The Aging Population in the Twenty-First Century : Statistics for Health Policy.

The Aging Population in the Twenty-First Century -- Copyright -- Contents -- Preface -- ORIGIN OF THE STUDY -- EARLY PANEL ACTIVITIES -- CONCURRENT ACTIVITIES -- ACKNOWLEDGMENTS -- 1 Introduction and Summary of Recommendations -- BACKGROUND -- HEALTH POLICY ISSUES -- The Changing Policy Agenda -- Implications for the Panel's Approach -- RECOMMENDATIONS -- Priority Recommendations -- General Recommendations -- A Word about Costs -- ORGANIZATION OF THE REPORT -- Structure of the Report -- Chapter 2: Social, Economic, and Demographic Changes among the Elderly -- Chapters 3 and 4: Health Status, Quality of Life, and Health Transitions -- Chapter 5: Health Promotion and Disease Prevention -- Chapter 6: Quality of Care -- Chapter 7: Long-term Care -- Chapters 8 and 9: Financing and Utilization of Health Care Services -- Chapter 10: Enhancing the Usefulness of National Statistical Systems -- Chapter 11: Methodological and Statistical Issues -- Projecting and Determining Statistical Needs -- Information on the Healthy Elderly -- Data on Functioning to Supplement Diagnostic Information -- Longitudinal Data on the Elderly -- Information on the Responsiveness of Both Acute and Long-term Care Systems -- Better Information about Long-term Care Services -- Data on Risk Factors for the Elderly -- Better Data on Special Subgroups of the Elderly -- Characteristics of Future Cohorts of Elderly -- Important Data Bases Outside the Scope of the Report -- 2 Social, Economic, and Demographic Changes among the Elderly -- THE CHANGING DEMOGRAPHIC STRUCTURE OF THE POPULATION -- Population Forecasts -- Forecasts by Sex -- Forecasts by Race -- Geographic Distribution of the Elderly Population -- Marital Status and Living Arrangements -- Education -- Income -- Labor Force Participation -- Dependency Ratio -- Morbidity Patterns -- THE LIMITATIONS OF AVAILABLE DATA.

IMPLICATIONS FOR THE STUDY -- 3 Health Status and Quality of Life -- HEALTH STATUS -- Characteristics of Health Status and Data -- Successful Aging -- Longevity Extension and Compression of Morbidity -- Transitions from Morbidity to Disability and Mortality -- The Need for Acute and Chronic Care -- Determinants of Disease in Old Age -- Special Characteristics of Illness Behavior in the Elderly -- Underreporting of Health Conditions -- Multiple Pathology -- Atypical or Altered Presentation of Disease -- HEALTH DATA -- Major Sources of Health Statistics -- The National Health Interview Survey -- The NHIS Supplement on Aging -- The Longitudinal Study on Aging -- The Integrated System of Health Interview Surveys -- The National Health and Nutrition Examination Surveys -- The NHANES I Epidemiologic Follow-up Survey -- Data on Cause of Death -- The Importance of Longitudinal Studies -- FUNCTIONAL STATUS -- Characteristics of Functional Status -- Physical Function -- Cognitive Function -- Mental Health Function -- Social Function -- Assessing Functional Status -- QUALITY OF LIFE -- The General Concept -- Some Dimensions of Quality of Life -- Health Status -- Satisfaction with Life -- Functional Status -- Availability of Social Support System -- Productive Activity -- Quality of Life for the Institutionalized Elderly -- Conclusion -- 4 Health Transitions and the Compression of Morbidity -- DATA NEEDS AND RECOMMENDATIONS -- 5 Health Promotion and Disease Prevention -- INTRODUCTION -- DEFINITIONS, FEDERAL INITIATIVES, AND GOALS -- Federal Initiatives -- Goals -- HEALTH PROMOTION AND DISEASE PREVENTION FOR THE ELDERLY -- The Plasticity of the Aging Process -- Risks Associated with Normal Aging -- The High Incidence of Chronic Disease and Illness among the Elderly -- Increases in Average Life Expectancy and Individual Variability -- CRITICAL ISSUES -- DATA NEEDS.

Public Knowledge about Health Promotion and Disease Prevention -- The Role of Physicians -- Providers of Health Maintenance and Disease Prevention Services to the Elderly -- 6 Quality of Care -- A FRAMEWORK FOR QUALITY OF CARE ASSESSMENT -- THE ROLE OF NATIONAL INFORMATION SYSTEMS -- 7 Long-term Care -- INTRODUCTION -- DEFINITIONS OF LONG-TERM CARE -- UTILIZATION OF LONG-TERM CARE SERVICES BY THE ELDERLY -- Functional Disability -- Longitudinal Studies -- SERVICE STATISTICS -- Providers of Care -- Types of Care -- Informal Supports -- STANDARDIZATION OF MINIMUM DATA SETS -- EXPENDITURE DATA ON LONG-TERM CARE -- 8 The Financing of Health Care Services for the Elderly -- INTRODUCTION -- Sources of Funding -- Medicare -- Medicaid -- The Veterans Administration -- Other Government Programs -- Private Insurance Programs -- Expenditures on Health Care -- The Frail Elderly -- Future Changes -- DATA REQUIREMENTS -- Timely Data on Expenditures for the Elderly -- National Medical Expenditure Survey -- Follow-Up Studies of the Elderly in the NMES through Administrative Records -- Outreach Program for the NMES and Timely Release of NMES Tapes -- Timely Data from the Medicare Statistical System -- Improved Access to Medicare Data -- The Health Care Financing Administration Data System for Capitation -- Disability-Medicare Linked File -- Data for Policy Analysis of the Prospective Payment System -- Medicaid Data -- Medicaid Eligibility Quality Control System -- Data Resources Required to Study the Medicaid Spend-down Phenomenon -- Private Insurance Data -- Cost-of-Illness Data -- 9 Health Services Utilization -- INTRODUCTION -- Need for Services -- Impact of Public Policies -- Supply of Alternative Sources and Types of Care -- Living Arrangements and Access to Informal Care -- Availability of Trained Personnel -- Technological Advances or Changes.

Attitudes and Values of Potential Recipients and Providers of Care -- DATA SOURCES ON HEALTH CARE UTILIZATION -- Data Related to Health Personnel Trained to Work with the Elderly -- Measuring the Effects of Changes in the Organization, Provision, and Coverage of Health Care Services -- Changes in Provider Characteristics -- Changes in Utilization Patterns -- Relationship between Health Status and Health Services Utilization -- Access to Care -- Population Subgroups -- 10 Enhancing the Utility of Statistical Systems -- INTRODUCTION -- NATIONAL DATA -- Background on Federal Statistical Policy -- Legislative Authority for Statistical Policy -- Office of Management and Budget -- Administration on Aging -- Informal Coordination Activities -- COORDINATING, PLANNING, AND SETTING PRIORITIES FOR STATISTICS ON THE ELDERLY -- Resources -- Decentralized Responsibility for Statistics on Aging -- Content -- Coverage -- Data Detail -- Uniform Definitions, Concepts, and Classifications -- Periodicity -- Data Access -- Confidentiality -- Administrative Records -- Data Linkages -- Enhancement of National Surveys -- Survey of Income and Program Participation -- FEDERAL-STATE DATA ISSUES -- Background -- Vital Statistics and Data on Mortality -- Disability Statistics -- Age Detail -- Dissemination of Age-detailed Substate Data -- Timely Substate Data -- Social Service Statistics -- Private Data Bases -- Hospital Data -- Nursing Home Data -- Health Maintenance Organization Data -- Hospice Data -- Commercial Health Insurance Data -- Professional Association Data -- Summary -- 11 Statistical Methodology for Health Policy Analysis -- INTRODUCTION -- LONGITUDINAL INFORMATION -- The Rationale for Longitudinal Studies -- Designing Longitudinal Studies -- Designs and Their Implications for Longitudinal Data Analysis -- Analytical Strategies -- RECORD LINKAGE.

The Rationale for Record Linkages -- Obstacles to the Use of Record Linkage Techniques -- Obstacles to Performance of Record Linkages -- Obstacles to Dissemination and Use of Record Linkage Results -- PROJECTIONS FOR AN AGING POPULATION -- QUANTIFYING UNCERTAINTY -- References -- Appendix A Background Papers -- HEALTH AND RELATED ISSUES -- STATISTICAL METHODOLOGY FOR POLICY ANALYSIS -- IMPROVEMENT OF DATA RESOURCES FOR POLICY ANALYSIS ON AGING -- Appendix B Effects of Budgetary Constraints on Federal Statistical Programs -- BUREAU OF THE CENSUS -- NATIONAL CENTER FOR HEALTH STATISTICS -- NATIONAL CENTER FOR HEALTH SERVICES RESEARCH -- HEALTH CARE FINANCING ADMINISTRATION -- NATIONAL INSTITUTE OF MENTAL HEALTH -- SOURCES OF INFORMATION -- Appendix C Descriptions of Data Bases Mentioned in the Panel's Recommendations -- REFERENCE -- Appendix D Long-term Health Care Minimum Data Set -- Appendix E Acronyms -- Appendix F Biographical Sketches.

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