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Aging Older adults are more likely to use health services and to require assistance conducting daily tasks than are younger people. But in many countries they also represent an untapped resource as potential workers. Accordingly, determining the prevalence of physical limitations among the elderly is essential for forecasting both their long-term needs and the feasibility of efforts to extend their engagement in the labor force. The direction of trends in health of the elderly is being actively researched in the United States, and some results are quite positive. Recently Population Council president Linda Martin, Vicki A. Freedman of the Polisher Research Institute, and Robert F. Schoeni of the University of Michigan published a systematic review of the evidence on improved functioning of older Americans. At the same time, Council sociologist Zachary Zimmer, Martin, and the former director-general of Taiwan’s Bureau of Health Promotion, Ming-Cheng Chang, have been investigating the question for one of the first times in an Asian nation, namely Taiwan. Asia, and Taiwan in particular, are aging even more rapidly than the West, so the answer has important policy implications there too. However, the researchers conclude that Taiwan does not appear to have been experiencing the same improvement in late-life health as has been occurring in the United States. Aging in the United States “The greatest improvements appear to have occurred in the ability to carry out so-called instrumental activities of daily living, such as household chores and shopping,” says Martin. These abilities were measured in four of the surveys. For example, analysis of the National Health Interview Survey found that the proportion of people ages 70 and older who needed help with such activities declined from 14.5 percent in 1982 to 10.9 percent in 1996. Less clear is the evidence for trends in activities of daily living, such as bathing and feeding oneself. Difficulties with these activities are concentrated among the most severely disabled. Some surveys indicated that difficulties had become less common, while others suggested they had become more common. Evidence regarding trends in limitations in cognition and such basic physical tasks as walking and climbing showed consistent declines in prevalence, but only one or two surveys assessed each of these measures, so the evidence base is thin. The review also found that evidence about differentials across population groups and about what is driving the declines is limited. Possible explanations include changes in the demographic and socioeconomic composition of the older population, the prevalence and treatment of underlying chronic diseases, and the physical environment that facilitates daily activities. Without understanding the causes, it is difficult to predict future trends or to conclude that improved functioning means that future medical expenditures will be lower. Rather it could be that the improvements have been achieved as a result of past increases in health care costs. Growing older in Taiwan The study showed that the prevalence of functional limitation increased between 1993 and 1996 and between 1996 and 1999. For example, in 1993, 25.5 percent of people 65 years and older had trouble walking or climbing stairs. By 1996, that figure had risen to 30.1 percent. In 1999, 35.7 percent of people in this age group had at least one of these limitations. Even after taking age, sex, education, ethnicity, and marital status into consideration, older adults in Taiwan were more likely to report limitations in 1999 than in 1993. One possible reason that more older people appear to have limitations is the change in old-age survival in Taiwan. The country established its Universal Health Insurance program in 1995. The introduction of this plan is reported to have resulted in a rapid and dramatic increase in the use of both outpatient and inpatient care. Concurrently, Taiwan experienced an increase in life expectancy. “People with severe limitations may have been more likely to have died before the introduction of the Universal Health Insurance program,” says Zimmer. “If people with severe disabilities were more likely to survive because of improved health care, then we would expect the prevalence of functional limitations to increase." Contradictory findings across populations? What the two populations do have in common is the likelihood that the elderly of tomorrow will be quite different from those of today. Many of these differences, such as greater educational attainment among more recent cohorts, may have positive implications for health. So even though the recent trend in late-life health is negative in Taiwan, Zimmer notes that "Young people in Taiwan are growing up under very different circumstances than did the older people now living in Taiwan. They are likely to enter their senior years much healthier than did their elders." Sources Zimmer, Zachary, Linda G. Martin, and Ming-Cheng Chang. 2002. "Changes in functional limitation and survival among older Taiwanese, 1993, 1996, and 1999," Population Studies 56(3): 265–276. Expanded version published as Policy Research Division Working Paper no. 155. New York: Population Council. (PDF) Outside funding See Also | |||||||||||||||||||||||||||||||||||||||||||||||
