incurred during episodes of severe disability, with the remaining (8%) incurred during episodes of mild/moderate disability. Residual lifetime unpaid home/community care averaged 3,200 hours for males and 4,000 hours for females, with approximately one-third of those hours incurred during episodes of mild/moderate disability. The criteria for identifying severely disabled persons introduced by HIPAA effectively targeted the high-cost disabled subpopulation. This group accounted for the overwhelming majority of purchased LTC services, and a large majority of unpaid LTC services, over age 65. Sex differences in expected per capita lifetime LTC costs were substantial, with females outspending males 2.8 to 1.